1 15 11 https://www.nal.usda.gov/exhibits/speccoll/files/original/3fa7e18d3b907f3d708fc5867c4c229b.pdf cd638aeb403ea695e94aa4951cdbec3e PDF Text Text Item ID Number 01772 Author Corporate Author ROpOTt/ArtlClO TltlO Typescript: A Chronology of Events in the Congressionally Mandated Epidemiologic Study of Viet Nam Veterans and Projected Dates for the Completion of Various Tasks in the Design of the Study, revised July 7,1981 Journal/Book Title Yoar 0000 Month/Day Color D Number of ImaQes 2 DOSOrlptOU NOtOS Provides chronology from passage of Veterans Health Programs Extension and Improvement Act of 1979 to OTA review of draft protocol by September 21,1981. Monday, June 11, 2001 Page 1773 of 1793 �A Chronology of Events in the Congressionally Mandated Epidemiclogic Study of Viet Nam Veterans and Projected Dates for the Completion of Various Tasks in the Design of the -Study. December 1979 Congress passes Veterans Health Programs Extension and Improvement Act of 1979 (PL 96-151). The Act directs (1) the Administrator of the VA to prepare a protocol (plan) for the study of Viet Nam veterans who may be experiencing health effects resulting from exposure to dioxins contained in Agent Orange; (2) the Director of the Office of Technology Assessment to. review and approve the study protocol within 180 days after passage of Act (that time period ended about June 20, 1980). If the OTA Director did not approve the plan by then, he was periodically to report to Congress reasons for the lack of approval. Dec. 20, 1979 President signs Act into Law. December 1979 VA decides to use competitive bid procedure to select an epidemiologist to design the study protocol. Feb. 4, 1980 VA publishes its intention to let contract for design of the protocol in the Commerce Business Daily. Mar.,19, 1980 VA issues Request for Proposals (RFP). Apr. 11, 1980 Conference of potential bidders hosted by VA. May 6, 1980 National Veterans Law Center initiates legal action and bid protest about procedures used by VA in soliciting bids. May 8, 1980 Last day for receipt of bids. May 1980 A selection board of government experts reviews the bids and makes tentative ranking. No further action is taken because of legal suit and bid protest pending against VA. Jun. 13, 1980 Judge Harold H. Green of the DC District Federal Court asked that GAO make a ruling about the issues raised in the bid protest. August 1980 OTA begins making periodic reports to the Committees of Congress about reasons it has not approved the study protocol. At that time, VA expected to issue contract in September. Subsequent reports kept Congressional Committees informed of continuing legal delays . Feb. 2, 1981 GAO finds in favor of VA, and VA can proceed with letting contract. �Feb/Mar 1981 VA contacts bidders and seeks updated information about their interest in and capability to design the study protocol. April 1981 VA reconstitutes selection board of government experts to examine revised bids. May 1, 1981 VA selects the School of Public Health, University of, California at Los Angeles (UCLA) to design the study protocol. May 1981 OTA begins to assemble panel to review the study protocol. May 26, 1981 UCLA requests and is subsequently granted a 30-day extension of the contract. THESE EVENTS BRING US TO THE PRESENT Early August 1981 Draft of study plan to be delivered to VA. The draft plan is to be distributed by the VA to the following organizations for review: 1. OTA 2. The National Academy of Sciences 3. The Interagency Work Group to Study Possible Long-Term Effects of Phenoxy Herbicides and Contaminants 4. The Veterans Administration Committee on Health-Related Effects of Herbicides OTA expects to complete its review of the draft protocol within 30 days of its receipt from VA. Assuming that OTA receives the protocol in mid-August, the review will be finished by mid-September. Mid-August 1981 Dispatch of the draft protocol to all members of the OTA review panel. Week of Sept 7, 1981 Meeting of the review panel to discuss the protocol and consider what suggestions might be made to UCLA to improve the study plan. Week of Sept 14, 1981 OTA staff will prepare written report of the review and suggestions for modification of the study plan. By Sept 21, OTA .review document will be delivered to VA. 1981 Following review of the August draft, the reviewers' comments and suggestions will be forwarded to UCLA. Approximately 30 days will be allowed for those modifications to be incorporated or rejected with explanation by UCLA. The revised protocol should reach VA sometime in October. If it requires review by the 4 organizations listed above, additional time will be required for completion of the study plan and its review. After completion of the study .plan, a decision will have to be made about what organization should carry out the study. Revised July 7, 1981 � 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. 066 Folder The folder containing the original item. 1772 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/. Title A name given to the resource Typescript: A Chronology of Events in the Congressionally Mandated Epidemiologic Study of Viet Nam Veterans and Projected Dates for the Completion of Various Tasks in the Design of the Study, revised July 7, 1981 Subject The topic of the resource study protocol Agent Orange Exposure Study legislation UCLA ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/a39b757d31534a68c9eaea6d2d287289.pdf 56f16f4ef5c249e66ba5ae8ee2a0e092 PDF Text Text Item ID Number 01726 Author Corporate Author RODOrt/ArtlCle Title Press Release: Agent Orange Research, October 27, 1983, UPI, Washington, D.C. Journal/Book Title Year 000 ° Month/Day Color Numbor of Images n 1 Doscripton Notes Monday, June 11, 2001 Page 1727 of 1793 �X UPI. WASH. DC October 27, 1983 ;:_ _ AGENT ORANGE RESEARCH .. . . . . . . ._ . - .. 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THE fiGENT ORfiNGE STuDY IS TO DETERMINE WHETHER VIETKfiH VETERiiftS *•?**"! ?•/•"! J f jf.n :.*r* rv r-r"t: r*f r « A A ^« T.% T» j?^* ;.•;•*« « r .n r n *~ .". ir « { ; f J-T* c .•.». t.* .*£•{" T"?~ -.': wi •.••:• 4 •' T ;.•••• v .*•.™. .^ t.-.-i r *j f e H Gf i H T 'nttVE ettN t/irO-bhD J U Int h t K t f i H & t * ilNy V i t i W n f i f t i t K H W i i N .ij-s.:r«:T! c.~r 5*r •••-.r-'.rrrs nr-/fv* j"~ t"»?{j*J"r« n!.-~ •::•,-•:•,•• T-rrsfr: -{r-.i-: -•:•: -rrrr^r--utfitKrii.* hRt n i urvLn»tr\ K i b K Or o u f r c f u f t u L U N b - J c f t f i ni.nj.in c r r c l i i •r r! .^ j; ;: ^ T* .*• rs.". i:.". s 11 .• .^. n r « ^f .^ «r .". r- .*•. ? * .~* f i-' ??*•?• T i;."! w itiriri v'i:fcKh'fto NnU i/iy a u i otK'J't iri V i L i f i n i i . Tt-rr : n ~i'-,5 T?" Sr? : V.! iT: T«:"«: {'ftrs* 1 :*: f. •'. Hit O L J « h » C . b i L L TiLOlj l i i ^ L u v L O 4'DJ J Ol« I* ~ ~ t^J -•. .* st n tt- t" .*. ^r :.*."• • .* r n .^ r x .n ."• T* : ? r* .• .* " .*• .*" •"" s." r. .—.-, T f .• .1 .-i .1 ?•.•.• r T r .— .r .•J.^.T ;'~ t lit, nnUyid Uf .* ? .*"• z t n t: r .^ .". / .• .^ .^ i .• •'. •*• --t.'.-. f.-..-..-.-. n OLi'ihitiK'0 .-. .*,- .*. .•, ,•; y •.• v.-:.— briLiifiF — ( U int M i y U s Ur i n t u n i t itfi. HtKKY ^ntniUfo y-«fiifi. « .•"..•: .1 T-r ii ••" •*• ^" rt .f t: r tf.". «.— .— £.- .T .-.•.-.-r.r :.-.-..-..•.• i» 11 r inE .- .— j;... —.— f K h l i l U , Ur rfiriftti yfcriirt U K n i U i U t o hilc- tftfcft tij&iUfiilKr if« int o L f i n i t FOR aeOUT 125 VEMRS. JHCKSON DIED OF H HEfiRT UTIflCK IN SEPTEKEER. UPI 18-27-83 07:03 PED (i) � 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. 064 Folder The folder containing the original item. 1726 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/. Title A name given to the resource Press Release: Agent Orange Research, October 27, 1983, UPI, Washington, D.C. Subject The topic of the resource Agent Orange Exposure Study legislation ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/ab95496c4c638a5bb49f9afdbf295521.pdf 26f4c9788c35e677e92b4f733907390f PDF Text Text Item ID Number °1498 Author Gough, Michael Corporate Author Report/Article TltlO Typescript: Chapter 9: The Political Assessment: A Congressional View Journal/Book Title 000 Year ° Month/Day Color n Number of Images 10 DOSCrlptOH Notes Tnis Tuesday, May 15, 2001 manuscript is a draft version of a chapter or section from the following book: Agent Orange and its Associated Dioxin: Assessment of a Controversy. Young, A. L. and G. M. Reggiani, eds. New York: Elsevier, 1988. This book is available in the NAL collection, call no.: RA1242 T44 A3. Page 1498 of 1514 �CHAPTER 9 "THE IMPORTANCE OF AGENT ORANGE AND DIOXIN WAS ACKNOWLEDGED WHEN THE HIGHEST LEVELS OF GOVERNMENT BECAME INVOLVED," THE POLITICAL ASSESSMENT: A CONGRESSIONAL VIEW MICHAEL GOUGII In December, 1979, Congress passed and President Carter signed Public Law 96-151, which instructed the Veterans Administration to carry out a study of possible long-term health effects resulting from exposure to dioxin-containing herbicides in Vietnam. This was not the first time that Congress had considered Agent Orange. Almost a decade earlier, in 1970, Senator Philip Hart; of Michigan held hearings about the possibility that spraying with Agent Orange was causing birth defects in Vietnam and that the use of the same herbicides could be harmful for the population of the United States. In response to those hearings, the Department of Health reduced the use of 2,4,5-T in the United States and the Department of Defense stopped Agent Orange spray missions in Vietnam. The law that was passed in 1979 mandating the Agent Orange study resulted from veterans testifying before Congress that Agent Orange had caused cancer, birth defects, and other health effects. It directed the Veterans Administration to study ground troops who had served in Vietnam to see if any long-term health effects in veterans or their families could be related to the use of Agent Orange. To prod the Veterans Administration along, Congress said that the protocol for the study had to be designed within 180 days or the Congress had to be told the reason why. 9: 1 �The OTA (Office of Technology Assessment), which is a technical support office of. Congress, was directed by law to review and approve the plans for the Veterans Administration study and to monitor the conduct of the resulting study. The bulk of my presentation is about OTA's role, but before going into that, I will discuss other major events in the Agent Orange issue. Some results are now available from the Ranch Hand study, the mortality and morbidity study of the Air Force personnel who flew the spray missions in Vietnam, which was well underway in 1979. The Air Force had responded early to Congressional inquiries and realized that they had an occupational health problem. They moved ahead on their own without the intense prodding Congress put on the Veterans Administration for the ground troop study. George Lathrop has dismissed those studies. Also in December, 1979, President Carter established the Agent Orange Working Group (AOWG), composed of Executive Branch agencies with programs that touched on possible effects on health of dioxin, Agent Orange, and herbicides. In February, 1980, the Office of Technology Assessment was invited to sit with the Agent Orange Working Group as an observer, and it became an active participant in this group. In August, 1981, President Reagan placed the Agent Orange Working Group into the Cabinet Council on Human Resources, elevating and enlarging the scope of the work group. The Agent Orange Working Group has had profound effects on Executive Branch efforts to try to better understand dioxin and Agent Orange. Among the several studies coordinated by the Agent Orange Working Group (ten major epidemiological studies scheduled for completion by 1990 and five ongoing health surveillance projects), one is complete. It is the 9: 2 �Birth Defects Study carried out by the Center for Disease Control. This study has two conclusions: the tfirst conclusion was that there is no association between service in Vietnam and birth defects. The second conclusion was th,a,t there may be an association between opportunities for exposure, to Agent Orange and a handful of birth defects, As soon a,s the results of that study were released, at least one bill was written in the Senate which was to provide compensation to all veterans who had fathered children with spina bifida, a. colleC" tion of tumors,and cleft lip with or without cleft palate, That legislation never left the Senator's office. The people who had clone the study at the Center for Disease Control, i.e., Dave Hricson and his colleagues, came to Congress. They talked to congressional staff in great detail about the structure of the study, its strengths and limits, and how to draw conclusions from its results. They also went to the American Legion, the Disabled American Veterans, the Vietnam Veterans of American, and other veterans organizations, where they explained the study and convinced those veterans that the connections that had been shown, although theoretically valid, woulcl not make a great deal of sense biologically. This was a great achievement for solid scientific exposition and convincing people not to be afraid and consequently do something foolish. Some scientists still argue about the meaning of those possible connections between exposure to Agent Orange and birth defects. The Birth Defects Study, like many of the other Agent Orange studies, was clone for political reasons. Politically, it has been examined and tried. The Congress looked at the conclusions and decided no harm had been associated with Agent Orange. So the CDC Birth Defects Study, from the point of view of politics, is over. The Congress will not reopen it. 9: 3 �It is Interesting to note in this context that in the Agent Orange lawsuit which was settled in the District Court of New York in May, 1985, Judge Weinstein also considered the CDC Birth Defects Study. He reached the same conclusion as Congress, deciding that the study results were not sufficient to sustain any association between Agent Orange and birth defects. Thus, in the judicial system also, the CDC Birth Defects Study has been weighed and found not to be convincing in demonstrating any association between Agent Orange exposure and b i. r th de f e c t s . These are events which are very important. It should be kept in mind that here we are not dealing with a purely scientific issue but with very sensitive and complicated political and social issues. The scientific conclusions, therefore, \vhile they are very important to us to understand whether or not: d.i.oxin and Agent Orange cause disease, still are less important to society than the decisions that are made in the courtrooms and in the Congressional Hearing Rooms. To come back to OTA, Congress wrote OTA into the Agent Orange study because of disagreement between the Senate and House Committees on Veterans' Affairs. Sensitive to veterans' complaints that the Veterans Administration was indifferent to their claims of harm from Agent Orange, the Senate wanted the study to be carried out by some other agency. The House Committee, on the other hand, had more faith in the Veterans Administration and acted to preserve Veterans Administration's responsibilities for research on veterans' health. The two committees compromised, giving responsibility for the study to the Veterans Administration and mandating that the Office of Technology Assessment make periodic reports to the committee, keeping Congress informed about progress or lack o f i t. 9: 4 �This was an entirely new role for the Office of Technology Assessment, and its constitutionality has been questioned. The question arose a month after Congress directed the Veterans Administration to do the Agent Orange study. At that time, Congress passed another law directing the National Institute for Occupational Safety and Health to do a study on dioxinexposed workers, and, again, Congress required that the Office of Technology Assessment review and approve the protocol and monitor the conduct of the study. President Carter vetoed that law on the basis that giving a congressional branch agency--the Office of Technology Assessment—veto authority over the execution of an Executive Branch study was a violation of separation of powers doctrine, Executive Branch lawyers concluded after examining the case that the bill was unconstitutional. Legislative Branch lawyers, however, concluded that it was constitutional. Neither branch has taken the case to court, and the issue is unresolved. The veto of the NIOSH bill was successful. President Carter's veto message also instructed the Administrator of the Veterans Administration to ignore the provisions of Public Law 96-151 which directed the Veterans Administration to submit the study plan to the Office of Technology Assessment for review. However, Senator Alan Cranston, at that time Chairman of the Senate Committee on Veterans' Affairs, wrote the Administrator that ignoring the provision would not be a wise course. He pointed out that Congress must provide funds for the Veterans Administration study and that funding depended, on the Office of Technology Assessment reviewing and approving the study plan. The Office of Technology Assessment was part of the process, and it has played an active role in Agent Orange issues ever since. 9: 5 �OTA assembled an Advisory Board to participate in its Agent Orange activities. The panel includes academics--epidemiologists and statisticians, a toxicologist, a neurologist, and a gynecologist. Then there are members who represent stakeholders. There are three representatives from chemical companies that made the Agent Orange components: Monsanto, Dow Chemical, and American Cyanamid. They are neatly balanced by representatives of the American Legion, the Disabled American Veterans, and the Vietnam Veterans of America. Despite the congressional requirement that a protocol be written in 180 days, the Veterans Administration did not produce one within that time. The Veterans Administration was sued by veterans' groups because of some of its procedures. There was a hearing before the General Accounting Office about the methods used by the Veterans Administration to contract for the protocol design. All of these events contributed to the protocol's being late. When the Office of Technology Assessment received the first draft of the protocol, we rejected it as inadequate. The basic plan of the protocol was to compare morbidity and mortality rates between two groups of veterans, one which had been exposed to Agent Orange and one which had not been. In response to OTA's and others' criticisms, the protocol was revised. The revision process just dragged along. It was not until September, 1982, two and a half years after Congress passed the law, that OTA approved the protocol. By that time the Agent Orange Working Group Science Panel had become convinced that it was really impossible to separate exposed from not- exposed veterans, and they were urging that a study be done to compare the health of veterans who had gone to Vietnam with the health of veterans who have not gone to to Vietnam, A study of that type would at least provide a 9: 6 �clue as to whether or not Vietnam veterans in general were suffering from ill effects as a result of that experience. The recommendation placed pressure on the Veterans Administration to do a "Vietnam Experience Study" even though the Administration was planning an Agent Orange study. Rather than making a decision between the two studies on its own, the Veterans Administration asked for another review of their protocol from the National Academy of Sciences. In September, 1982, all the delay came to a head because Congress had exhausted its patience. One hundred and: one representatives from the House of Representatives wrote a letter to the Veterans Administration requesting that the study be transferred from the Veterans Administration to some other agency. Dr. Vernon Monk of the Centers for Disease Control, in testifying before the House Veterans' Affairs Committee, said that the Centers for Disease Control was well placed to do the study. The Senate Veterans' Affairs Committee reaffirmed its previously held conviction that the responsibility for the study should be transferred somewhere else. The result was that the execution of the study was taken from the Veterans Administration and given to the Centers for Disease Control. The Centers for Disease Control finally resolved the controversy about whether to do an Agent Orange Study or a Vietnam Experience Study: they are doing both. The CDC studies are the largest, probably the most compjLicated, and the most expensive epidemiology studies ever conceived. They will cost at least $70 million, involve interviews of 30,000 veterans, and 10,000 physical examinations to be carried out at the Lovelace Clinic. The Vietnam Experience Study is relatively straightforward. Looking at the records easily establishes whether or not a veteran went to Vietnam. The two cohorts can thus 9: 7 �be easily assembled, with the men who went to Vietnam on one side and those who did not on the other; then their health can be examined. The Vietnam Experience Study is underway and on schedule. The same cannot be said about the Agent Orange Study,because it is much harder to say whether or not a veteran was exposed to Agent Orange. In January, 1985, the Centers for Disease Control sent the Office of Technology Assessment a summary of their efforts to resolve the exposure problem. At that time the Centers for Disease Control were able to identify the locations of battalions on the ground in Vietnam, A battalion is about 1,000 men, four maneuver companies and a headquarters company. The battalion that the Centers for Disease Control provided as an example was spread out along a line of 40 kilometers. It was not possible to know where the 1,000 men actually were. Were 990 at the middle of the line or were they at one end? Were they spread out evenly along the entire line? No one knows. One way to decide that a battalion was exposed is to declare that any Agent Orange spray mission within a fixed distance caused exposure. In practice, AOWG and CDC have accepted that a spray mission at a distance of two kilometers'might result in exposure. Now consider an airplane spraying Agent Orange somewhere within two kilometers of the battalion spread out on the 40 kilometer line. It is very hard to say who of the battalion was exposed and who was not. Even assuming that exposure could be ascertained, it is impossible to know how much exposure took place. OTA was very critical of the plans to decide a battalion was exposed on the basis of such data. This criticism was expressed in periodic reports sent to the congressional committees. 9: 8 �Right: now, I think a majority o£ the OTA Advisory Board feels that the study on Agent Orange should not go on because of difficulties in deciding who was exposed and who was not. The panel has not voted on this issue, and I could be wrong, in my assessment, but I don't think so, If, after seeing more details about exposure, OTA decides the study is impossible, Congress could decide not to do the study. That would involve an act of courage on the part of the Congress because it has made a commitment that this study would be done. The Veterans' Affairs Committees of the Senate and of the House may face the dilemma, having promised the veterans to do the study, that they have changed their mind. I used to think that, no matter what the technical problems, the study would be done. I am no longer so certain. Congress has considered, over and over again, providing compensation to veterans who claim ill effects from Agent Orange exposure. At one time there was a list of over 20 diseases being considered as compensable. Congress finally passed a law which provides compensation for chloracne and porphyria cutanea tarda (PCT), if they occurred within one year after .leaving Vietnam, Although there are very few cases of either disease, the law was not a hollow gesture on the part of the Congress. They wanted to do something to compensate veterans who had been harmed, but, at the same time, they wanted to limit compensation to diseases that might be connected with Agent Orange, Subsequently, Congress directed the Veterans Administration to set up a special committee to review claims about diseases resulting from Agent Orange exposure. That committee will function only until the studies of the Centers for Disease Control arc complete, because at that moment we expect to have the answer to our questions. 9: 9 �Summing up, we can say that Congress is working out the Agent Orange controversy. In 1979, Congress refused to make a decision about whether or not Agent Orange had caused health, effects. Instead, Congress directed the Executive Branch to gather information for making a decision. By now, some results have come in. The Air Force's studies on Ranch Hand personnel provide no convincing evidence that Agent Orange has affected human health. The Birth Defects Study, performed by the Centers for Disease Control, also failed to provide convincing evidence of a connection between Agent Orange and human effects. Congress has directed the Veterans Administration to compensate two conditions which have been related to dioxin exposure should they appear in Vietnam veterans. The judge in the Agent Orange class action stated that the veterans had failed, to prove their case in court that Agent Orange was the cause of their illnesses. These points are convincing many people that, regardless of all the fears about Agent Orange and the toxicity which might reside in the dioxin molecule, exposure to Agent Orange, if it occurred, has not harmed the veterans. However, that is not yet the end of the Agent Orange controversy. Intellectually and emotionally the veterans might accept that they have not been able to prove that their diseases were caused by Agent Orange, but they can always contend that no one could prove the contrary. Probably, Agent Orange will pass away as a political issue. Some veterans will continue to contend they were harmed, but the decisions already made in Congress and in the courtroom will convince many people that no detectable harm was done. As more study results come in, if the results continue to show no health effects, they will reinforce the conclusions already made. 9: 10 � 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. 056 Folder The folder containing the original item. 1498 Series The series number of the original item. Series III Subseries II 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 Gough, Michael Title A name given to the resource Typescript: Chapter 9: The Political Assessment: A Congressional View Subject The topic of the resource legislation AOWG CDC VA ao_seriesIII 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. 041 Folder The folder containing the original item. 0960 Series The series number of the original item. Series III Subseries I 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 Pettinati, L. G. Perrelli Source A related resource from which the described resource is derived Minerva Medica Date A point or period of time associated with an event in the lifecycle of the resource 1979 Title A name given to the resource Pesticides in Rural Pathology Subject The topic of the resource legislation industrial exposure safety ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/bb5999a175d6f193dec6655bd179050a.pdf 01f9121d57b63f750bec84db5ba5c681 PDF Text Text Item ID Number 00900 Author Meselson, Matthew S. Corporate Author Herbicide Assessment Commission of the American Ass Report/Article TitlO Hearing: Background Material Relevant to Presentations at the 1970 Annual Meeting of the AAAS Journal/Book TltlO War Related Civilian Problems in Indochina, Part 1: Viet Year 1971 Month/Day Color n Number of Images 49 DOSCrlpton NOtOS Alvin L Friday, March 16, 2001 Young filed this item under the category "Human Exposure to Phenoxy Herbicides and TCDD" Reprinted in the Congressional Record, Volume 118 (no. 32), 3 March 1972, pp. S3226-3233. Page 900 of 967 �Reprinted in the Congressional Record, Volume 118 (no. 3 2 ) , 3 March 1972, pp. S3226-S3233. HERBICIDE ASSESSMENT COMMISSION OF THE AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE BACKGROUND MATERIAL RELEVANT TO PRESENTATIONS AT THE 1970 ANNUAL MEETING OF THE AAAS MatthewS. Meselson Harvard University, Cambridge, Mass. Arthur H. Westing . Windham College, Putney Vermont John D. Constable Harvard Medical School, Boston, Mass, Contents 1. 2. 3. 4. Introduction Land and Peoples of South Vietnam Military Use of Herbicides in South Vietnam Herbicide Toxicology: Stillbirths and Birth Defects 1 8 . . 14 23 The observations and evaluations of the Herbicide Assess ment Commission are those of its individual participants and should not be attributed to the AAAS or any of its component organizations. �INTRODUCTION Over the past nine years, approximately one-seventh of the land area of South Vietnam has been treated with chemical herbicides .in order to reduce vegetation and to destroy food crops in connection with * military activities. This large scale application of herbicides has occasioned concern within'the scientific community that there may be serious effects on the land and people of Vietnam. Unfortunately, large areas of ignorance have prevented any satisfactory evaluation of the possible effects; of their implications for economic and health planning in Vietnam; and of their broader implications regarding the use of herbicides. In order to obtain reliable information, the American Association for the Advancement of Science, the largest organization of scientists in the United States, has sought to encourage and participate in the conduct of a systematic on-site study of the effects of herbicides on the ecology and on human welfare in South Vietnam. As a first phase of such a study, the AAAS Board of Directors, in December 1969, commissioned the preparation of a detailed operational plan for determining. " . . . the short-term and long-term consequences of the use of herbicides on the ecology of South Vietnam and on human welfare." The AAAS Herbicide Assessment Commission, the name under which this AAAS endeavor is known, began ^Herbicides are chemicals intended to kill or reduce vegetation. When they cause leaf fall, with or without killing the entire plant, they are sometimes called defoliants. We shall use the more general term, herbicides. \ �its work in February 1970. Herbicides have been widely used since World War II in many parts of the world for such beneficial purposes as agricultural and aquatic weed control, forest, range, and watershed management, and the clearing of rights of way. In the United States, about 150 million pounds of synthetic organic herbicides were used in 1965 to treat approximately 140 million acres, one fourteenth of the land area of the country. However, there are serious difficulties in extrapolating this backlog of experience to the assessment of the effects of herbicides in Vietnam. First of all, the choice of areas to be sprayed is based on very different considerations in the two cases. Domestically, herbicides are generally used to improve land values. In military applications, land values are clearly not of primary concern. For example, herbicides are used domestically to improve pine forests by selectively killing less desirable species. Militarily, the objective of spraying a forest is simply to remove as much cover as possible. Again, herbicides are used in farming to kill weeds but in war they are used to destroy food crops. Beyond the clear difference in objectives between civil and military applications of herbicides, there are several additional factors which limit the applicability of domestic experience to the evaluation of possible effects in Vietnam. Among them are: (i) little experience with �the application of herbicides in comparable tropical ecosystems; (ii) little previous attention to the possible ecological consequences of herbicide application over a very large contiguous area; (iii) limited experience with the military rate of application, which is more than ten times higher than the average domestic rate; (iv) a meager backlog of domestic experience with tv/o of the four herbicides that are used militarily; (v) no monitoring of the quantities of herbicides or herbicide impurities and breakdown products that may be entering the Vietnamese diet; and (vi) a need for more information regarding the possible negative medical or ecological side effects of herbicides even as they are used domestically. In this last regard, it must be remembered that although the use of herbicides is very widespread it is also quite recent, more or less paralleling and now exceeding that of chemical insecticides. Direct examination of herbicide-treated areas in Vietnam by qualified scientists has so far been quite limited. However, an important start on the study of sprayed timber stands was made during 1967 and 1968 by the USAID Forestry Branch. On the basis of aerial observations, it was estimated that approximately nine thousand square kilometers of forest had been sprayed by mid-1967. After conducting brief ground inspections at .three treated sites in early 1968, Dr. Barry Flamm, Chief of the Forestry Branch, tentatively concluded that while a single spraying causes 10 to 20 percent killing of merchantable trees, two treatments in successive years �kill 50 to 100 percent in the type of forest studied. An increase in grass cover was noted in sprayed areas and it was anticipated that bamboo also would increase. Flamm suggested further studies and recommended that forest reserves receiving two or more treatments be planned for reforestation. During 1968 the U . S . Mission in Vietnam conducted a review of various aspects of the herbicide program. In order to obtain a preliminary assessment of ecological effects, Dr. Fred S. Tschirley of the U. S. Agricultural Research Service was asked to participate. Tschirley, a botanist, toured Vietnam from mid-April to mid-March 1968. He made aerial observations of mangrove forests and semi-deciduous upland forest areas. He also revisited the three sites established by Flamm and came to the same conclusions regarding the effects of single and multiple herbicide treatment on this forest. Tschirley also noted that mangrove species are killed by a single treatment, and estimated that sprayed mangrove forests might return to their original condition in approximately twenty years. Tschirley stressed the need for information on the successional behavior of herbicidetreated Vietnamese forests and strongly urged the initiation of long-term ecological research after the cessation of hostilities. In March 1969 two American zoologists concerned with the ecological impact of herbicides in Vietnam, Dr. Gordon H. Orians of the University of Washington and Dr. Egbert W. Pfeiffer of the University of Montana, visited Vietnam for two weeks. They made aerial observations �of sprayed upland forests and also inspected a mangrove area by motor launch. They found no evidence of recolonization along the shore line and reported a near absence of fructivorous and insectivorous birds in the sprayed areas. They too, strongly recommended a major research effort, to be conducted jointly with Vietnamese scientists. Following the establishment of the AAAS Commission, our work was conducted in several stages including a trip to Vietnam in August and September 1970. We inspected several types of herbicide-treated areas in order to acquire information upon which more extensive studies could be based. Our observations extended into several areas not previously studied and, in certain instances, significantly differed with prior reports. Previously, the Commission conducted a survey of the relevant literature. At the same time, numerous experts and officials in various fields were consulted for information and advice. A list of questions for possible study was drawn up and circulated for comment to over 200 individuals and agencies as a means of identifying important problems and building a base of information. Then, in June, a five-day working conference was held at Woods Hole, Massachusetts in order to further define a tractable number of specific problems for systematic study and to assist in planning the subsequent tour of South Vietnam. The conference was attended by twenty-three specialists in various fields including tropical ecology, forestry, agricultural economics, mircrobiology, soil �science, plant physiology, herbicide chemistry, photogrametry, medicine, and anthropology. Eleven of the participants had various degrees of experience in Southeast Asia. Although all were present as private individuals, they included persons from universities in the United States and abroad, from industry, and from several departments of the U. S. Government. In Vietnam, our objectives were to improve our identification of important problems for study and to determine the facilities, methods, and geographical areas that would be most suitable for future work. We attempted to obtain enough specific information and experience to partly bridge the gap between the very limited picture of the situation available from reading and consultation in the United States and actual conditions as they exist in Vietnam. In fact, we were able to make some specific observations that should be of value even at this preliminary stage. Although we went to Vietnam as independent scientists on behalf of the AAAS, we were given the full official support of the U. S. Mission and of the Government of the Republic of Vietnam, who showed their concern with the problem by supplying letters of introduction and every assistance in Saigon and in the provinces. Our living quarters, office facilities and ground transportation were generously and expeditiously provided by the U . S . Agency for International Development. Extremely valuable helicopter overflights and �f I other air trips were arranged by USAID, the American Embassy, and, especially, by the U. S. Military Assistance Command. However, our itinerary and daily activities were decided upon solely by ourselves. We consulted with Vietnamese university and ministry specialists in botany, zoology, soil science, agronomy, chemistry, forestry, and medicine. We made several field trips with Vietnamese professors and graduate students. We interviewed numerous farmers and village officials for first hand information on herbicide effects. We conducted aerial and ground inspections of herbicide treated and untreated areas and conducted studies of possible health and congenital anomoly changes in selected regions. Food-chain components and human sample materials were collected and brought back for chemical analysis. �LAND AND PEOPLES OF SOUTH VIETNAM South Vietnam occupies the southeastern extremity of the Southeast Asian Peninsula and has a crescent-shaped area of 170,000 square kilometers. It is about 1,300 kilometers long, extending from 8°33' to 17° north latitude. Its average width is about 150 kilometers, falling between about 104° and 109° east longitude. To the west lie Laos and Cambodia, to the east the South China Sea. Populations: The 1970 population of South Vietnam is estimated to be 17.5 million, concentrated in the southern third of the country and in a narrow strip along the eastern coast. More than 80 percent are ethnically Vietnamese. The largest minority are the Highlanders of Montagnards, a group of tribal peoples racially and linguistically distinct from the ethnic Vietnamese. Estimated to number approximately one million, the Montagnards are distributed throughout the upland areas in the northern two-thirds of the country. Geographic Regions: South Vietnam is divisible into four main physiographic regions. The Mekong Delta region constitutes the southernmost quarter, extending over about 40,000 square kilometers with about 5 million inhabitants. Flat and often marshy, it is dissected by the five arms of the Mekong River, several lesser rivers, and many navigable streams and canals along which the rural population is concentrated. The rivers are so sediment-laden that in some places the coastline advances by as much as 75 meters per year. �. • The very fertile central part/ where most of the Delta population live/ is the principal rice production area in Vietnam and also is a - major source of coconut, banana, and other fruits. In the northern portion of the Delta, extending from the Cambodian frontier, there lies an extensive, poorly drained marsh, the Plain of Reeds. Mangrove forests line much of the coast of the Delta and occupy two particularly large areas, the Camau Peninsula in the far south, and the U Minh Forest in the v/est. The Mekong Terrace region constitutes a wide band lying north of the Delta region, extending from Cambodia to the sea. Its area is about 30/000 square kilometers. Somewhat more elevated than the Delta but still mostly flat, this region is heavily forested in the north and mostly cleared for fanning in the south. It possesses a wide-variety of soils and drainage conditions/ supporting not only rice but many other crops, including fruits, fibres, sugar and rubber. The population is approximately six million, half of it in Saigon and its environs. Two of the principal rivers of this region, the Saigon and the Dong Nai, join just south of Saigon and then branch into a complex of meandering channels in a mangrove forest known as the Rung Sat. One of these channels is the main shipping route linking Saigon to the South China Sea. The 'Highland, region of South Vietnam, occupying about 65,000 square kilometers but containing only about a million people, extends northward from the Terrc.ce region all the way to the demilitarized zone which �10 divides Vietnam at the seventeenth parallel. On the east it is bounded by the Truong-Son range, which rises steeply out of the coastal plain, and on the west by Cambodia and Laos. The Truong-Son slopes gradually to the west forming an area of rugged mountains and plateaus penetrated in places by low plains opening into Cambodia. As recently as twenty years ago this region was inhabited almost entirely by Montagnards. Even now, after a major influx of lowland Vietnamese, the Montagnards constitute more than half of the population. Most of the Highland region is forested. There are also large areas covered with grass, brush, or bamboo. A large fraction of the forest is kept at an early stage of development by the Montagnard practice known as sv/idden agriculture. The forest is cut and burned, farmed for rice, vegetables, and other crops for two or more years until the land loses its productivity, and then allowed to lie fallow for several years before the cycle is repeated. Although most of the inhabitants of the highland region are subsistence farmers, there is intensive commercial cultivation of vegetables, fruits, coffee, tea, and rubber in some areas. The large-scale production of vegetables for the Saigon market in the vicinity of Dalat is particularly noteworthy. The Coastal Plains region, covering about 25,000 square kilometers, is a narrow strip located between the mountains and the sea, �il extending from the Mekong Terrace region north to the seventeenth parallel. The strip is constricted in several places where branches of the Truong-Son range reach nearly to the sea, forming a series of large coastal plains. The population is approximately four million. Little of the region is forested, most of it being planted to rice, manioc, sweet potato, peanuts, and sugar cane. Climate; South Vietnam has a warm humid climate. The mean temperature is 25-27°C and the average yearly precipitation is approximately 150 to 300 cm, depending on location. The seasonal range of temperatures is not large, less than 5°C in most places. Precipitation, however, is subject to great seasonal variations. In all regions except the Coastal Plains, the wetest season occurs in the summer when the prevailing winds are southwesterly, bringing warm humid air from the Gulf of Siam and the Bay of Bengal. During this time the rains are usually not steady, but occur as heavy afternoon showers. A pronounced dry season occurs during the winter, when the wind is generally from the northeast. On the Coastal Plains, the dry season starts late in the winter and lasts approximately half the year. In this region, rainfall is highest in the autumn, with serious flooding in some years. In the late autumn, the entire east coast of South Vietnam is subject to typhoons coming from the South China Sea. Land Cover: be distributed as ibllows: The cover types of South Vietnam are estimated to �12 Forest Hardwood Mangrove Rear ma ngrove Rubber Pine Square Kilometers 100,000 2/800 2/000 1/000 1,800 . Approximate total forest area 107,600 Other Brush wood/ coffee and tea plantations Crops Savannah Dune grass and trees Swamps and marshes Urban areas 11,000 37,000 1,300 1,100 8,500 1 00 Water and unaccounted Total area 7,200 . 173,800 Under the designation "forest" are included all lands with trees whose crowns cover more than twenty percent of the area. Only about half of the total forest area is stocked with trees of sufficient size for commercial logging. Thus, the area covered by merchantable hardwoods is approximately 50/000 square kilometers. Of this, about two-thirds is in the Central Highland sand one-third in the Mekong Terrace region in a broad arc extending across the country north of Saigon. Administrative Divisionsi__and__Milita_ry^_Reg_ions; South Vietnam is administratively divided into forty-four provinces, plus six autonomous �13 municipalities. Each province is divided into a number of districts which are subdivided into villages. Each village contains several hamlets. For military purposes, provinces are grouped into four Military regions, formerly known as Corps Tactical Zones. Military Regions III and IV generally correspond to the Meklong Terrace and the Mekong Delta regions, respectively. The northernmost five provinces comprise Military Region I, while the twelve remaining provinces to the south make up Military Region II, both regions include highlands and coastal plains. �14 MILITARY USE OF HERBICIDES IN SOUTH VIETNAM The military use of herbicides in South Vietnam began on an experimental scale in 1961. It became operational in 1962 with the aerial spraying of twenty square kilometers of forest and three square kilometers of crop land. Much of the spraying that year was conducted in the mangove forests of the Camau peninsula, at the southern extremity of the country. In successive years, the use of herbicides grew rapidly, reaching a peak in 1967 and then declining somewhat in 1968 and 1969. Data for1970 is not yet available. An estimate of the area treated in each year through 1969 is as follows: Estimated Area Treated with Herbicides in South Vietnam* .Acres Square Kilometers 2 (1 km = 247 acres) Year Forest Land 1962 1963 1964 1965 1966 1967 1968 1969 1970 4,940 24,700 83,486 155,610 741,247 1,486,446 1,267, 110 1,221,415 DATA 741 247 10,374 65,949 101,517 221,312 63,726 65,700 NOT YET 5 , 68 1 24,947 93,860 221,559 842,764 1,707,758 1,330,836 1,287,115 AVAILABLE Total 4j, 9 84, 95 4 529,566 5,514,410' Crop Land Total Forest Land Crop. Land 20 100 338 630 Total 3 1 42 267 421 896 258 266 3,422 6, 914 5,388 5,211 2, 154 22,336 3,001 6,018 5, 130 4,945 23 101 380 897 •' 20,182, *The number of acres treated is calculated by multiplying the gallons of herbicide used by one-third. This procedure is based (cont. on following page) �15 Herbicides Used in Vietnam. Three different formulations account for nearly all of the herbicides disseminated in Vietnam. They are known by the designations Orange/ White, and Blue, corresponding to the color of the stripe painted around the 55-gallon drums in which they are shipped from the United States. They are used in Vietnam as received, without dilution. Their compositions as well as that of agent Purple, an early formulation very similar to Orange, are shown in Table 1. Orange has been the most extensively used, accounting for approximately sixty percent of all herbicide consumption in Vietnam. It is an undiluted mixture of the n~isobutyl esters of 2,4-D and 2,4,5-T. Orange acts as both a defoliant and a systemic plant killer on broad leafed and woody vegetation. It has been used mainly for forest clearing and to a lesser (continued from preceding page) on the fact that the average spraying rate is taken to be approximately three gallons per acre of defoliated swath produced. The quantity of herbicide used is known rather accurately but the estimation of the average area of the spray swath could be somewhat in error. For example, records of actual spray flights suggest that at least under some conditions approximately 1.4 acres of swath are produced for each three gallons of herbicide sprayed. The total area estimates given here are subject to at least two additional corrections. However/ neither is very great. First, the calculated areas should be increased to take account of spraying by helicopters and by ground equipment. This is not included in the estimates given in the table, which refer only to spraying done by C-123 fixed-wing aircraft. Judging from the reported total amount of herbicide used by all types of equipment in 1968 and 1969, it appears that no more than twenty percent was applied by means other than C-123 aircraft. Second, the calculated areas should be reduced by a factor estimated as at least sixteen percent, because of the fact that some areas have been treated more than once. As these two corrections tend to cancel each other, and as neither is very great, they are not taken into account in the table. �16 Table 1 MILITARY HERBICIDES Agent ORANGE: 2,4-D and 2 , 4 , 5 - T Active Ingredients: Concentrations: Application: Agent WHITE: 2,4-D and Piclorarn Active Ingredients: Concentrations: Application: Agent BLUE: A 1:1 mixture of the n-butyl esters of 2,4-dichlorophenoxyacetic acid and 2 , 4 / 5 -trichlorophenoxya cetic acid. 4.1 and 4 . 4 Ib./gal. Undiluted at 3 gal./aere. A 4:1 mixture of the tri-iso-propanolamine salts of 2,4-D and 4~amino-3, 5, 6-trichloro-picolinic acid in water. 2.0 and 0.54 Ib./gal. Undiluted at 3 gal ./acre. Cacodvlic Acid Active Ingredients: Concentration: Application: A 6:1 mixture of sodium dimethyl arsonate and dimethyl arsenic acid in water. 3.1 Ib/gal. Undiluted at 3 gal ./aere. �17 extent for-crop destruction. In tropical dicotyledenous forests, leaf fall occurs in three to six weeks after application, with surviving trees or branches refoliating within a year. Similar formulations are known on the domestic herbicide market under the generic name of brush killers. One of these, differing slightly from Orange by containing isobutyl 2,4,5-T as an additional ingredient was used in Vietnam until 1965 under the name Purple. The use of Orange was ordered stopped by the Department of Defense in April 1970, because of concern arising from tests on. laboratory animals showing commercial samples of 2,4,5-T to be teratogenic. The next most commonly used herbicide is agent White, a water solution of the tri-isoprop?nolamine salts of 2,4-D and picloram, together with surfactants and a rust inhibitor. Accounting for approximately thirty percent of total herbicide consumption, it was first introduced in quantity in 1967 when the military demand for Orange outstripped the U . S . production capacity for 2,4,5-T. White is mainly used for forest clearing, giving somewhat longer lasting results than Orange. Similar formulations are used in the U.S. for spraying power line rights of way, although picloram is not permitted for agricultural applications. Agent Blue is a water solution of the sodium salt of cacodylic acid (sodium dimethyl arsenate), plus surfactants, rust inhibitor, and antifoam. It makes up somewhat less than ten.percent of all herbicide used. �18 It acts to desiccate or dry out vegetation with v/hich it comes into contact. It is more effective on grasses than Orange or White and acts more rapidly, withering all types of vegetation within a few days. It is used both for defoliation and for crop destruction, particularly against rice. Picloram, 2,4-D, and 2,4,5-T are all known as plant growth regulators and cause similar physiological responses, including defoliation, stimulation of growth, induction of callus formation, and striking changes in the shapes of stems, fruits, leaves, and other plant parts. These herbicides may be absorbed either through the leaves or the roots. Under some conditions, herbicide deposited on the leaves causes them to fall before enough is transported to cause systemic poisoning of the entire plant. In such cases the. plant often recovers. The biochemical mechanisms of action of these chemicals are unknown, in spite of a great deal of research. However, the main cause of plant death following systemic poisoning appears to be unbalanced growth of tissue, particularly phloem, resulting in blockage of nutrient flow, and in the formation of lesions vulnerable to microbial • infection. M ethod .of..Ao pi i cat ion. Herbicide spraying in Vietnam is done by fixed-wing aircraft, helicopters, and various types of ground equipment. The principal means of application has been the twin-engine C-123 cargo aircraft. Between January 1952 and January 1969, C~123s made more than 19,000 individual spray flights. The aircraft is fitted with a 950-gallon tank �19 from which.the liquid herbicide is pumped at approximately 250 gallons per minute to spray booms under each v/ing and to a third boom at the tail. . It is discharged through thirty-two nozzles of 9.5 milimeter internal * diameter distributed along the three booms. When the herbicide hits the airstream, it is dispersed into droplets having a mass mean diameter of 0.35 milimeters. One aircraft produces a rather sharply defined swath of affected vegetation approximately 85 meters wide and 15 kilometers long, depending somewhat on operating conditions. Records of individual spray flights suggest that some swaths ar3 up to 100 meters wide and 18 kilometers long. Standard operating conditions are~~an air speed of 240 kilometers per hour and an altitude of 50 meters above tree top level. In order to minimize inadvertent applications from drift and volatilization, spraying is not supposed to be done when wind speed exceeds 15 kilomters per hour or temperature exceeds 29°C. Calculations based on assumed drop size distributions suggest that even with a 15 kilometer per hour wind, drift should not be an important problem beyond about 3 kilometers from the line of application. However, the actual drop size distribution for the C-123 equipment has not been measured in the field. Aerial spraying by helicopter is done by the UH-1 "Huey" aircraft mounting a 200 gallon tank. For crop destruction missions, the application rate is sometimes reduced to about half the value delivered by C-123, since even about 1 gallon of Blue per acre is enough to prevent the maturation of rice. �20 Location of herbicide applications. No systematic and detailed information on the locations of herbicide spraying in Vietnam has been made generally available, However, the U . S . Army Chemical Staff in Saigon has kept a log for each C-123 mission since July 1965. Records for spraying before that time may be on file in official archives kept in Omaha, Nebraska, and St. Louis, Missouri. The log in Saigon includes the data most relevant to any study of herbicide effects. These are the dates and map coordinates of spraying, the type of herbicide, and the quantity actually sprayed. Map coordinates are given to the nearest 100 meters. At present, this information is classified Confidential. Although truly satisfactory information is unavailable at present, it is possible to put together a rough idea of the amount of terrain of different types that has been sprayed and of the location of the principal areas of heavy exposure. This has been done on the basis of published information and aerial observations made by ourselves and by others. Tropical Hardwoods. The greatest expenditure of herbicides in Vietnam has been on fairly mature tropical hardwood forest. Flamm places the area of such forest sprayed through 1969 at 13,500 square kilometers, about a third of it sprayed more than once. Hardwood forests of one kind or another and in various conditions make up about nine-tenths of forested land in south Vietnam. The forestry services of the French colonial government estimated the total area of economically valuable hardwood �21 forests at 50,000 square kilometers, leaving out forests that were badly degraded, very young, or located on particularly inaccessible mountain terrain. A recent estimate of the total hardwood forest estate, based on low resolution aerial photography and on U. S. Army terrain travel difficulty maps is 100,000 square kilometers. However, this includes a large fraction of the forest in the central highlands that is kept at a very early successional stage by swidden agriculture. An intermediate value, about 75,000 square kilometers, can be estimated from a vegetation map published by the Government of Vietnam. As a rough approximation then, it appears that some twenty percent of the relatively mature hardwood forest has been treated with herbicides, a third of it more than once. Mangrove and Rear Mancrrove. To the southwest of Saigon, and along much of the coast of the Delta, are dense mangrove forests covering about 3,000 square kilometers. According to Tschirley, about one-third of this forest type had been sprayed by the end of 1967. With continued herbicide operations in the Delta, the proportion is now probably close to one half. Inland from the mangroves in the western part of the delta are nearly 2,000 square kilometers of forests of Melaleu ca 1 eucadendron, sometimes called rear mangrove. We are unaware of how much, if any, of this forest type has been sprayed, �22 Strip Spraying. Aside from blocks of forest within which herbicides have been extensively applied, a considerable amount of spraying has been done in short narrow strips scattered v/idely throughout South Vietnam. Strip (as opposed to bloc) spraying has been done along roadsides, perimeters of military installations and also in forests. In the Delta, it has been done along canals and rivers. Although much of it has been accomplished by C-123s, a large fraction has been done by helicopters and therefore may not have been systematically recorded. Crop Destruction. Finally, somewhat more than 2 , 0 0 0 square kilometers of cropland is reported to have been sprayed. If little of this area includes re-spraying, it would represent about five percent of the 38,000 square kilometers of crop land in South Vietnam of which a little over two percent was sprayed in the peak year of 1967. Being located almost entirely in the central highlands, rather than on more productive soil, the percentage of the total national crop production affected would be less than the percentage of South Vietnamese farmland that has been sprayed. However, only about a tenth of South Vietnam's farm land is in the highlands, so that within this region a considerable fraction of the farmland has been sprayed. �23 HERBICIDE TOXICOLOGY: STILLBIRTHS AND BIRTH DEFECTS HAC OBSERVATIONS AND PROBLEMS FOR STUDY The following is an analysis of the work which was done by the HAC in the evaluation of the feasibility of demonstrating any change in the pattern of births in Vietnam which might have resulted from the exposure of some of the Vietnamese population to 2 , 4 , 5 - T , o r its contaminant dioxin, agents certain animals, which have been reported to be teratogenic under certain laboratory conditions in / If indeed any such effects of the 2 , 4 , 5 - T exposure on the Vietnamese population are to be detected, it would be appropriate to study these in at least four ways, looking for: 1. Changes in the occurrence of malformations and/or still births in a relatively stable population. 2. Changes in the frequency of any of the more common identifiable malformations in relation to other common malformations. 3. The relatively sudden appearance of an otherwise very rare or unknown deformity in significant numbers (the classical previous example being thalidomide induced phocomelia). 4. Changes in the incidence of specific abnormalities, anatomical or biologic, that have been shown to result from laboratory experiments with 2-4-5,T in animals. Consideration will be given to each of these possibilities. All of them are somewhat difficult to examine precisely but numbers two and three are, we �24 believe, subject to relatively precise evaluation even under war time conditions in Vietnam, while the first and last are a great deal more difficult to elucidate. These methods of study are all subject to very significant limitations, some of which are now presented. Size and Accessibility of the Population Exposed Directly to throughout this report, Herbicides. Although, as frequently noted/precise information as to all the locations of herbicide spraying has not been made available to the HAC; and it is therefore, difficult to be certain how much defoliation has in fact been done in more densely populated areas, it nevertheless appears to be true that the bulk of Agent Orange used in Vietnam has been sprayed in relatively remote and sparsely populated areas of mangrove and other forests. This figure is particularly hard to estimate since the crop destruction program is carried out in more populated areas and although Agent Blue (without 2,4,5-T) has been favored for this, Agent Orange has also been used. The population directly exposed to 2,4,5-T presumably does not exceed five percent (and may even be one percent or less) of the total population of Vietnam, although this must be more accurately determined from precise spray apparent data. This factor alone strikingly dilutes any/effects of the spraying on birth when statistics / those directly exposed are a d d e d to the total statistics of the country, but this effect is even more accentuated by the fact that most of this population is necessarily in remote and usually insecure areas and therefore information regarding medical effects, if any, can only be gradually expected to filter out from the sites of direct exposure. An unknown proportion, but probably quite significant, of the exposed population, consists of �25 Montagnard people whose births are normally at home or in villages and are rarely recorded in the Government of Vietnam medical system or allowed . for in the GVN statistics. Status of Records: Availability and Accuracy. In general/ maternity records are in some respects among the most reliable available to the field investigator in Vietnam. Traditionally/ midwifery in Vietnam has been strictly independent and, employing female mid wives/ has been rather less subject to change of personnel than has the rest of the Vietnamese health system. In all hospitals or dispensaries staffed by a midwife, whether national or rural, a daily record book is kept in which all deliveries are recorded. It is agreed by almost all observers that this record, providing the original has not been lost/ is reasonably accurate as far as the limited information it contains. Thus, it is our feeling that almost complete accuracy is available concerning the number of births, sex of the children, weight of the newborn and whether or not the infant survived. In theory, obstetrical abnormalities or infant malfonnations are recorded. If these are positively noted in a record, then they are reliable, at least within the diagnostic acumen of the midwife recording them, but, as will be shown subsequently a negative record is of no significance whatsoever. It is our belief that within these simple statistics/ the accuracy of provincial hospitals, district hospitals, and village dispensaries is comparable. This assumption may not be strictly true and is subject to factors such as the desirability of registration of living children, which might lead to the concealment of a stillbirth or neonatal death; or the reluctance of village or district mid wives to report �26 large numbers of stillbirths when transfer of difficult cases to the provincial hospital is expected by the Ministry of Health. Nonetheless, the uniform agreement of numerous Vietnamese doctors and midwives with whom we consulted that this reporting is usually reliable, supports our opinion. In the capital area (Saigon-Gia Dinh) modern statistical methods have been introduced, particularly at Tu-Du, and increasing accuracy is reflected thereby. The Vietnamese Health System. The Ministry of Health provision for the medical care of the people of Vietnam is through a system of rather strictly graded medical facilities. A village will often, but not always, contain a dispensary of extreme simplicity staffed by a rural health worker and/or midwife with only a few months training. Nonetheless, in one province studied by the HAG nearly twice as many births were recorded in village dispensaries as in the provincial hospital for a comparable period. All district capitals have a dispensary and at the time of the visit of the HAG it was reported by the Ministry of Health that all of these were at least partially staffed. Personnel usually include national health workers and midwives, many of whom are well trained, but these facilities do not normally have a doctor available and except for deliveries usually do not have in-patient facilities. In the province studied in detail by the HAG the district dispensaries delivered somewhat fewer children than the provincial hospital. �27 All provincial capitals have a hospital with doctors as well as nationally trained nurses and mid wives. There is a very wide range of quality among these facilities and some overlap, with certain district dispensaries better staffed and equipped than some provincial hospitals. In addition, there are the medical facilities x in the larger cities, not provincial capitals, including Da-Nang and Saigon. These include specialty hospitals arid, in general, the best facilities in the country. Because of their accessibility and concentration of more interesting patients, most studies of Vietnamese medical statistics have been made at the level of provincial and city hospitals although most patients, and particularly a large number of deliveries, are, in fact, cared for at the district and village level. Records of these smaller facilities show a strikingly lower level of stillbirths and obstetrical difficulties than do provincial hospitals. This is believed to be a true statement of the facts by Ministry of Health officials and the HAG, and presumably reflects the referring of "' „ difficult cases to provincial or city hospitals. Military security and adequacy of transportation will, of course, improve the degree of referral and tend to increase the differential reported between the two groups of reporting hospitals. In the capital, approximately one quarter of the babies are delivered at Tu Du, a large teaching hospital devoted exclusively to maternity, another quarter are delivered at other government hospitals, and about onehalf at private maternities. These latter are very quick to refer patients to �28 the government hospitals and report essentially no complications for fear of difficulties with the Ministry of Health. In this respect, it is of interest to note that nearly one-half of the total maternal deaths reported by Tu Du in 1965 were, in fact, referred "in extremis" from outside hospitals. The official health statistic report of the government of Vietnam for 1967 states: "Moreover, private maternities dare not tell the truth on the deaths of who carne for delivery." The registration of births in the Republic of Vietnam is still very incomplete. It is believed that close to all of the births in the capital area are registered. In the remainder of the country, current government estimates are that about one-half of all births are registered in any form and, as we shall see in the case of Tay Ninh, the provincial hospital itself may not be an accurate reflection of figures for the entire province. Although we emphasize the accuracy as to birth weights and stillborns of the midwife record books when they can be consulted in their original form it cannot be over-stressed that the recording of congenital abnormalities is extremely patchy and seems to reflect the interest of the midwife at different periods. The midwives from whom we received such good help in this study nearly uniformly agreed as to this deficiency. Even when malformations are recorded, their nature is often incompletely noted. Only in the capital is cleft palate distinguished from cleft lip in the records and a number of midwives agreed that the inside of the mouth of the infants was almost never examined. The nature of fatal anomalies is very rarely recorded and essentially no autopsies are performed on stillborns. �29 Rates of Stillbirths and Reported Congenital Anomalies in the Capital arid Provinces. The extensive study of congenital malformations hydatidiform moles and stillbirths in the Republic of Vietnam 1960-1969 carried out under the auspices of the Department of the Army and the Vietnamese Ministry of Health by a team headed by Dr. Robert T. Cutting has row become available and most of the more.limited investigations carried out by the HAC will be related to this major army undertaking. Unfortunately, in spite of persistant efforts, this material was not available to the HAC at the time of their visit to Vietnam. Saigon. Studies of the records of Tu Du for the last decade, which include about one-quarter of registered Saigon deliveries and covering between 12,000 and 30,000 births a year, show a definite decrease in still- 0 birth rates. There was a noteable discontinuity in 1967 when the rate fell W from 36 per thousand in 1966 and 38 per thousand in 1965 to 26 per thousand and remained at this lower level for 1968 and at 29 per thousand in 1969. <• j ''*\^ v During the same period, there was a slight reduction in the overall rate of recorded malformations. It is the opinion of the medical staff at Tu Du that some, at least, of the reduction of the stillbirth rate is from considerably improved medical care as shown by the fact that in the years 1963-1964 no babies under a kilogram in weight survived out of 310 being born alive while in .1965 and 1966, 55 survived out of 391 delivered. The rate of hydatidiformnioles at Tu Du also dropped slightly. It should be noted that the figures for moles at Tu Du reported by Cutting do �30 not include choriocarcinomas which at most provincial hospitals are included in the mole figures and would raise the Tu Du percentage by nearly twenty percent during the years 1963 and 1964. Countrywide Data. The Cutting study reports a general down- trend in stillbirths during the period 1960-1969, taking all of the data together. This is shown by the solid line in Figure 1. Grouping these countrywide data into pre- and light-spraying years (1960-1965) and heavy spraying years (1966-1969), the stillbirth rates are found to average 36.1 and 32.0 per thousand live births, respectively. Finding a similar downward trend in moles and deformities, Cutting concludes that "Sorting the data into two time periods, before (1960-1965) and after (1966-1969) the large scale military use of herbicides, failed to show any effect of herbicides. Rather, a downward trend was observed in all categories of abnormal birth events." However, these trends are caused by the data from the capital area (Tu Du, Hung Vuong, Bien Hoa), which account for approximately twothirds of the births studied. When the data for the capital are subtracted the trends are reversed. This may be seen below. �31 Abnormal Birth Events as Reported by Cutting Rates per Thousand Llvebirths Light-spray ing (1960-1965) Heavy-spraying (196C-1969) Countrywide Stillbirths Moles Malformations 36.1 6.6 5.5 32.0 5.6 4.5 Countrywide minus Capitol Stillbirths Moles Malformations 32.0 3.1 2.3 38.5 5.3 3.1 Plotted year by year, the countrywide data with the capital area subtracted shows a decided upward trend, peaking in 1967, as shown by the dashed line in Figure 1. Tay Ninh. Rather than attempting to survey the provincial hospitals from a large number of areas, the HAG concentrated their efforts on the study of possible changes in malformation and stillbirth rates in the province of Tay Ninh. Although, as in other areas where agent Orange has been used mainly for forest defoliation (as opposed to crop destruction)the total number of directly exposed Vietnamese is probably low, the northern portion of Tay Ninh has been heavily defoliated and the rivers draining the areas of defoliants run through the remainder of the province and are a source of fish for some of the population. As has been noted by Cutting, the earlier maternity records of the Tay Ninh City provincial hospital and most of the Tay Ninh district �32 dispensaries are no longer available but we were fortunate in being able to study the daily record book in its original form at the provincial hospital for the years 1968 through 1970, although this was apparently not available to the army group. Study of these records was of interest and in striking contrast to the figures reported by Cutting. Although two months (November and December 1968) are missing from the original data book and only Ministry of Health summaries could be obtained, a higher rate of stillbirths, 64 per thousand livebirths, was shown from these records in Tay Ninh than recorded anywhere else by Cutting and his group. The HAC noted 351 stillbirths in the years 1968 and 1969, the years for which Cutting reports 208. The data for Tay Ninh City provincial hospital are as follows: Year 1968 1969 1970 (7 mos.) Livebirths 2,765 2,361 1,688 Stillbirths Rate per 1,000 Livebirths 161 190 171 58.0 80.5 101.0 It was very striking that among 2,551 births recorded in 1969, not a single specific congenital deformity or malformation was noted. The nudwives, the chief of whom had been there for ten years, agreed that a fair number of deformities had been seen but had not been, in fact, recorded. *It was noted that in 1969, while 184 stillbirths were reported in the summaries given at the end of each month in the data book if every birth registered was individually examined, 190 stillbirths were noted. �33 We were able to .survey all of the reported births from village, districts, and provincial facilities in Tay Ninh for some recent months and in this way try and weigh appropriately the importance of the provincial hospital as a reporting agency. Tay Ninh City provincial hospital has shown a remarkable monthly uniformity in births since 1967 with annual totals something under 3,000. Records have also bo<>n faily consistent from the two larger of the Year 1967 (9 utos./ 1968 1969 1970 (7 n.os.) Livebirths 1,818 2,765 2,361 1,688 'As recorded by C u t t i n g . Original data book unavailable to HAG. four district dispensaries in lh o province. The largest, Heiu Thien, with 1,000 births per year approximates a provincial hospital as a facility. For four months in 1970 essentially complete figures are available from all of the districts and villages in Tay Ninh province as well as the provincial hospitals. These include all medical facilities reporting to the Ministry of Health and are said by their otficials to include over seventy percent of total births in the district. They show that during this period, February through June 1970 (excluding April for which reports were incomplete) 2,281 births with 20 stillbirths (i.o., 8.8 per thousand Uvebirths) were reported �34 from the districts and villages with the village dispensaries accounting for about two-thirds of this number, while during the same period, Tay Ninh City Provincial Hospital reported one-half as many births, 1,028, v/ith 89 stillbirths (i.e., 95 per thousand livebirths), more than ten times that of the outlying districts. Clearly, therefore, the birth statistics from Tay Ninh City Provincial Hospital, with a stillbirth rate of 95 per thousand, are quite different from those from all of Tay Ninh Province including villages and districts which reported a combined total of 3,309 births with 109 stillbirths or a rate of 34 per 1,000 livebirths. Although specific determinations were not made in other provinces, except partially in the Rung Sat, it is expected that differing degrees of variations of this sort will be found in all provincial capital hospital statistics as compared to complete provinces. It is noted that if the districts and villages were able to reduce their stillbirth rate by one-half, by referral, this v/ould not be sufficient to fully explain the discrepancy in stillbirth rates. Better than fifty percent prenatal diagnosis of impending stillbirth is unlikely to be consistently possible. We do not know the reason for this striking difference in Tay Ninh. We note that all districts surveyed by Cutting in various parts of Vietnam also showed very low stillbirth rates. An incidental study was made of the prevalence of twinning at Tay Ninh City Hospital. For the period July 1968 to July 1970 (excluding the two months in 1970 for which no figures are available) 79 multiple births occurred, including one set of triplets, out of a total of 7,010; or approximately 11.2 per 1,000, almost exactly the same figure as reported by Drs. Oliver and Hong tor Saigon in 1952 to 1962. �35 Rung Sat. A similar, less extensive survey, of the RSSZ area was carried out. Dispensaries at Can Gio and Quang Xuyen closely bordering the defoliated mangrove forest annually reported several hundred births with very low rates of stillbirths and no deformities recorded. We were definitely informed that any patient with impending stillbirth or evidence of obstetrical complications was referred to Vung Tau. Although Vung Tau serves as the provincial hospital for this area, it is not in fact the provincial capital but an independent city. Vung Tau Hospital with a monthly birth rate very close to that of Tay Minn showed a strikingly lower rate of stillbirths; 26 per 1,000 in 1968 and 30 per 1,000 in 1969 (9 months) and 22 per thousand in 1970 (7 months). The rate of twinning was 8.9 per 1,000 (54 out of 6,198). It is of interest that among this large number of births only one mole is recorded. This patient was transferred to Tu Du in Saigon. During the same period, a total of 6,198 births were reported with no congenital abnormalities recorded. Although Vung Tau includes in its referral area a zone of intensive defoliation of mangroves, most of its patients may be supposed to have had minimal herbicide exposure either directly or possibly through the food chain. They apparently do not regularly eat fish from streams emanating from sprayed forests as do the inhabitants of Tay Ninh. *The actual figures were 2,569 births and 67 stillbirths in 1968; 2,179 births and 64 stillbirths in nine months of 1969; and 1,450 births and 31 stillbirths in seven months of 1970. �36 .Conclusions. For the proper comparison of provincial birth statistics it is essential that total provincial figures including district and village dispensaries and allowance for referral out of the province be obtained. This has been done by the HAC for Tay Ninh. Other total provincial figures not being in hand for comparison, the fact nonetheless remains that Tay Ninh City Provincial Hospital, serving a heavily defoliated province, showed an average stillbirth rate in 1968 and 1969 of 68 per 1,000 livebirths. During this same time, the Tu Du rate v/as 27.5 per 1,000 and that of the Army sample of the entire country 31.2 per 1,000. The rate of 68 per 1,000 is higher than any reported from any provincial hospital by Cutting. Changes in the Prevalence of Common Congenital Anomalies: Saigon Childrens Hospital. In attempting to analyze the frequency of different congenital abnormalities in Vietnam, in contrast to their absolute frequency, we are very fortunate to have the elaborate study of all of the abnormalities seen at the Saigon Childrens Hospital prepared by Dr. Le Anh, an analysis of the 4,002 cases of congenital abnormality seen for the period 1959 to 1968. Her study is complete in that every case is evaluated and there are no "miscellaneous" or "other" categories as is characteristic of almost one-half ot the malformations reported by the few maternity hospitals that do, in fact, report any significant number of deformities. Dr. Le Anh is well aware of sophisticated methods of describing and subdividing anomalies and of recent etiological considerations. Whereas, most other Vietnamese �37 hospitals would not distinguish cleft lip from cleft palate, if reporting the deformity at all, Dr . Le Anh carefully distinguishes them. The annual admission rate for congenital anomalies at the Saigon Childrens Hospital has been almost the same for the years 1964 to 1968 (618, 565, 650, 667, and 554). Saigon Childrens Hospital is the only special childrens hospital in Saigon, or in fact in Vietnam, and during these years would have received most children that could be referred for possible surgical correction of congenital anomalies. Recently the establishment of the CMRI Unit at Cho Ray has added another facility. This unit started in July of 1968. The CMRI has tended to draw patients from the provinces even more than has the Saigon Childrens Hospital, arid their activity may account for the slight decrease in Saigon Childrens Hospital congenital anomalies admitted in the last year. Nonetheless, the vast majority of types of anomalies treated by the Saigon Childrens Hospital are never seen at CMRI. The CMRI from July 30, 1968 to February 1970 repaired no less than 381 cases of cleft lip and 180 cases of cleft palate. Saigon Childrens Hospital—types of^cases. Saigon Childrens Hospital does not have an obstetrical unit and they accept only cases for which surgery might be indicated and only children that survive long enough for transfer to be accomplished. Their statistics, therefore, represent a very selected group of congenital anomalies but among these their statistics should reflect any relative change of frequency. Saigon Childrens Hospital—sources of patients. Although Dr. Le Anh's report does not analyze the individual provincial origin of each of the 4,002 anomalies, there is an analysis of provincial origin of all cases over the years. Of 4,002 admissions, 1,57'z came from Saigon and Cho Lon, �38 910 from Gia Dinh, 293 from Long An, 164 Dinh Tuong, 162 from Bien Hoa, all of these being rather near the capital. Eight other provinces sent in fifty or more cases during the decade and each of the other provinces of South Viet Nam supplied a few cases. The Saigon Childrens Hospital series, therefore, predominately represents material from the capital and surrounding areas but all of the country is represented. Saigon ^Chilfo Numbers J?reaJ:ej:^ Relation to In the years 1964 to 1968 Tu Du reported about one-quarter of all Saigon deliveries including a total of 680 malformations, approximately one-half of which survived. During the same period, the Saigon Childrens Hospital admitted 3,054 case's of which about 1,900 were from Saigon. Even if every one of the surviving anomalies from Tu Du (340) were, in fact, admitted to the Saigon Childrens Hospital and these represented a quarter of all of those born in. Saigon, then at the most only something just over half of all malformations occuring were being reported by the capital area maternities. It would appear that completeness of recording by maternities is very different for different types of congenital anomalies. Some obvious anomalies such as cleft lip would appear to be fairly accurately reported. During these same years, Tu Du reported 132 surviving patients with cleft lips. During this time, Saigon Childrens Hospital admitted 408 cleft lips, 55 cleft palates and 83 combined cleft lip and palates or a total of 546 cleft lips of all types of which about 380 originated in Saigon. If all of the �39 children with cleft lips were in fact referred to the Saigon Childrens Hospital and if Tu Du was reporting one-quarter of those born in Saigon these figures would be consistent with reasonably accurate reporting by Tu Du. Other deformities are grossly incorrectly reported and one of the most interesting of these is imperforate anus. This, except in the very rare forms where the obstruction is not at the anal orifice itself, is very easy to recognize, has been known fora long time, is subject to surgical repair and although requiring correction is not immediately fatal so would not result in the victim's being reported as a stillbirth. The Saigon Childrens Hospital figures show that this is one of the commonest abnormalities admitted there with 453 cases being admitted in ten years. In 1964, 1965 and 1966, Tu Du reported only eight surviving cases of imperforate anus. During the same period, Saigon Childrens Hospital admitted 139 cases, about .120 coming from Saigon. It is of some interest that Cutting in his list of all reported malformations among 480,087 live births reports only six cases of imperforate anus from all maternities when very many more would have been expected. As another example, the Saigon Childrens Hospital reports 44 cases of spina Bifida during the decade with Tu Du reporting only 3 cases during most of this period and Cutting reporting only 8 cases out of 480,087 live births in the same period. Chang e sin Cert a in Ano ma]:',e s. The figures from Saigon Childrens Hospital show no apparent change in the relative frequency �40 of any anomalies aside from the three exceptions detailed below. Year Total Cases Club Foot Cleft Palate 1959 1960 1961 61 214 196 335 142 618 3 2 1 0 0 2 1 1 8 2 0 1 1 1 0 5 2 12 23 13 - 1962 -< M963 ' '1964 '1965 J966 1967 1968 «a usi 3111 ^V. ^53 1««* 'Wi 565 650 651 554 '/"\ *•* Spina Bifida n,f. I 2 1 3 73 £2 ^3 /<? 4 T 7 1 4 <*"66 1 ' 13 n!2 x1!1 1 ^ ry\v\ Cleft Lip* 2 40 17 48 17 102 60 69 110 67 + *~\> ns\ rv\v» T^I **•{ r* ^^*^ ** The number of club feet reported is so small, and so small a percentage of those born are referred to the Saigon Childrens Hospital, that these figures are recorded for completeness only. Great caution is necessary in any interpretation of these figures. Although the total cases seen at Saigon Childrens Hospital of both spina bifida and cleft palate have shown significant increase the relative rates (to total admission for congenital defects) were fairly high in the period 1959-1963. During this time the hospital was subject to severe vicissitudes—political and other—and it may well be that serious anomalies absolutely requiring treatment such as most cases of spina bifida but not cleft palate would relatively increase, but this is only a supposition. The increase in spina bifida in 1967 and 1968 may be because of better recognition by x-ray but Dr. Le Anh in noting this rathe* 3^ striking increase, did not consider this possibility and Dr. Tran Ngoc Ninh, y chief of the Saigon Childrens Hospital, could offer no explanation for the �41 increase. The change in cleft palate frequency may, of course, reflect better examinations with the patient's mouth being open. Recent enthusiasm and availability of cleft lip repair has increased the search for these cases— often by American soldiers—and some pure cleft palate may have been incidentally brought to treatment. The repair in 1968-1970 of .180 cleft palates at CMRI is of interest but we have not determined how many of these were pure cleft palates without associated cleft lip as is true of the Saigon Childrens Hospital series. Careful studies are certainly indicated as to the nature, provincial origin and future frequency of these cases. Conclusions. Most surgically correctable congenital anomalies treated by the Saigon Childrens Hospital have shown no major change in their relative frequency of occurrence during the last decade. There are two notable exceptions to this. The occurrence of spina bifida and pure cleft palate (withoutassociated cleft lip) have both shown unexplained increases during the last three years but as noted many factors may have caused this numerical increase at Saigon Childrens Hospital. The Occurrence of Rare Striking Anomalies. Three principle sources of information are available to try and determine whether any striking visible unusual anomaly has occurred in Vietnam in recent years. It is to be remembered that any anomaly that resulted in a stillbirth is unlikely to be noted. Autopsies are not being performed and the nature of monsters is not being recorded. Only an easily detectable non-fatal anomaly would �.' ' I ,' 3 ' 42 be observed. It is the belief of the IIAC that such changes have, in fact, probably not occurred on the basis of three principal sources of information. 1. The Saigon Childrens Hospital report which shows no listing of a new or striking abnormality. Saigon Childrens Hospital might not have been aware of an anomaly that was not appropriate for surgery. On the other hand, the author of this study is fully familiar with, for example, thalidomide induced phocomelia, and no suggestive anomalies appear on the total list. 2. Another source of information is the Minister of Health, Dr. Tran Minn Tung, who felt confident that even a single case of any striking phocomelia type abnormality born anywhere within the government system would be reported to him within a short time and who was unaware of any such changes in spite of a certain number of suggestive articles in the Vietnamese press. 3. Perhaps the best source is Father Lichtenberger, Professor of Genetics at the Faculty of Saigon, geneticist to Tu Du Hospital and the best known expert on chromosome abnormalities in Vietnam. He has lived in Vietnam for many years and has seen many of the interesting monsters of one sort or another occurring in Saigon and some of the other parts of the country. He has not been aware of any suggestive changes. �43 Changes in the Indicence of Specific Abnormalities Related to Laboratory Experiments. Laboratory experiments in animals with 2 , 4 / 5 - T indicates toxicity to the gastro-intestinal tract with hemorrhage and other changes. Cystic kidneys have been demonstrated as well as a few cases of cleft palate in the offspring of exposed pregnant animals. Specific search has not been made among the exposed Vietnamese population for gastro-intestinal tract or urinary tract changes that might be present. It must be remembered that only a very small percentage of congenital abnormalities and malformations are visible and easily detected. Many biochemical and other occult abnormalities, although with significant effects on life expectancy, only can be demonstrated with laboratory study generally unavailable in Vietnam. Conclusion: Laboratory study would indicate that possible teratogenic effects of 2,4,5-T may be of a nature very difficult to identify in Vietnam. Ovcra 1.1 Conclus ion s: Studies of changing rates of stillbirths, particularly as reported by the government maternity system are subject to great errors of interpretation even when they are made somewhat more valid by the inclusion of total provincial figures. Although the reported rate of stillbirths in Tay Ninh province, extensive areas of which were treated by 2,4/5-T, are higher than the highest provincial hospital rates reported by Cutting, this type of evidence is not sufficient to draw any firm etiological conclusion. The same must be said of the sharp upward trend in stillbirths �'»<>•>* 44 recorded by Cutting for areas outside of the capital. Even more difficult is any estimate of tits rate of congenital malformations, the variations in the reporting by different maternities making the figures useless for statistical comparison. There has been a considerable increase in the cases of spina bifidei and cleft palate (without cleft lip) reported at the Saigon Childrens .Hospital. Otherwise, the HAG is fairly confident in reporting that there has been no significant change in frequency of any of the relatively common congenital anomalies consistent with life that might appear at a childrens uobpital among those patients presenting themselves for treatment in the GVN health system. The HAC found no evidence of any new striking\bnor- mality of a congenital type and consistent with life occurring in Vietnam ir recent years but this statement1 is made with the recognition that much of the directly exposed population is unavailable for study at this time. Future Direction of Studies. The following areas would seem to require more exhaustive investigation along the lines of thought of the preceeding chapter. 1. With the aid of local Vietnamese authorities and, it is to be hoped, with the complete spray data available from the U. S. Department of Defense, the Vietnamese population exposed to 2,4,5-T could be much more precisely identified and isolated and tl>e individuals studied for possible effects of the agent. �45 This would particularly include very careful studies of gastro-intestinal tract, urological tract and biochemical changes of children born after exposure. 2. In specially selected defoliated areas of the country, more careful autopsy of monsters and other stillborns arid neonatal deaths with congenital abnormalities should be carried out. 3. Further study is certainly indicated of the incidence of spina befida and cleft palate in Vietnam with particular study of the provincial origin and possible herbicide exposure of the patients involved. 4. Further careful provincial studies of rates of stillbirths with efforts to accumulate data from all of a number of provinces both sprayed and unsprayed for comparison should be done. 5. Those children with defects should have careful studies as to their origin and possible exposure to 2,4,5-T. 6. Notes should be further taken of reported ill effects of 2,4,5-T by both GVN and NLF, including chromosome changes reported by the latter, and study made seeking for these effects specifically among the Orange exposed population. �46 Figure Legend Figure 1: Incidence of Stillbirths per One Thousand Livebirths, 1960-1969. Data are from the U. S. Army—ON Ministry of Health study by Cutting, et al. The anomalously high stillbirth rate for 1960 for births outside the Capital is based on relatively few reports. Total 0 Total minus Capital Area (Saigon-Bien Hoa) �47 n » * 5 i i V'v.,? >. ''•• .. r f * "n^rr- ••'"'. " ,* .,? r (i ....' « u r ii U j) j ,T o j < ..'.' 'j : V . ;* >> i. ~....^' ft » -\ ' >i C 'j V.J> ..„• --- i) ou 0 9 /\ vxC ! \ 45 _ /? 0 1 , •. Sr \ ^ o J \ **j^ «_«,-/?*, « \ / ^ \ 1 V .. ^ .^ o^ § ^ 30 — 1 // \ e 35 \ 1 aV 40 \ " ^ o \ \ \ \ \ ^ / / 1 / / \tf 20 ^ L I960 i™m. ! , „, i , ! 62 L 64 Year 1 66 • 1 68 i �y ,•' t « ' > The preceding has been printed in "War Related Civilian Problems in Indochina, Part I: Vietnam. Hearings before the Subcommittee to Investigate Problems Connected with Refugees and Escapees. Committee on the Judiciary. U.S. Senate, 92nd Congress, 1st Session, 21 April 1971." � 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. 040 Folder The folder containing the original item. 0900 Series The series number of the original item. Series III Subseries I 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 Meselson, Matthew S. Arthur H. Westing John D. Constable Description An account of the resource <strong>Corporate Author: </strong>Herbicide Assessment Commission of the American Association for the Advancement of Science Source A related resource from which the described resource is derived War Related Civilian Problems in Indochina, Part 1: Vietnam. Hearings before the Subcommittee to investigate Problems Connected with Refugees and Escapees. Committee on the Judiciary. U. S. Senate, 92nd Congress, 1st Session, 21 April 1971. Date A point or period of time associated with an event in the lifecycle of the resource 1971 Title A name given to the resource Hearing: Background Material Relevant to Presentations at the 1970 Annual Meeting of the AAAS Subject The topic of the resource Southeast Asia herbicide toxicology legislation veteran health and hygiene ao_seriesIII 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. 038 Folder The folder containing the original item. 0847 Series The series number of the original item. Series III Subseries I 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 Lacey, Pamela Vincent A. Lacey Source A related resource from which the described resource is derived The Journal of Legal Medicine Date A point or period of time associated with an event in the lifecycle of the resource 1982 Title A name given to the resource Agent Orange: Government Responsibility for the Military Use of Phenoxy Herbicides Subject The topic of the resource Ranch Hand dioxin legislation litigation ao_seriesIII 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. 033 Folder The folder containing the original item. 0628 Series The series number of the original item. Series III Subseries I 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 Epstein, Samuel S. Source A related resource from which the described resource is derived Trial Date A point or period of time associated with an event in the lifecycle of the resource 1983-11-01 Title A name given to the resource Problems of Causality, Burdens of Proof and Restitution: Agent Orange Diseases Subject The topic of the resource dioxin health effects legislation litigation ao_seriesIII 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. 033 Folder The folder containing the original item. 0624 Series The series number of the original item. Series III Subseries I 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 Ember, Lois R. Source A related resource from which the described resource is derived Chemical and Engineering News Date A point or period of time associated with an event in the lifecycle of the resource March 28 1983 Title A name given to the resource Legal Remedies for Toxics Victims Begin Taking Shape Subject The topic of the resource dioxin Missouri New York legislation ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/bcc6c17157f0a97a565050a554e38d09.pdf 5eb7456a98e018827f84bdc312ff1a75 PDF Text Text Item ID Number °0589 Author Davis, Miriam Corporate Author Tne Llbrar y of Congress Congressional Research Servic Report/Article TltlO Agent Orange: Veterans' Complaints and Studies of Health Effects, Issue Brief Number IB83043 Journal/Book Title Yeer Month/Day Color March 3 n Number of Images 19 DeSCrlptOU NOtOS Alvin L. Young filed this item under the category "Human Exposure to Phenoxy Herbicides and TCDD" Tuesday, February 20, 2001 Page 589 of 680 ��AGENT ORANGE: VETERANS' COMPLAINTS AND STUDIES OF HEALTH EFFECTS ISSUE BRIEF NUMBER IB83043 AUTHOR: Miriam Davis Environmental Health Fellow Michael Simpson Science Policy Research Division THE LIBRARY OF CONGRESS CONGRESSIONAL RESEARCH SERVICE MAJOR ISSUES SYSTEM DATE ORIGINATED 03/03/83 DATE UPDATED 03/03/83 FOR ADDITIONAL INFORMATION CALL 287-5700 0304 �CRS- 1 IB83043 UPDATE-03/03/83 I ISSUE DEFINITION From 1962 to 1971 the United States Air Force (USAF) sprayed various herbicides (chemicals that kill plants) in South Vietnam. The purpose of the spraying was to defoliate jungle growth and to destroy enemy crops. The most extensively used of these herbicide mixtures was known as Agent Orange, which is an equal mix of two common herbicides called 2,4,5-T and 2,4-D (2,4,5-trichlorophenoxyacetic acid and 2,4-dichlorophenoxyacetic acid). A contaminating chemical present in the mixture in small amounts was TCDD (2 , 3 , 7 , 8-tetrachlorodibenzo-para-dioxin) , or simply "dioxin." Dioxin is a contaminant produ-ced in the manufacture of 2,4,5-T. Its toxic effects to some laboratory animals are well known, yet its effects on humans are not fully understood. Since 1977, veterans have attributed a number of illnesses to Agent Orange exposure, including skin conditions, cancer, fatigue, nervousness, numbness in the extremities, vision and hearing impairments, birth defects in children, and other ailments. Veterans have urged the Veterans Administration (VA) to provide for medical treatment of these disorders and many have filed for disability compensation. Under P.L. 97-72, the Veterans' Health Care, Training, and Small Business Loan Act of 1981, Congress directed the VA to furnish medical care to Vietnam veterans, irrespective of age and financial status, for any condition which might possibly have resulted from exposure to Agent Orange. However, disability compensation for the veterans' illnesses has been denied unless it can be shown that the disabling condition began during the period of service. This criterion of "service connection" effectively denies claims for any latent disorder arising from military service. Until a rigorous scientific link between Agent Orange exposure and the health problems of the veterans can be established, the Veterans Administration will probably continue to deny the majority of veterans' requests for disability compensation. The VA and other Federal agencies are sponsoring a variety of research efforts to investigate the connection between Agent Orange and veterans' health problems. Recent congressional interest has focused on the transfer of responsibility from the VA to the Centers for Disease Control for the legislatively mandated epidemiology study of Vietnam veterans' health problems. The following questions continue to surround the debate effects of exposure to Agent Orange: over -- What are the adverse health effects of Agent Orange, and what studies are being conducted to answer this question? -- How much and what kind of scientific evidence is required to prove the right to disability compensation for _the veterans? -- On whom does the burden of proof lie to establish the link between Agent Orange exposure and adverse health effects? the health �CRS- 2 — IB83043 UPDATE-03/03/83' What constitutes fair treatment of the veteran until the scientific studies are concluded? BACKGROUND AND POLICY ANALYSIS History The USAF operated its herbicide spraying program in South Vietnam until the late 1960s when the National Cancer Institute released animal studies which showed that the herbicide 2,4,5-T caused birth defects in mice. At the same time, newspapers in Vietnam began to report health problems, including birth defects, in rural populations which had been exposed to herbicides. As the USAF was winding down its herbicide spraying program, it was also recognized that the military supplies of 2,4,5,-T contained amounts of dioxin suspected of being hazardous. The dioxin, which occurs as'a contaminant in the manufacture of 2,4,5-T, has been found to be highly toxic to animals. In fact, the birth defects previously attributed to 2,4,5-T exposure are now thought possibly to be related to the contaminating dioxins. The average levels of dioxin in the military Agent Orange were about 2 ppm. There were even greater concentrations of dioxin in other military herbicides less frequently used in South Vietnam: approximately 32.8 ppm in Agent Purple, and 65.6 ppm in Agents Pink and Green. In October 1969, the Air Force first restricted the use of Agent Orange to areas remote from populations; then it stopped all airplane spraying of Agent Orange in early 1970'and all helicopter spraying of Agent Orange by 1971. All remaining Agent Orange stocks were gathered and stored at naval facilities in either Gulfport, Mississippi, or Johnston Island in the Pacific until they were incinerated at sea in 1977 during the PACER HO project. The total amount of herbicides sprayed in South Vietnam from January 1962 to February 1971 was about 107 million pounds, according to a USAF report. Approximately 276,000 gallons of Agents Green, Pink, and Purple were sprayed in South Vietnam prior to 1965 when they were replaced by Agent Orange. Approximately 11 million gallons of Agent Orange were then sprayed in South Vietnam -- making it the most widely used herbicide of the war. Ninety percent of Agent Orange was sprayed on 2.9 million acres of inland forests and mangrove forests for defoliation, 8% was sprayed on enemy crops for crop destruction, and the remaining 2% was sprayed around base perimeters, cache sites, waterways, and communication lines. The Department of Defense initially maintained that only a limited number of U.S. military personnel could be positively identified as having been exposed to Agent Orange i'n South Vietnam (i.e., the crews of aircraft that were used to spray herbicides). However, following the publication of a 1979 General Accounting Office (GAO) report documenting ground troop exposure, the DoD has acknowledged that greater numbers of ground troops were exposed to Agent Orange through the USAF spraying program. Most recently, the DoD has attempted to arrive at an exposure index for individual ground troops. The American Medical Association has reported that about -2.4 million Vietnam veterans may have been exposed to herbicides. This figure includes ground troops, 1,200 flight crewmen who were responsible for the spraying under Operation RANCH HAND, and 200 U.S civilians who were involved in destroying the excess quantities of Agent Orange at sea. Details about U.S. personnel exposures are presented in the following section. �CRS- 3 IB83043 UPDATE-03/03/83 V Following reports of various health problems in some 'Vietnam ^veterans widespread concern about the possible health effects of Agent Orange was expressed. Many veterans have filed claims for disability compensation with the VA, basing their claims on Agent Orange effects. In 1979, a group of veterans initiated a class action suit against herbicide manufacturers for negligence and product liability. The manufacturers include Dow Chemical, Monsanto, Hercules, Diamond Shamrock, and Thompson-Hayward. This litigation is still in progress depending, in part, on the outcome of federally sponsored studies of the health effects of Agent Orange. Chemical manufacturers filed a third-party suit in 1980 against the U.S. Government that was later dismissed by a New York Federal District Court. Personnel Exposed to Herbicides. The early trials that were conducted in South Vietnam to improve aircraft spray systems were performed by the USAF Special Aerial Spray Flight Division at Langley Air Force Base, Virginia. During late 1962 and early 1963, the Crops Division at Fort" Detrick and the USAF Armament Laboratory at Eglin Air Force Base, Florida, were also involved in efforts to improve spray system components in support of Operation RANCH HAND. Most of the personnel involved in the actual handling of herbicide drums were Vietnamese. However, a USAF flight mechanic or crew chief was responsible for ensuring that each aircraft was properly loaded and that the spray systems were functional. Each herbicide aircrew consisted of a pilot and copilot, a flight mechanic, and a spray unit. The aircrews were frequently joined by South Vietnamese and U.S. observers. As noted in a USAF report: "within the aircraft, it was not uncommon to have herbicide leakage from around the numerous hose connections joining the spray tank and pumps with the wing and aft spray booms. In hot weather, the odor of herbicide within the aircraft was decidedly noticeable" (Young et ai., 1978: 1-18). It .is also suspected that, due to destruction of the tanks by enemy fire, crew members were acutely exposed to herbicides. In an effort to determine which ground units were'exposed to Agent Orange after it had been deposited on the ground, the Army Agent Orange Task Force and the American Cancer Society are attempting independently to correlate ground unit location with the location of aerial spraying missions. The USAF has data on 6,542 herbicide spraying missions that took place between August 1965 and February 1971 on its HERBS computer tape. These data were compiled on a mission-by-mission basis from reports and files in various offices in the U.S. and South Vietnam. After evaluating the HERBS data in a 1974 report, the National Academy of Sciences (NAS) concluded that the data accounted for approximately 86% of all herbicide operations in South Vietnam, and that "despite certain recognized deficiencies," the HERBS tape is "areliable source for an assessment of the major part of the herbicide operation in South Vietnam" and "is the best and in fact the only available comprehensive computation of the major part of the herbicide operations conducted in the Vietnam war." Since this NAS evaluation, the Army Agent Orange Task Force has been in the process of expanding the scope of the HERBS data to incorporate other herbicide sprays -- including perimeter base spraying and any unplanned dumping of herbicides from U.S. aircraft' that were under enemy attack. Despite this relative confidence in the location of the aerial and some ground spraying missions, it is difficult to determine which particular ground troops in. a given location were actually exposed and to what extent they were exposed. Although aerial spraying apparatus was' designed to �CRS- 4 IB83043 UPDATE-03/03/83 deliver the herbicide in a specified manner to reduce dispersion, no such standardized equipment was used for perimeter base spraying or other non-aerial delivery modes. Furthermore, additional troops may have been exposed in areas for which military records are incomplete. For example, not all information is available on helicopter operations flown by the Vietnamese Air Force before 1968. Thus, attempts to model the conditions of exposure in order to determine individual or group exposure levels are jeopardized by the lack of verifiable exposure information. When the DoD suspended all use of Agent Orange in South Vietnam, the USAF was 'left with an inventory of 2.22 million gallons in two locations, in Vietnam and in Gulfport, Mississippi. In April 1972, the stocks in South Vietnam were transported to Johnston Island in the Pacific for storage. Problems began to arise in both U.S and Pacific locations concerning leakage from the drums. After exploring a number of options, the USAF decided to dispose of the Agent Orange by burning it at high temperatures at sea. This operation was performed in 1977 with permission from the EP'A. About 110 USAF personnel from the Air Force Logistics command and about 100 civilian employees hired by a contractor were involved in the destruction process. Environmental monitoring of the transfer operations was performed by members of the USAF Occupational and Environmental Health Laboratory. Extensive environmental monitoring of the test incineration procedures was performed. Certain physical parameters of the actual incineration process were monitored. Physical' examinations of personnel involved in the actual incineration procedures, administered both before and after these procedures, revealed no adverse health effects. Health Effects of Dioxin and Phenoxyherbicides There are as yet no conclusive scientific studies on the long-term human health effects of Agent Orange exposure. In their absence, an understanding of health effects must rely on animal and/or human occupational exposure studies of dioxin and phenoxyherbicides. The following paragraph summarizes what is known about the health effects of these constituents of Agent Orange. Workers exposed to high concentrations of dioxin and/or 2,4,5-T (as well as other chemicals) are commonly found to have a painful skin condition known as chloracne. Chloracne can appear weeks to months after initial exposure and in some cases persists up to many years after exposure. Chloracne, however, can result from exposure to other chlorinated compounds besides 2,4,5-T. Studies of exposed workers have indicated a variety of other health problems; yet, there is not enough information at this time to establish a cause and effect relationship between phenoxyherbicides and these disorders. Soft-tissue sarcoma, a form of 'cance.r/ has been reported among Swedish workers who were exposed to phenoxyherbicides. Reports from a variety of sources associate dioxin and herbicide exposure with stomach cancer, neuromuscular weakness, liver enlargement, and liver enzyme abnormalities. Birth defects were first reported in South Vietnamese refugees living in North Vietnam, but, due to the difficulty of conducting studies in a war-torn country, the research on these reports was widely believed to be improperly executed. In animal studies, only certain strains of pregnant mice exposed to dioxin show fetotoxicity and birth defects in offspring. Exposed male mice do not have deformed offspring. Current Use. The EPA has registered 2,4-D for widespread domestic use on such crops as corn, grain, and sugar cane, as well as on non-crop areas; 2,4,5-T is currently used on rangelands, rice fields, and industrial vegetation sites, whereas approval for its other domestic uses -- forests, �CRS- 5 IB83043 UPDATE-03/03/83 rights-of-way, pastures' -- was suspended by the EPA in 1978. registered use of '2,4,5-T depends on negotiations that began in 1979 Dow Chemical and the EPA. Future between Herbicides 2,4,5-T and 2,4-D are commercially available either alone or in combination. The combination mixture (under Dow's Trademark, Esteron) differs from Agent Orange primarily in the level of dioxin. Existing Dow inventories of 2,4,5-T contain less than 0.1 parts per million (ppm) dioxin, whereas previous formulations of 2,4,5-T used in Agent Orange contained about 2 ppm dioxin. Although standards for dioxin levels in 2,4,5-T have not been officially set by the EPA, the EPA's Science Advisory Committee recommended in 1971 a level of 0.1 ppm. Veterans' Complaints and Veterans Administration Efforts Veterans who believe they have been exposed to Agent Orange have complained of a variety of illnesses for which they seek 'medical treatment and disability compensation. These illnesses include: skin conditions, cancers, nervousness, numbness in extremities, vision and/or hearing impairments, birth defects in their offspring, and reduced libido. Veterans have also complained about the paucity of scientific information available on the health effects of Agent Orange and about the sluggishness with which the VA has responded to their concerns. Specifically, the General Accounting Office (GAO) has recently reported that over half of the veterans responding to their questionnaire were dissatisfied with the amount of information they had received from the VA about Agent Orange. To fill the perceived information gap, various State 'governments, including New York and New Jersey, have attempted to disseminate information on Agent Orange to State veterans. < The VA maintains that it outset by initiating health exposed and by implementing description of the research has responded to veterans' concerns from the programs to identify veterans who may have been research projects on health effects. A detailed projects is provided later in this brief. Since 1978 the VA has provided a physical examination for Vietnam veterans who thought they were exposed to Agent Orange. The VA maintains a registry of all the veterans who have come to VA hospitals and health care facilities for the exam. The registry also contains information collected during the examination. As of Dec. 1, 1982, 101,721 veterans had received the initial exam, and about 80% of the records had been coded into the computer. The idea behind the registry is to determine whether veterans have a higher incidence of particular diseases. GAO auditors have investigated the effectiveness of the v Agent Orange examination program. The findings are summarized in an October 1982 report, "The V A ' s Agent Orange Examination Program: Actions Needed To More Effectively Address Veterans' Health Concerns." The report is 'critical of the exam for being incomplete, poorly designed, and for being administered by physicians who were not familiar with the reported health effects of Agent Orange. In an appendix to the report, the VA challenges these findings by citing improvements that 'have taken place since the evaluation; however, the GAO disagrees with the VA rebuttal in the same appendix. The GAO report is also critical of the registry because it cannot be used to determine the incidence of specific illnesses among veterans -- a major purpose for which the registry was supposedly designed. Medical Treatment: P.L. 97-72. Before the enactment of P.L. 97-72 in �CRS- 6 IB83043 UPDATE-03/03./83 1981, 'veterans who complained of Agent Orange-related illnesses were in a ranking of the lowest priority for medical treatment at VA hospitals. This is because these illnesses were defined as not being "service-connected." To have qualified at all for this treatment at this low-priority level, the veteran had to be destitute. The "Veterans' Health Care, Training, and Small Business Loan Act of 1981" (P.L. 97-72) elevated Vietnam veterans' priority status for treatment at VA hospitals for any Agent Orange-related problem. Veterans who complain of such problems are now considered for treatment irrespective of age or finances with the same priority status as former prisoners of war and ahead of veterans with "non-service connected" conditions. The Vietnam veterans' contention of exposure is acceptable in the absence of evidence to the contrary. It is the duty of a '"responsible staff physician (to) make a determination as to whether the condition resulted from a cause other than the specified exposure." To aid the staff physician, the VA has developed guidelines which identify conditions that are not considered to be related to Agent Orange exposure (Federal Register, Nov. 17, 1982). The VA contends that P.L. 97-72 is being implemented successfully, yet veterans' advocates and State Agent Orange commissions allege that veterans are uninformed about the new legislation and that treatment is still difficult to obtain at certain VA medical centers. The VA has initiated a new system to monitor the impact of P.L. 97-72 on Vietnam veterans' medical treatment. P.L. 97-72 also extended the readjustment counseling program for Vietnam veterans for another three years. The counseling programs are currently located in "Vet Centers," which are distinct from VA medical facilities. Disability Compensation. As of Jan. 3, 1983, veterans had filed 16,102 disability claims with the VA for disorders they attribute to Agent Orange exposure. The vast majority of these claims have been denied because they are not considered as being "service connected." The policy of the VA is that a disability is considered "service-connected" if it arises during or is aggravated by military service. "Service-connection" establishes temporal correspondence with military service, not causation, as the determinant for disability payments. Chronic conditions arising before discharge or within one year after discharge are presumed to be "service-connected." The policy implies that for a veteran to receive disability payments for ailments possibly related to Agent Orange exposure, it must be proved that the condition first appeared during the service or within a year of discharge. This precludes disability for latent disorders because "service-connection" criteria cannot be met. The VA acknowledges that the skin disorder, chloracne, is causally related to Agent Orange exposure. On Apr. 15, 1980, in a statement before the House Veterans.1 Affairs Subcommittee on Medical Facilities and Benefits, former VA administrator Max Cleland said that "the relationship between accidental human exposure to Agent Orange constituents and the development of long-term illnesses other than chloracne remains speculative at present." Even though the VA does view chloracne as an immediate effect (acute effect) of Agent Orange exposure, the basis for awarding disability stems from the occurrence of chloracne during the service. Temporal coincidence with active duty is the major criterion, irrespective of cause, for chloracne or any other veteran complaint. The total of 1237 (15.3%) claims which were granted were awarded primarily for skin conditions (94%) and for cancer, psychiatric, and neurological conditions (6%), among others. �CRS- 7 IB83043 UPDATE-03/03/83 The VA denied 6,824 claims after there was a confirmed diagnosis of the disease for which the veteran had filed a claim. The denied claims fall into the following categories: 4091 for various skin conditions; 2432 for nervousness and headache, or fatigue; 907 for paralysis or numbness; 791 for gastrointestinal or genito-urinary conditions; 487 for malignancies which include leukemia, lymphoma, melanoma, and Hodgkin's disease; 359 for impaired sexual activity; 463 for eye, ear, nose, a-nd throat pathology; 289 for lung conditions; 247 for cardiovascular conditions, and 146 claims denied for miscellaneous conditions. (Since each claim could fall into a variety of different categories, the category figures do not equal 6,824.) The VA policy is that the resolution of disability claims for conditions that are now defined as "non-service connected" (and therefore denied) will depend on the results of scientific studies which are described below. Since it is expected that these studies will take years to complete, the Chief Medical Director of the VA, Dr. Donald Custis, has testified at a hearing of the House Veterans Affairs Subcommittee on Investigations and Oversight on Sept. 15, 1982, that "It may well be that the Congress cannot wait for scientific answers in the short term, in which case it may well be that the sociopolitical aspect of this problem will have to be addressed." Current...._or. Proposed Studies of ^Health Effects Many branches of the Federal Government are conducting research on the health effects of Agent Orange and phenoxyherbicides. Research efforts range from large-scale epidemiology studies of Vietnam veterans to studies of cancer among Kansas residents exposed to herbicides. The following paragraphs provide an overview of research efforts at the Department of Defense, the Veterans Administration, and the Department of Health and Human Services. The impact of the following studies on VA disability policy is not clear; the VA has not established any formal criteria for how their policies might be altered by scientific findings. Due to the recent transfer of the legislatively mandated epidemiology study of Vietnam veterans and to the interest which this study has generated all along, it will be discussed first. E p i de m i o 1 o g y Study. The large epidemiology study of Vietnam veterans exposed to Agent Orange, mandated by P.L. 96-151 in December 1981, has been the focus of much of the debate over the health effects of Agent Orange. P.L. 96-151 directed the VA to perform the study of long-term health effects among veterans using' a protocol that was subject to approval by the congressional Office of Technology Assessment (OTA); in addition, the OTA director was given the task of monitoring the progress of the study. The protocol was reviewed by the OTA, the VA advisory group on the health-related effects of herbicides, the science panel of the Agent Orange Working Group, and the National Academy of Sciences. P.L. 97-72 allowed for future expansion of the scope of the study. The implementation of the study was delayed until October 1982, at which time the responsibility for conducting the study was transferred from the VA to the Centers for Disease Control (CDC). The transfer was accomplished following letters to the VA from the Veterans Affairs Committees of the House and the Senate. The letters expressed concern over the lack of progress on the study and concern over the VA's credibility with the veterans; consequently, the VA was urged to relinquish the. study to an independent research body. While the VA acceded to this request, former VA Administrator �CRS- 8 Nimmo'attributed the delay of the protocol review process. study IB83043 to legal UPDATE-03/03/83 challenges and to the On Jan. 18, 1983, the CDC formally accepted responsibility for the study in a written agreement with the VA. Under the agreement, the VA is to provide the CDC with $3 million to fund the study, yet the CDC is assured of autonomy in its design and implementation. The project will actually consist of two studies, one on the health effects of Agent Orange and the other on the health effects of the Vietnam experience. The study' designs are expected to be ready for OTA review in April 1983. Preliminary reports suggest that the veterans under study will be divided into three groups (cohorts) — one group made up of those who were likely to have been exposed to Agent Orange, another group constituting those who were unlikely to have been exposed, and a final group of veterans who did not serve in Vietnam and who were not likely to have been exposed. The DoD'is assisting the CDC in establishing criteria for assigning an individual veteran to a particular group. The selection process will depend on the use of DoD records ' of ground troop movements relative to herbicide spraying. Completion of the study is expected by the end of 1987. Department of Defense. The Air Force is conducting "The Ranch Hand Study," an epidemiological study of personnel exposed to herbicides during the Air Force's aerial spraying program in Vietnam (Operation Ranch Hand). These personnel were members of flight crews involved in the handling and/or spraying of herbicides, and they were presumed to have been heavily exposed. This study population of 1,260 personnel is being compared to a control population consisting of unexposed flight crew members. The purpose of the study is to determine whether Ranch Hand flight crews suffered adverse health effects compared to the control population. The study consists of three parts: a mortality study; a morbidity (disease) study which includes birth defects in offspring; and a follow-up period of physical examinations at specific intervals (up to 20 years) from the onset of the study. Information for the morbidity and follow-up portions is collected by questionnaires administered in the homes of the participants and by extensive physical and psychological tests. These data are collected by the independent contractors Louis Harris and Associates and Kelsey-Seybold Clinic, respectively. Before data collection began in 1980, the entire study protocol had been reviewed by the University of Texas School of Public Health, the U.S Air Force 'Science Advisory Board, the Armed Forces Epidemiological Board and the National Academy of Sciences. The initial phases of mortality and morbidity data collection were completed in December 1982. For the morbidity study, participation in the questionnaire and physical examination has been very high (greater than 95%) and an interim report is expected by the summer of 1983. The findings of the mortality study (due to be released early in 1983) suggest that there are no differences in the number of deaths between the Ranch Handers and controls. Periodic reassessment of the mortality findings are planned throughout the 20-year study by the Air Force School of Aerospace Medicine. While the Ranch Hand Study is expected to provide some valuable information about the population of herbicide sprayers, the applicability of the Ranch Hand Study to the experience of ground troops has been questioned. For example, the herbicide exposure conditions are thought to differ between the two groups. The Ranch Handers were heavily exposed at sporadic intervals (repeated acute exposures) and the exposure was through the skin, through inhalation, and through ingestion. After the missions, the flight crews were �CRS- 9 IB83043 UPDATE-03/03/83 required to shower. While the extent and mode of ground troop exposure are less certain, it is likely that the mode of ground troop exposure was primarily due to skin contact and to inhalation. The duration of ground troop exposure was likely to be for longer periods due to operational movements through contaminated areas. Thus, because the exposure conditions of Ranch Hand personnel did not mimic those of ground troops, the general relevance of the Ranch Hand study is not certain. One of the criticisms raised by the National Academy of Sciences in their May 1980 review of the Ranch Hand protocol was that adverse health effects were not likely to be found because the sample size was too small and the follow-up period was too short. In response, the Air Force did extend the follow-up period to 20 years; nevertheless, the problem of sample size makes it unlikely that the study will detect certain cancers that are relatively rare. The impact of Agent Orange exposure on the incidence of these rare cancers (e.g., soft-tissue sarcoma and non-Hodgkin's lymphoma), may be most appropriately determined by the case control sutdies in New York State and at.the National Cancer Institute. V e t e r ans Adm i n i s t rat ion. The Veterans Administration intends to spend $6.7 million of the total 1983 medical research budget of $163 million for projects on the health effects of herbicide exposure and, more generally, the health effects of combat duty in Vietnam. The majority of these research dollars ($4.2 million) is destined for the epidemiology study of Vietnam veterans, a mortality study, and an identical twin sibling study. Due to congressional pressure, responsibility for the conduct of the epidemiology study has been transferred from the VA to the CDC. Funding for the epidemiology study, however, will continue to be provided by the VA. Both the mortality and the twin study address the impact of the Vietnam experience rather than Agent Orange in particular. The purpose of the mortality study is to examine the cause-of-death and the death rate in Vietnam veterans by comparison to veterans who did not serve in Vietnam. The idea is to determine whether military service in Vietnam has resulted in different death profiles since the end 'of the war. Computer records will provide the information, and this information will be collected and coded by contractors for the VA. The project is expected to be finished by 1985. The Identical Twin Study, -also sponsored by the VA, is designed to determine whether the current psychological and physical health of Vietnam veterans has been adversely affected by their service. In this study, a group of VA researchers in St. Louis is attempting to study 450 pairs of identical twins; one twin served in Vietnam during the period of herbicide exposure, whereas the other twin was not stationed in Southeast Asia. Initial findings of this study are expected by October 1984. The VA has also established the Chloracne r Task Force to identify veterans with skin conditions and then to see if . there are bona fide cases of Chloracne within this group. Thus far, a dermatologist who is serving as a consultant at the Washington VA office has found 12 tentative cases of Chloracne which require further investigation. Another VA research activity is a study of dioxin in the fat tissues of veterans. In conjunction with the EPA, the VA intends to find out whether Vietnam veterans have higher levels of dioxin in their fatty tissues than non-Vietnam veterans. Background levels of dioxin in the U.S. male population are also to be analyzed. To detect dioxin concentrations in the fat, tissue is removed surgically from the abdomen and the sample .is analyzed on gas chromatography/high resolution mass spectrometry instruments. �CRS-10 IB83043 UPDATE-03/03./83 l Department of Health and_ Human Services: Centers for Disease C o n tr o1/B irth Def e_c t Stu dy. An ambitious epidemiology study is underway in Atlanta to find out if Vietnam veterans show an increased risk of having children with birth defects. Using the case-control method, CDC researchers are interviewing 7000 parents of children with birth-defects and 3000 parents whose children are normal. The interview process is used to establish the military history of the parents. This information will be analyzed to determine wheth'er parents who served in Vietnam are at greater risk of producing children with birth defects. Already one-half of the interviews has taken place, with initial findings expected by September 1983. Sponsors of the study are DHHS, VA, and DoD. DHHS: National Cancer^ I n s t i t u t e / Can c e r Study. Epidemiologists are investigating a Kansas population for the relationship between herbicide exposure and various cancers. The research question is: do such cancers as soft tissue sarcoma and various lymphomas result from herbicide exposure? Kansas residents are considered a good population for studying herbicide exposure because in this wheat-growing State herbicides are used much more often than insecticides. In other States, herbicides are frequently used in combination with insecticides, which are also implicated in producing cancer. Insecticide exposure would confound the results of such a cancer study. Preliminary results of this study are anticipated by the'fall of 1983. DHHS; National Institute of^Occupational Safety and Health/Dioxin Worker Registry. NIOSH is compiling a ' registry of workers involved in the manufacture "of 2,4,5-T and related compounds because these compounds contain dioxin as a contaminant. Worker exposure records on 3000-5000 individuals, compiled from all 12 U.S. sites of production, will go back to the 1940s. T'he purpose of the registry is to establish whether the mortality rates are higher in this,population of exposed workers than in a comparable group in the U.S.population. The protocol has been reviewed by an independent university-affiliated group of scientists, and the analysis of the findings is due by 1985. Role of State Commissions or Advisory Groups Several States have established their own agencies in response to veterans' complaints of Federal inactivity on the Agent Orange question. Although these organizations vary in structure, their functions are essentially similar: to identify State Vietnam veterans and to provide and coordinate various social services for these veterans. For example, various State commissions disseminate information on Agent Orange and assist in scheduling Agent Orange examinations at VA medical centers. Those States which have commissions or programs on Agent Orange are as follows: California, Connecticut, Georgia, Hawaii, Illinois, Kansas, Maine, Massachusetts, Minnesota, New Jersey, New York, Oklahoma, Ohio, Pennsylvania, Texas and West Virginia. (Wisconsin's program has been discontinued.) Some .of these States are funding their own research programs aimed at answering questions on the health effects of Agent Orange. In the "spring of 1983, New York is due to release findings of a study on the incidence of soft-tissue sarcoma among State veterans relative to other State inhabitants. Soft-tissue sarcoma has been implicated as a possible long-term health effect of herbicide exposure. New York State has also undertaken a mortality study to see if death rates are higher among Vietnam veterans than other State residents of the same age group. �' I CRS-11 IB83043 UPDATE-03/03/83 The New Jersey State Commission on Agent Orange has a variety of pro-jects underway. One task has been to assemble information on a bacterial infection called Melioidosis, which may have afflicted veterans who were exposed to the bacterium while in Vietnam. The Commission is beginning a project to determine whether blood tests can be reliably used to measure dioxin levels. Blood tests would obviate the need for more expensive and painful surgical procedures now performed for this purpose. In addition, the New Jersey Commission on Agent Orange distributes pamphlets on how to fill out VA disability claims forms. The role of the State commissions is growing to include advocacy for State veterans. State representatives have testified at congressional hearings and at the VA advisory committee meetings to bring attention to veterans' complaints. At the Nov. 30, 1982, meeting of the VA advisory committee on the health-related effects of herbicides, the spokesperson for State agencies endorsed legislation that would establish the presumption of a "service-connection" for chloracne and soft tissue sarcoma "so that veterans' disability claims for these disorders would be awarded. Because of the lack of State funds, some of the State commissions are no longer active and others are i.n jeopardy. State commissions have requested Federal funds on the grounds that they assist in the administration of VA programs such as the scheduling of Agent Orange examinations and informing State veterans about Agent Orange exposure. Previous Congressional Ac^tipn As previously discussed, two major pieces of legislation have been enacted in the 96th and 97th Congresses- to provide for Vietnam veterans' medical care and to mandate studies of the health effects of Agent Orange: P.L. 96-151, The Veterans' Health Programs Extension and Improvement Act of 1979; and P.L. 97-72, Veterans' Health Care, Training and Small Business Loan Act of 1981. The 'legislative proposals of the 96th and 97th Congresses were generally directed to the status of disability claims that are now denied by the VA because they are not considered as "service-connected." In Representative Daschle's proposed 97th Congress bills, H.R. 7146 and H.R. 7110, the presumption of service connection would have been legislatively established N for soft-tissue sarcoma and chloracne, respectively. The presumption of service connection would have permitted veterans with these disorders to collect disability payments because the conditions were presumed to have arisen during the service. Two other 97th Congress bills, H.R. 523 (Rep. Roe) and H.R. 2297 (Rep. Downey), were designed to provide a presumption of service connection for all chronic conditions specifically related to Agent Orange exposure which appear later than one year, after discharge. Existing law requires that disabling conditions only appearing before discharge or within one year after discharge are presumed to have arisen during the service. Finally, a number of bills were introduced to transfer the conduct of the epidemiology study from the VA to the Department of Health and Human Services. This was accomplished -- although non-legislatively -- with the transfer of responsibility to the Centers for Disease Control in the DHHS. LEGISLATION H.R. 209 (Long) Requires the Secretary of Health and Human Services to arrange for an �CRS-12 IB83043 UPDATE-03/03/83 independent epidemiological study of persons exposed to the chemical dioxin, used in the h.erbicide known as Agent Orange. Introduced Jan. 3, 1983; referred to Committee on Energy and Commerce. H.R. 212 (Long) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation "frojn the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxyherbicide known as Agent Orange or other phenoxy herbicides. Introduced Jan.3, 1983; referred to Committee on Veterans Affairs. H.R. 331 (Roe) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation from the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxy herbicide known as "Agent Orange" or other phenoxy herbicides. Introduced Jan. 3, 1983; referred to Committee of Veterans Affairs. H.R. 462 (Applegate) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation from the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxyherbicide known as Agent Orange, or other phenoxy herbicides. Introduced Jan. 6, 1983; referred to Committee on Veterans Affairs. H.R. 509 (Hammerschmidt) Amends Title 38 of the United States Code to provide that progressive muscular atrophy or amyotrophic lateral sclerosis developing a 10 per centum or more degree of disability within seven years after separation from active service during a period of war shall be presumed to be service connected. Introduced Jan. 6, 1983; referred to Committee on Veterans' Affairs. H.R. 1135 (Downey) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation from the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxy herbicide known as Agent Orange, or other phenoxy herbicides. Introduced Feb. 1, 1983; referred to Committee on Veterans Affairs. H.R. 1382 (Downey) Provides that any award by the Veterans' Administration of compensation for a disease or disability in a veteran resulting from exposure to Agent Orange shall be retroactive to the date the veteran first applied to the Veterans' Administration for compensation for such disease or disability. I n t r o d u c e d _ F e b . 10, 1983; referred to Committee on Veterans' Affairs. �CRS-13 IB83043 UPDATE-03/03/83 '*. i S. 374 (Specter) A m e n d s Title 38, United States Code, to provide a presumption of service connection for the occurrence of certain diseases in veterans who were exposed to phenoxy herbicides while serving in the Armed Services in Southeast Asia during the Vietnam era. Introduced Feb. 2, 1983; referred to Committee on Veterans Affairs. HEARINGS U.S. Congress. House. Committee on Interstate and Foreign Commerce. Subcommittee on Oversight and Investigations. Agent Orange: exposure of Vietnam veterans. Hearing, 96th Congress, 2d session. Sept. 25, 1980. 249 p. Involuntary exposure to Agent Orange and other toxic spraying. Hearings, 96th Congress, 1st session. June 26 and 27, 1979. 256 p. U.S. Congress. House. Committee on veterans' Affairs. Ad Hoc Subcommittee on Hospitals and Health Care. Legislation to improve medical programs administered by the Veterans Administration (H.R. 2157, H.R. 2953, and H.R. 2999). Hearing, 97th Congress, 1st session. Apr. 28, 1981. 54 p. U.S. Congress. House. Committee on Veterans' Affairs. Subcommittee on Medical Facilities and Benefits. Herbicide "Agent Orange." Hearing, 95th Congress, 2d session. Oct. 11, 1978. 62 p. Oversight hearing to receive testimony on Agent Orange. Hearing, 96th Congress, 2d session. Feb. 25, 1980. 121 p. ._ _, oversight hearing to receive testimony on Agent Orange. Hearing, 96th Congress, 2d session. July 22, 1980. 459 p. Scientific community report on Agent Orange. Hearing, 96th Congress, 2d session. Sept. 16, 1980. 145 p. U.S. Congress. House. Committee on Veterans' Affairs. Subcommittee on Oversight and Investigations. Current status of Agent Orange studies. Hearing, 97th Congress, 1st session. May 6, 1981. 385 p. Federal Agent Orange activities and the vet center program. Hearing, 97th Congress, 2d session. Sept. 15, 1982. 164 p. U.S. Congress. Senate. Committee on Veterans' Affairs. Agent Orange update and appendix: Agent Orange activities (part II) . Hearing, 96th Congress, 2d session. Sept. 10, 1980. 1368 p. Oversight on issues related to Agent Orange and other herbicides. Hearing, 97th Congress, 1st session. Nov. 18, 1981. 500 p. �CRS-14 IB83043 UPDATE-03/03,/83 VA health resources and program extensions and appendix: Agent Orange activities. Hearing, 96th Congress, 1st session, on S. 741 and S. 196. Apr. 10, 1979. 462 p. Veterans' Programs Extension and Improvement Act of 1981. Hearing, 97th 'Congress, 1st session, on S. 26 (titles II and III, only), S. 380, S. 458, S. 636, S. 689, S. 872, S. 914, S. 921, and related bills. Apr. 30, 1981. 685 p. Vietnam veterans' readjustment. Hearings, 96th Congress, 2d session. - F e b . 21, Mar. 4, and May 21, 1980. Part 2. 595-2082 p. i ADDITIONAL REFERENCE SOURCES American Medical Association. Council on Scientific Affairs. Health effects of "Agent Orange" and dioxin contaminants. 1981. 37 p. Boffey, Philip. Agent Orange: Despite spate of studies, slim hope for answers. New York Times, 1982. 24 p. Cookson, Clive. "Emergency" ban on 2,4,5-T herbicide in U.S. Nature, v. 278, Mar. 8, 1979: 108-110. Galston, Arthur W. Herbicides: V. 29, Feb. 1979: 85-90. a mixed blessing. Bioscience, International Agency for Research on Cancer. IARC monographs on the evaluation of the carcinogenic risk of chemicals to man: 2,5,5-T, v. 15, Aug. 1977. JRB Associates. Review of literature on herbicides, including phenoxy herbicides and associated dioxins. Washington, Veterans Administration, 1981. 2v. National Research Council. The effects 1 of herbivcides in South Vietnam: Part A. Summary and conclusions. Washington, National Academy of Sciences, 1974. AD-774-749. 398 p. National Research Council. The effects of exposure to Agent Orange on ground troops in.Vietnam. Washington, National Academy of Sciences, 1982. 24 p. New Jersey State Commission on Agent Orange. 1982. 54 p. Legislative Report. Reggiani, G. Toxicology of TCDD: short review of its formation, occurrence, toxicology and kinetics, discussing human health effects, safety measures and disposal. Regulatory Toxicology and Pharmacology, v. 1, 1981: 211-243. Rosenblatt, Jean. Compensating victims of toxic substances. Editorial Research Reports. v. 11, Oct. 1982: 759-772. Tung, T.T., T.K. Anh, B.Q. Tuyen, D.X. Tra, and N.X. Hugen (1971). Clinical effects of massive and continuous utilization of �'V* 1 CRS-15 -* ». U.S. IB83043 . defoliants on civilians. . . . Vietnamese Studies, 29: . UPDATE-03/03/83 . 53-81. General Accounting Office. U.S. ground troops in South Vietnam were in areas sprayed with herbicide orange. Nov. 16, 1979. FPCD-80-23. VA's Agent Orange examination program: auctions needed to more effectively address veterans' health concerns. Oct. 25, 1981. HRD-83-6. Young, Alvin et al. The toxicology, environmental fate and human risk of herbicide orange and its associated dioxin. The Surgeon General, U.S. Air Force, Washington, D.C. Oct. 1978. �APPENDIX A LISTING OF FEDERAL ORGANIZATIONS ON AGENT ORANGE January, 1983 I. Cabinet Council on Human Resources Agent Orange Working Group (AOWG) Chairman: James Stockdale (HHS) Alternate: Bart Kull Members: HHS, VA, DoD, Dept. Agriculture, Dept. Labor, EPA, ACTION Agency, OMB, OSTP, Council of Economic Advisors, Dept. State (OTA- Observer Status) Activities: Moniter and coordinate Federal Research activities on health effects of Agent Orange. Science Panel: Dr. Vernon Houk (CDC) II. Veterans Administration Advisory Committee on Health Related Effects of Herbicides Chairman: Dr. Barclay Shephard (VA) Members: VA, Veterans Groups, FDA, CDC, EPA, Army Medical Corps, Dept. Agriculture, NIH, private universiites Activities: Advise Administrator of VA on health effects of Agent Orange Agent Orange Projects Office Acting Director: Dr. Barclay Shephard (VA) Members: In-house administrative and research staff, Dept. of Medicine and Surgery, VA Activities: Coordinate and moniter epidemiology projects at VA on Agent Orange and related research effortsAgent Orange Policy Coordinating Committee Chairman: Everett Alvarez, Jr. (VA) Members: In-house staff involved in medical information and medical claims. Activities: Review VA policy to make recommendations on Agent Orange issues to the administrator of the VA. III. Department of Defense Army Agent Orange Task Force (AAOTF) Chief: Richard Christian (Army) Members: Army, Navy, Air Force, Marines, and civilian staff Activities: Provide VA with information from military records for the research projects on Agent Orange. � 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. 032 Folder The folder containing the original item. 0589 Series The series number of the original item. Series III Subseries I 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 Davis, Miriam Michael Simpson Description An account of the resource <strong>Corporate Author: </strong>The Library of Congress Congressional Research Service, Major Issues System Date A point or period of time associated with an event in the lifecycle of the resource March 3 1983 Title A name given to the resource Agent Orange: Veterans' Complaints and Studies of Health Effects, Issue Brief Number IB83043 Subject The topic of the resource VA health studies legislation ao_seriesIII 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. 029 Folder The folder containing the original item. 0471 Series The series number of the original item. Series III Subseries I 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 Batten, C. R. Description An account of the resource <strong>Corporate Author: </strong>California Forest Protective Association, Sacramento, California Date A point or period of time associated with an event in the lifecycle of the resource June 30 1978 Title A name given to the resource The Phenoxy Herbicides in California: A History of Conflict Subject The topic of the resource dioxin legislation ao_seriesIII 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. 019 Folder The folder containing the original item. 0280 Series The series number of the original item. Series II 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/. Description An account of the resource <strong>Corporate Author: </strong>Arkansas State Plant Board, Feeds, Fertilizers, and Pesticides Division, Little Rock, Arkansas Title A name given to the resource Typescripts with attached letter: Agricultural Application Service Act and Economic Poisons Act and Regulations, 1965 & 1966 Subject The topic of the resource legislation herbicide regulation