1 15 13 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1869 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Bender, Gerald C, Jr. Title A name given to the resource Memorandum: to Interested Persons from Gerald C. Bender, Jr., regarding Wisconsin Mortality Study, July 23, 1985 Subject The topic of the resource state-funded Vietnam veterans study mortality trends cancer risk assessment alcohol use ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/b677371336f0a60017b46af9dd5a1d6f.pdf a3e56005c1947ba2597cabb4591043d8 PDF Text Text Item ID Number 01868 Author Shepard, Barclay M. Corporate Author ROpOTt/ArUdO TltlB Critique of West Virginia Mortality Study Journal/Book Title Year 1986 Month/Day February 4 Color a Number of Images 36 UOSCrtytOn NOtBS ltem inlcudes critique, as well as attached 1) M. L. Neighbors Diversified Maritime Services, Inc. advertisement and 2) Vietnam-Era Veterans Mortality Study, West Virginia Residents 1968-1983, Preliminary Report, January 1986. Wednesday, July 11, 2001 Page 1869 of 1870 �FEB 04 1986 Critique of West Virginia Mortality Study The West Virginia Department of Health has recently completed a mortality study (copy attached) of Vietnam-era veterans based on the recipients of a state bonus. The State offered a differential bonus to all West Virginia residents who served in the military during the Vietnam era with a larger amount going to those who served "incountry". 41,059 in-country (Vietnam veterans) and 41,782 non-incountry (non-Vietnam) veterans received the bonus. The list of bonus recipients was matched against state vital statistic records resulting in 1225 male Vietnam-era veterans who had died between 1968 and 1983. For each deceased male veteran a copy of the Report of Separation From Active Duty (DD 214) was reviewed to determine dates and place of service. The latter was determined by receipt of at least one of the three medals awarded for service in the Southeast Asia theater of operations. In addition, cause of death information was obtained on each deceased veteran. Of the 1225 deceased veterans, 615 were in the group of Vietnam veterans and the remaining 610 were non-Vietnam veterans, i.e., veterans who served elsewhere during the same period of time. When comparing causes of death between all veterans in the group and non-veterans of similar age only those classified as accidents, poisoning, and violence were elevated among the veteran group. Deaths due to cancer were statistically the same in both groups. Other causes of death were lower in the veteran group, a commonly observed phenomenon known as the "healthy veteran effect". A stated by the authors, the study has a number of limitations which must be kept in mind when interpreting the results: "In spite of the intense publicity given to the bonus campaign, it is likely that many veterans or their survivors never applied for the bonus. Thus, those veterans who did qualify for a bonus represent an unknown proportion of the actual number of West Virginia males'who served in the military during the Vietnam era. It cannot be assumed that the proportion was similar for both [groups]. Furthermore, because the mortality tape identified only residents of West Virginia who died during the study period, deaths in that period among veterans who no longer resided in West Virginia at the time of their demise would not have been counted among the 1,225 veterans deaths ascertained. . . With respect to a comparison between in-country and era . veterans, it cannot be assumed that similar proportions of the respective candidate population qualified for the bonus or that the death rates among in-country veterans who were no longer West Virginia residents were similar to those among era veterans who were no longer residents." �There were 145 cancer deaths of which 71 were in the group of Vietnam veterans and 74 were among the non-Vietnam veterans. In comparing specific types of cancers between these two veteran groups, only Hodgkin's disease, testicular cancer, and soft tissue sarcoma were elevated in the Vietnam veteran group. In each instance, however, the number of actual cases was small, i.e., 5 cases of Hodgkin's disease, 3 testicular cancers and 3 soft tissue sarcomas. As the authors state: "These findings must be interpreted cautiously ... since ... the site- specific cancer deaths were derived from a relatively small number . . and would . therefore be subject to ... large random fluctuations". In addition to the stated limitations of the study, as pointed out by the authors, there has been no systematic review of military personnel records, except for the DD 214 reviews as noted above, to validate the Vietnam service status of the study subjects. Because of the interest and concern over the relationship between soft tissue sarcoma and exposure to the phenoxy herbicides, the authors have now requested a review of the personnel records of the 3 veterans recorded as having this diagnosis. All.three of these were reported to have occurred in the in-country veteran group. The first of these is now known to have served in Thailand, not Vietnam, and would not have been exposed to Agent Orange. This is an example of the serious effect of misclassification especially when dealing with small numbers of subjects. In addition, there has been no systematic review of hospital or other clinical records to validate cause of death information or confirm the specific cancer diagnosis. Again, when dealing with relatively small numbers, a few errors in diagnosis can significantly alter the conclusions. In summary, this study appears to have been well designed and well conducted as far as it goes. As noted by the authors, however, it has inherent limitations and additional data are needed to validate some of the conclusions. BARCLAY M. SHEPARD, M.D. Director, Agent Orange Projects Office �«J£. tLAet&Ad&Ht- 1 January 1986 ANNOUNCEMENT M. L. NEIGHBORS, DIVERSIFIED MARITIME SERVICES, INC., announces that it is now able to offer part time consultative service or representation in the Washington, DC area to additional firms or persons that are engaged or have an interest in maritime related business ventures or business involving the disposal of chemical waste. Such work may also be arranged for in locations other than the Washington DC area as mutually agreed, and on either a prime or sub-contract basis. Among services offered are: A. Maintaining continuous contact with federal agencies having jurisdiction or control over maritime or chemical waste disposal ventures, and submittal of reports on matters of client interest. Rapid "feed-back" on specific information of more urgent interest can also be provided. B. Projection of U.S. chemical waste disposal requirements, in general or with specificity. C. Assisting in the initiation of either a maritime project or a project involving chemical waste disposal (except services involving the disposal of chemical waste by incineration at sea cannot be provided until after 30 November, 1986). CORPORATE EXPERIENCE INCLUDES: Nineteen years involvement with Department of Defense vessel charters and military cargo movement contracts. Thirteen years involvement with various offices of the Environmental Protection Agency that are responsible for regulating chemical waste disposal. This work included interaction with other federal agencies and with commercial firms offering alternative types of chemical waste disposal service. Written inquiries should be addressed to M. L. Neighbors, DMS Inc., 777 Fourteenth St., Suite 747, Washington, DC, 20005. Further information may also be obtained from Mr. Neighbors at phone number 564 1568 (area code 301 if calling from outside metro area). �WEST VIRGINIA HEALTH DEPARTMENT �VIETNAM-ERA VETERANS MORTALITY STUDY WEST VIRGINIA RESIDENTS 1968 - 1983 Preliminary Report January 1986 Arch A. Moore, Jr. Governor David K. Heydinger, M.D. Director, Department of Health �Alan P. Holmes, B.S.E.E., M.B.A. Principal Investigator WEST VIRGINIA DEPARTMENT OF HEALTH VIETNAM-ERA VETERANS MORTALITY STUDY COMMITTEE Charles Bailey Assistant Director, Health Statistics Center Roy C. Baron, M.D., M.P.H. Medical Epidemiologist Edward Bosanac, Ph.D. Research Consultant John Brough, Dr. P.H. Director, Preventive Health Services Charles Conroy, M.A. Agent Orange Program Coordinator Acting Director, Community Health Services Loretta Haddy, M.A., M.S. State Epidemiologist Alan P. Holmes, M.B.A. Director, Health Statistics Center ACKNOWLEDGEMENTS Sandra Y. Pope, Administrative Assistant, Agent Orange Program Eugenia Thoenen, Publications Coordinator, Health Statistics Center Thomas N. Leonard, Programmer/Analyst, Health Statistics Center Betty Jo Berry, Secretary, Health Statistics Center We would also like to thank Col. John W. Moon and the staff of , the West Virginia Department of Veterans' Affairs for their invaluable assistance in providing data used in this study. For further information, contact Charles Conroy, Agent Orange Program Coordinator 1800 Washington Street, East Charleston, WV 25305 Telephone: (304) 348-3210 �Vietnam-Era Veterans Mortality Study West Virginia Residents 1968-1983 The Agent Orange Assistance Program, established in 1982 by the West Virginia legislature, requested the Health Statistics Center of the Department of Health to conduct a study of the causes of death among state Vietnam veterans from 1968 through 1983.* The purpose of the study was to compare the mortality pattern among veterans with that of nonveterans in order to generate hypotheses regarding any differences in the causes of death among the former. A comparison of the causes of death among veterans who served in Vietnam with those among veterans who did not serve in Vietnam was also undertaken in order to speculate whether the Vietnam experience might be associated with a distinct mortality pattern. METHODS Identification of West Virginia Veterans West Virginia residents who served in the military during the years of the Vietnam Conflict were identified from the list *The Vietnam era is generally defined as extending from 1964 until 1973. For the purposes of this study, however, only those deaths from 1968 were considered because of the small number of deaths occurring before that year, in addition to difficulties imposed by cause-of-death coding changes over the longer interval. �of applicants for a military service bonus offered by the state Department of Veterans' Affairs in 1974. To qualify for a bonus, veterans had to meet the following criteria: 1) they must have rendered active service in the armed forces at some time between August 1, 1964, and March 28, 1973, inclusive, or have been recipients of the Vietnam armed forces expeditionary medal if they saw active service prior to August 1; 2) they must have been residents of West Virginia for at least six months prior to entry into active service; 3) they must have actively served for a period of at least ninety days unless discharged because of a servicerelated disability, and 4) they must have been honorably discharged. Efforts to notify eligible veterans or their survivors about the bonus program included one national public awareness campaign conducted in November 1975 and one conducted in July 1976. Public service announcements were issued over the television networks, and notices were posted in every major newspaper in the country and organizations on service advertised networks the bonus overseas. legislation Veterans' in their publications, and some offered assistance in filing for the bonus as a promotional device in their membership campaigns. Three different bonuses were offered. Veterans who did not serve in Vietnam ("out-of-country" or era veterans) were to receive up to $300 (Type 3 bonus); Vietnam veterans ("in-country" veterans) were to receive up to $400 (Type 4 bonus), and surviving relatives of veterans who died while in the service during the period designated by the legislature were to receive �$500 (Type 5 bonus). In West Virginia, the Department of Veterans' reported a total of 86,247 initial applicants. Affairs Of those who applied for the bonus, 83,730 veterans or survivors (97%) were eligible (Figure 1). Of these, 41,782 qualified for the Type 3 (Vietnam-era) bonus, 41,059 qualified for the Type 4 (Vietnam) bonus, and 889 qualified for the Type 5 bonus. Since this was to be a study of mortality following discharge from the service, the Type 5 bonus recipients were excluded from subsequent analyses. Names of the Type 3 and Type 4 qualifiers were, entered onto a computer tape, referred to as the "bonus tape." Identification of Veteran and Nonveteran Deaths A complete listing of West Virginia resident deaths from 1968 through 1983 was prepared from records maintained by the Health Statistics Center and entered onto a "mortality tape." The names on this list were then compared with those on the bonus tape in order to identify veterans who died during this period. For deaths from 1968 through 1978, the information had to be matched by name since social security numbers were not included on the mortality tape for these years. Any possible match generated in this manner was searched by hand and confirmed by comparing the social security number on the death certificate with that on the veteran application. From 1979 through 1983, it was possible to match by social security number. �FIGURE 1 WV VIETNAM VETERAN MORTALITY STUDY SELECTION OF STUDY POPULATION 1968-83 Bonus Tape 83,730 1 1 1 In -Country Vietnam 41,059 Not-in-Country Era 41,782 No-Match Death File 41,169 Females Era 3 Nonwhite Males Era 30 MatchedDeath File Era 613 Males Era 610 White Males Era 580 No-Match Death File 40,444 Died in Service 889 MatchedDeath File Vietnam 615 Females Vietnam 0 Males Vietnam 615 Nonwhite Males Vietnam 36 White Males Vietnam 579 �There were 1,234 initial matches between the bonus tape and the mortality tape, 614 Vietnam-era (Type 3) veterans and 620 in-country (Type 4) veterans. The veterans' discharge forms (DD-214s) were then manually checked to verify their in-country status.* This review reclassification of resulted several in records, the deletion leaving 1,228 and/or deceased veterans who qualified, 613 for the Type 3 bonus and 615 for the Type 4 bonus. Three of the deceased veterans, all Type 3 bonus recipients, were female. They were excluded from the final tape; the subsequent analyses included only deceased male veterans. Of the 1,225 male veterans who died (Table 1), 1,159 were white and 66 were nonwhite (65 black and 1 Hawaiian). nonwhite veterans were Type 3 (5%) and 36 were Type 4 Thirty (6%). Because nonwhite veterans constituted a small percentage of those who died, the study combined the mortality patterns of white and nonwhite veterans. For nonveteran males, deaths were identified from the mortality tape by deleting the records of all remaining female deaths and those of the 1,225 male veteran deaths. thus four groups defined for analysis: died; (2) male Vietnam-era-only There were (1) all male veterans who (Type 3) veterans who died; *In-country status was determined by the receipt by the veteran of one of three service medals (the Vietnam service medal, the Vietnam campaign medal, or the Vietnam expeditionary medal) as noted on the DD-214. These medals were awarded to military personnel who served in the Southeast Asia theater of operations. �TABLE 1 TYPE 3 AND TYPE 4 MATCHES BETWEEN BONUS TAPE AND MORTALITY TAPE BY YEAR 1968-83 YEAR VIETNAM-ERA (Type 3) IN-COUNTRY (Type 4) TOTAL 1968 4 13 17 1969 14 16 30 1970 17 22 39 1971 16 33 49 1972 26 31 57 1973 33 22 55 1974 25 29 54 1975 50 47 97 1976 47 46 93 1977 50 40 90 1978 54 35 89 1979 53 44 97 1980 58 51 109 1981 53 70 123 1982 55 59 114 1983 56 56 112 TOTAL 610 615 1,225 �(3) male in-country (Type 4) Vietnam veterans who died, and (4) all other West Virginia males (nonveterans) who died from 1968-83. DEMOGRAPHIC PROFILE OF DECEASED VETERANS Age Distribution The average age at death was 35.3 for all veterans, 35.1 for era veterans and 35.4 for in-country veterans. Table 2 shows that the distribution of deaths by age for Type 3 and Type 4 veterans was similar. Tables 3 and 4 present the distributions of age at death by race for Vietnam-era and Vietnam veterans, respectively. Among white Type 3 veterans, the average age at death was 35.3, among nonwhites 31.3. For Type 4 veterans, the mean age at death for whites was 35.5, with 33.5 that for nonwhites. �TABLE 2 ALL VIETNAM-ERA VETERANS Age Distribution by Type of Service VIETNAM-ERA (Type 3) TOTAL IN- COUNTRY (Type 4) AGE GROUP f % % * 4 I 15-19 4 0.7 1 0.2 5 0.4 20-24 82 13.4 92 14.9 174 14.2 25-29 139 22.8 125 20.3 264 21.5 30-34 137 22.4 143 23.2 280 22.9 35-39 83 13.6 61 9.9 144 11.7 40-44 42 6.9 53 8.6 95 7.7 45-49 36 5.9 60 9.8 96 7.8 50-54 40 6.6 33 5.4 73 6.0 55-59 24 3.9 32 5.2 56 4.6 60-64 12 2.0 12 2.0 24 2.0 65-69 9 1.5 3 0.5 12 1.0 70-74 2 0.3 0 0.0 2 0.2 TOTAL 610 100.0 615 100.0 1,225 100.0 Average Age at Death 35.4 35.1 8 35.3 �TABLE 3 VIETNAM-ERA VETERANS (TYPE 3) Age Distribution by Race WHITE TOTAL NONWHITE AGE GROUPS % # % # % 1 19 4 0.7 0 0.0 4 0.7 20-24 77 13.3 5 16.7 82 13.4 25-29 131 22.6 8 26.7 139 22.8 30-34 127 21.9 10 33.3 137 22.4 35-39 79 13.6 4 13.3 83 13.6 40-44 42 7.2 0 0.0 42 6.9 45-49 33 5.7 3 10.0 36 5.9 50-54 40 6.8 0 0.0 40 6.6 55-59 24 4.2 0 0.0 24 3.9 60-64 12 2.1 0 0.0 12 2.0 65-69 9 1.6 0 0.0 9 1.5 70-74 2 0.3 0 0.0 2 0.3 TOTAL 580 100.0 30 100.0 610 100.0 Average Age at Death 35.3 31.3 35.1 �TABLE 4 IN-COUNTRY VIETNAM VETERANS (TYPE 4) Age Distribution by Race NONWHITE WHITE TOTAL AGE GROUPS % # # % t Z 19 0 0.0 1 2.8 1 0.2 20-24 87 15.0 5 13.8 92 14.9 25-29 114 19.7 11 30.5 125 20.3 30-34 135 23.3 8 22.2 143 23.2 35-39 59 10.2 2 5.6 61 9.9 40-44 51 8.8 2 5.6 53 8.6 45-49 59 10.2 1 2.8 60 9.8 50-54 29 5.0 4 11.1 33 5.4 55-59 30 5.2 2 5.6 32 5.2 60-64 12 2.1 0 0.0 12 2.0 65-69 3 0.5 0 0.0 3 0.5 70-74 0 0.0 0 0.0 0 0.0 TOTAL 579 100.0 36 100.0 615 100.0 Average Age at Death 35.5 33.5 10 35.4 �Branch of Service Review of the DD-214 forms showed that 718 (59%) of the deceased veterans had served in the army, 210 (17%) had served in the air force, 167* (14%) had served in the navy, and 120 (10%) had served in the marines (Table 5). Seventy-five percent of the in-country veterans who died had been in either the army or the marines, in contrast to 62% of the era veterans. Twenty-five percent of in-country veterans had served in either the air force or the navy, in contrast to 37% of, the era veterans. For 10 veterans, the branch of service was not recorded on the discharge forms. *Includes 3 coast guard veterans. 11 �TABLE 5 ALL VIETNAM-ERA VETERANS Branch of Service by Type of Service VIETNAM-ERA (Type 3) IN-COUNTRY (Type 4) TOTAL BRANCH OF SERVICE % * t % * % Army 340 55.7 378 61.5 718 58.6 Air Force 127 20.8 83 13.5 210 17.2 16.1 69 11.2 167 13.6 Navy 98* Marines 39 6.4 81 13.2 120 9.8 Unknown 6 1.0 4 0.6 10 0.8 610 100.0 615 100.0 TOTAL *Includes 3 coast guard veterans 12 1,225 100.0 �ANALYTIC METHODS In spite of the intense publicity given to the bonus campaign, it is likely that many veterans or their never applied for the bonus. survivors Thus, those veterans who did qualify for a bonus represent an unknown proportion of the actual number of West Virginia males who served in the military during the Vietnam era. It cannot be assumed that the proportion was similar for both Type 3 (era) and Type 4 (in-country) qualifiers. Furthermore, because the mortality tape identified only residents of West Virginia who died during the study period, deaths in that period among veterans who no longer resided in West Virginia at the time of their demise would not have been counted among the 1,225 veteran deaths ascertained. Because of these limitations, the records provide neither complete information about the total candidate population nor a comprehensive estimate of the force veterans who did qualify. the veteran and the of mortality among the With respect to a comparison between nonveteran groups, the data would underestimate the relative force of mortality among the veterans, if such a comparison were made. With respect to a comparison between in-country and era veterans, it cannot be assumed that similar proportions of the respective candidate population qualified for the bonus or that the death rates among in-country veterans who were no longer West Virginia residents were similar to those among era veterans who were no longer residents. 13 �The method of choice for a study of mortality when there is incomplete data on the population at risk is a proportionate mortality analysis. In this type of study the proportion of all deaths due to the disease(s) of interest in the study population is compared with the proportion of all deaths due to the disease(s) of interest in the comparison (referent) population. Such proportional rates do not express the risk of dying from a disease since the incidence is not measured against a population base. They simply suggest that there may be a difference worth investigating further. The validity of such a study rests on the assumption that there is no association between the study factor, i.e., veteran status, and the occurrence of other diseases. Since we cannot make this assumption, such an analysis is used to generate hypotheses or to conduct preliminary tests of etiologic hypotheses without collecting much additional data. The relationship between the proportion of deaths due to a specified cause in a study population and the proportion derived from the referent population is expressed as a proportionate mortality ratio (PMR). The PMRs in this study are standardized to adjust for selected confounding variables. When the veteran group and its subgroups were compared with the nonveteran group, adjustments were made by stratifying on age at death by 5-year intervals (15-19, 20-24, . . . etc.) and on year of death by 2-year intervals stratum, (1968-69, 1970-71, expected deaths were . . . 1982-83). For each calculated by determining the percentage the cause of death of interest contributed to all 14 �causes in the referent population and multiplying this result by the total deaths from all causes in the study population. The standardized PMR statistic (sPMR) is the ratio of the number of deaths of interest observed in the study population summed over all strata, multiplied by 100, and then divided by the expected values summed over all strata. Stratification by age only and not by year of death was done when the in-country (study) group of veterans was compared to the era (referent) group. This was done in order to avoid losing data from the study group when respective strata in the referent group had no deaths. An sPMR greater than 100 indicates that the cause of interest contributes a greater percentage of all deaths in the study population than in the referent population; an sPMR less than 100 indicates that the cause contributes a smaller percentage of all deaths in the study population than in the referent population, and an sPMR of 100 indicates that the cause of interest contributes the same percentage of all deaths in both groups. expected frequencies against confidence p-value for each cause of interest were tested the null hypothesis, i.e., proportionate mortality interval expressing The observed and structure, around the each each exact sPMR by group has the same calculating a 95% and also a one-tailed probability of finding the difference between the observed and expected frequencies. RESULTS In the period 1968 through 1983, there were 1,225 deaths among males who had served in the military during the Vietnam 15 �Conflict. Six hundred fifteen of the men served at least a portion of their duty in Vietnam (in-country, Type 4 veterans) and 610 had no experience in Vietnam (era, Type 3 veterans). For both groups combined, 716 deaths (58%) were from external causes (injury from accidents, poisoning, or violence), 237 (19%) were from cardiovascular neoplasms, 48 (4%) disease, were 145 from (12%) were nonmalignant from diseases malignant of the gastrointestinal system, 24 (2%) were from nonmalignant diseases of the respiratory system, 5 (-=1%) were from allergic, metabolic, and endocrine disorders, and 50 (4%) were from all other causes. With nonveteran West Virginia male deaths from 1968 through 1983 as a reference, Table 6 demonstrates the number of observed and expected deaths in each cause-of-death category for all veterans together and for in-country and era veterans separately. For all veterans, the observed distribution of deaths over these categories was significantly different from the expected (Chi square Goodness of Fit •» 50.2 with 6 degrees of freedom, p<10~8). Accidents, significantly poisoning, greater and proportion violence of accounted all veteran for a deaths than expected (sPMR excess), while deaths from allergic, metabolic, and endocrine conditions and from all other causes accounted for significantly smaller-than-expected deaths (sPMR deficits). For 16 proportions of all veteran cardiovascular, digestive, and �TABLE 6 ALL CAUSES OF MORTALITY Vietnam Veterans vs. Nonveterans West Virginia, 1968-83 ALL VETERANS vs. NONVETERANS IN- COUNTRY VETERANS vs. NONVETERANS ALL CAUSES °/. Accidents, Poisoning, and Violence (80E9) E0-99 716, '626.74 Cardiovascular Disease (9-5) 3049 237, '251.5 Malignant Neoplasms (140-209) sPMR (95Z CI) °/ 'E sPMR ERA VETERANS vs. NONVETERANS (95Z CI) ° / sPMR (95Z CI) (106-130) 354, '318.1 111* (100-124) 'E (106-123) 362. '308.6 117** 94 (83-107) 114, '129.1 88 (73-106) 123, '122.4 100 (84-120) 145, '142.4 102 (86-120) 71, '73.6 96 (75-122) 74, '88 6. 108 (85-136) Diseases of the Digestive System (520-577) 48, '56.7 85 (62-112) 29, '29.0 100 (67-144) 19, '27.8 68 (41-107) Diseases of the Respiratory System (460-519) 24. '29 3. 73 (47-108) 12, '16.7 72 (37-125) 12, '16.2 74 (38-129) 38* (10-96) 52** (33-77) 114** y Allergic, Metabolic, and Endocrine Diseases (240-279) All Other Causes (Residual) '19 2. 50. '29 9. 23** (7-53) 'll.2 9** (-=1-47) '06 1. 54** (40-71) 26. '68 4. 56** (36-81) 24, '61 4. Goodness of Fit X2. -50.2 odt p- 1 ' 08 *polsson p value*.05 **poisson p value£.001 �respiratory diseases, the standardized proportionate mortality ratios were less than unity when all veterans were compared with nonveterans, but the observed numbers of deaths in these categories were not significantly lower than the expected. proportion of veteran The deaths due to malignant neoplasms was similar to that of nonveterans. The pattern of death for in-country and era veterans evaluated separately relative to the nonveteran population was similar in both instances to the pattern observed for the groups combined. In a separate contrast with era veteran deaths as the standard (not shown), no difference was. observed in the overall mortality pattern between in-country and era veterans (Chi square Goodness of Fit = 7.0 with 5 degrees of freedom, p - .22). In order to evaluate more specific causes of death within the leading categories, the contrasts were repeated to obtain standardized proportionate category-specific mortality ratios for external causes (injury), cardiovascular diseases, and malignant neoplasms separately. Table 7 shows the distribution of injury deaths for veterans contrasted with nonveterans over five causes: motor vehicle accidents, non-motor-vehicle accidents, suicide, homicide, and all other external causes. Homicide accounted for a significantly smaller-than-expected proportion of the injury deaths among veterans. The standardized proportionate injury mortality ratio for motor-vehicle-related deaths among veterans was greater than 100 but was not a statistically significant 18 �TABLE 7 INJURY MORTALITY Vietnam Veterans vs. Nonveterans West Virginia, 1968-83 ALL VETERANS vs. NONVETERANS ° / sPMR (95Z CD 315, '9. 206 108 (97-121) 201, '0. 293 96 (83-110) 104 (85-125) ACCIDENTS. POISONING, AND VIOLENCE (E800-999) Motor Vehicle (E810-E825) Ron-Motor Vehicle (E800-E809, E826-E949) Suicide (E9SO-E9S9) HoBiclde (E960-E969) All Other Causes (E970-E999) IN-COUNTRY VETERANS vs. NONVETERANS 'E 111 '107.2 63. '81.5 77* (59-99) 26. '74 2. 95 (62-139) Goodness of Fit X^.--6.78 P-.15 *poisson p value-=.05 sPMR 107 (115 9-2) 100, '105.1 95 (77-116) 111 (85-144) sPMR (95Z CI) 154. '4. 105 110 (318 9-2) 101, '0. 142 97 (79-118) / '54.2 96 (72-126) 35, '14 4. 85 (59-118) 87 (45-152) (95Z CI) 161, '5. 101 ERA VETERANS vs. NONVETERANS °'E / 5 9 / '53.0 28. '02 4. 1 4 / '13.6 70* 103 (46-101) (56-173) Goodness of Fit XJ^-5.43 P-.25 °'E / 5 2 12 / '38 1. Goodness of Fit X2df-2.71 p-,61 �excess. For non-motor-vehicle fatalities, suicide, and all other causes, the expected numbers were similar to the observed. The overall pattern for veterans was not significantly different from nonveterans (Chi square Goodness of Fit » 6.78 with 4 degrees of freedom, p =.15). Separate comparisons of the in-country and era veteran populations with nonveterans similarly overall difference in the distribution reflected no of injury deaths; the ratios in each of these contrasts were similar to those observed for the combined veteran group. Among the cardiovascular causes of mortality there were no veteran deaths from either (Table 8), hypertension or rheumatic heart disease (p-=.005), fewer-than-expected veteran deaths from cerebrovascular disease (difference not significant), and more-than-expected veteran deaths due to ischemic heart disease (difference standardized not significant). proportionate cardiovascular The individual disease mortality ratios for in-country and era veterans were similar to the corresponding mortality ratios derived for the combined group. Proportionate cancer mortality ratios comparing veterans to nonveterans are shown in Table 9. veterans and respiratory the system nonveteran excess contributed population, accounted proportion of veteran cancer by In the comparison between all for deaths in-country identical to that contributed by 20 a era neoplasms significantly than of greater expected. veterans veterans. was the The virtually Melanoma of �TABLE 8 CARDIOVASCULAR DISEASE MORTALITY Vietnam Veterans vs. Nonveterans West Virginia, 1968-83 ALL VETERANS vs. NONVETERANS CARDIOVASCULAR DISEASES (390-459) Ischemic Heart Disease (410-414) Cerebrovascular Disease (430-438) °/. sPMR (95Z CI) 158. '141.5 112 (95-131) 18, '50 2. 72 (43-114) Hypertension (400-405) °65 '. Rheumatic Heart Disease (390-398) °/5.4 All Other Cardiovascular Diseases (415-429, 440-459) IN-COUNTRY VETERANS vs. NONVETERANS 61 '86 5. 0** 0** 104 *poisson p valuer .05 **poisson p value «.005 °/ 'E sPMR (95Z CI) °'E / sPMR (952 CI) / '67.7 111 (87-139) 83, '40 7. 112 (89-139) 73 (32-144) 10, '40 1. 71 (34-131) 75 8 / '09 1. - °/3.4 0* - °>1.9 0 / '30.2 103 (80-134) ERA VETERANS vs. NONVETERANS 31 - °/3.0 0* - °/3.5 0* (70-146) 30 '84 2. 106 - (71-151) �TABLH. » CANCER MORTALITY Vietnam Veteran* vs. Nonveterans West Virginia. 1968-83 IN-COUNTRY VETERANS vs. NONVETERANS ALL VETERANS vs. NONVETERANS MALIGNANT NEOPLASMS (140-209) sPHR (951 CD 135* (102-174) 123 (91-162) 462* (6-9) 1897 21, '69 2. 78 (819 4-1) 12, '. 66 182* (94-318) 79 (38-145) 6 128 (46-276) 7 123 (50-254) °>E Respiratory System "4. '31 (160-163) Trachea, Bronchus, 50 and Lung '07 4. (162) Larynx (161) Digestive Organs and Peritoneum (150-159) to to Malignant Melanoma of the Skin (172) Lymphoms (200-203, 208-209) '13 '. 10 / '12.7 Hodgklns Disease (201) /4.7 Hale Genital Organs (185-187) Leukemia (204-207) >,.7 6 /13.1 3 /0.7 % sPHR (951 CD 131* (87-187) 29, '09 2. 139* (93-199) 118 (76-174) 25. '19.5 128 (83-189) 49 2* (95-1349) 49 2* (95-1349) 77 (37-142) % 7 . 4 148 (40-378) %9 . 205* (89-406) 7 >6.2 113 (45-233) % 4 . 47 (10-136) % 4 . 208 (69-497) >/2.4 42 (1-233) 4 182 (49-461) %* . 83 (18-254) (17-100) 3 48 (10-139) V. 44 (9-129) (36-334) 2 /1.4 143 (17-508) 2 118 (5-435) (11-102) '41 /. 24 (-1-137) 3 51 (10-148) 250 (52-731) % 7 . 429* (90-1271) 200 (5-1071) 46* 129 */10 Soft and Connective Tissue (171) 3 Bone (170) 2 /K4 143 (18-531) Urinary Organs (188-189) 2 /5.6 36 (4-129) /15.6 103 (59-166) 16 / '21.2 (951 CD 10, '13.0 Brain i Nervous System (191-192) All Other Halfgnancle. 25 sPNR (911 3-4) 4 /1.2 29, '22.2 NONVETERANS 79 Oral Cavity (140-149) >3.1 °>E ERA VETERANS 40* •polaaon p value*.05 11, '14.0 /2.7 /2.2 /6.3 '05 '. V, '77 '. 0* 78 /1.7 /5.9 °OS '. V . 2 - (29-170) '. 27 ' , V 0 - 125 (3-663) 74 (10-305) 127 360-231) �TABLE 10 CANCER MORTALITY FOR VIETNAM VETERANS In-Country Veterans vs. Era Veterans West Virginia, 1968-83 OBSERVED, 'EXPECTED Respiratory System (160-163) (95Z CI) 93 (63-134) NS 110 (55-197) NS 7 280 (113-577) 0.014 5 833 (271-1945) 0.0004 222 (62-579) NS 500 (103-1461) 0.023 (12-118) 0.066 - - 29, '31.0 n Digestive Organs and Peritoneum (150-159) Lymphoma (200-203. 208-209) to Hodgklns Disease (201) POISSON p VALUE (Fisher's exact) sPMR / '10.0 '2.5 '. 06 U) Male Genital Organs (185-187) *!. /. Cancer of the Testls (186) V . Malignant Melanoma of the Skin (172) VT 46 Soft and Connective Tissue (171) \ oo Leukerolas (204-207) 3 Oral Cavity (140-149) 2 / All Others /1.9 2.4 8 / '12.7 158 (33-461) NS 83 (10-301) NS 63 (27-124) NS �the skin also accounted for a significantly greater-than-expected proportion of cancer deaths among all veterans, but the contribution of in-country veterans to this excess was trivial in comparison with that of era veterans. Deaths from leukemias and malignant neoplasms of the nervous system each occurred less frequently than expected among both veteran groups. tissue tumors, For soft a significant difference between observed and expected deaths was not found for all veterans combined. These tumors occurred only among in-country veterans and not among era veterans, however. When in-country veterans alone were contrasted with nonveterans, they had a significantly elevated standardized proportionate cancer mortality .ratio for soft tissue tumors. The contrast between in-country and era veteran cancer deaths shows the difference in the observed (3) and expected (0) soft tissue tumors for in-country veterans (Table 10). In-country veterans also have significantly elevated standardized proportionate contrasted cancer with era mortality ratios veterans. The for lymphoma difference is when more specifically attributable to Hodgkin's disease, for which there were five deaths in this group, compared with an expected 0.6. Finally, there was a statistically significant excess in the sPMR from testicular cancer among the in-country veterans. Discussion The present study demonstrates that the mortality experience 24 �among persons who served in the military during the Vietnam Conflict differs substantially from that of nonveterans. It also suggests that there may be important differences between the veterans who served in Vietnam and those who did not with respect to their cancer mortality experience. Differences in the mortality experience between veteran and nonveteran groups are influenced by a selection bias initiated at the time of induction to the military service. assure that healthy individuals In order to serve in the military, the preinduction screening process excludes persons with preexisting conditions such as diabetes and allergies, asthma, hypertension, have substantially metabolic disorders, rheumatic heart disease, and clinically apparent malignancies. veterans other lower Because of this selection, mortality rates than the nonveteran population for many years following their induction. This is known as the "healthy veteran effect." In the present study, this selection bias is the most plausible hypothesis to account for the significant sPMR deficits observed among veterans for mortality from allergic, metabolic, and endocrine disorders, all other causes, rheumatic heart disease, and hypertension. Moreover, it may also have contributed to the less prominently diminished sPMRs among veterans for cardiovascular, digestive, and respiratory diseases. While real differences in the mortality rates between veteran and nonveteran groups for selected causes are reflected 25 �in the sPMRs, proportionate they also mortality complicate the for other interpretation causes. Since of the proportionate contribution from all separate causes must sum to 100, the proportionate contributions among "healthy" veterans from causes that are not screened by the induction process become artificially inflated relative to their contribution among the "unhealthy" population. Injury, the leading cause of death for both veterans and nonveterans, played a significantly greater role among veterans, accounting for 58% of their deaths as opposed to an expected 51%. Since the study did not adjust for discrepancies in the health status between veterans and nonveterans, part of the excess in injury among veterans must be due to the relative absence of deaths from conditions that would exclude persons from military service. While an excess of these deaths araong nonveterans reciprocally diminishes the proportion of their mortality attributable to injury, there may be a real difference in life style and the propensity veterans and nonveterans. for risk-taking behavior between An evaluation of injury mortality alone, performed to eliminate distortion from the healthy veteran bias, showed only that homicide was significantly less important as a cause nonveterans. of injury death among veterans than On the other hand, while not significant, among the difference between the observed and expected number of veteran deaths from motor-vehicle accidents would suggest that this is at least one area where veterans may be at a substantially greater 26 �risk of death than nonveterans. This issue, however, and previous assertions that veterans are at greater risk of death from suicide cannot be adequately addressed by this analysis in the absence of more complete data on the populations at risk. While malignancies as a group accounted for similar proportions of veteran and nonveteran deaths, deaths from tumors of the respiratory system were a significantly more prominent cause of cancer death among veterans than among nonveterans. probable explanation for this finding would be A a greater prevalence of smoking among military as compared with nonmilitary personnel, but this cannot be substantiated from the limited information available on death certificates. In general, the pattern of death among in-country veterans from all causes, and within the subcategories of "accidents, poisoning, and violence" and "cardiovascular diseases," were similar to those observed for all veterans combined, and there were no substantial differences in the mortality patterns between in-country and era veterans for these categories. Among cancer deaths, however, there was strong statistical evidence to suggest that .Hodgkin's disease, cancer of the testis, and soft tissue tumors were more common among veterans who served in Vietnam than among veterans who did not. cautiously, however, These findings must be interpreted since the expected proportions of site-specific cancer deaths for in-country veterans were derived from a relatively small number (74) of cancer deaths among era 27 �veterans and would therefore be subject to considerably large random fluctuations. At the same time, the difference between the observed and expected numbers of soft tissue tumors among in-country veterans supports similar proportionate mortality findings study conducted in a previous by the Massachusetts Department of Public Health. Neither the Wisconsin study nor the New York study found significant differences between in-country and era veterans in the occurrence of soft tissue sarcomas. These studies, however, and the present one are limited by the absence of precise exposure data, unknown sizes of the candidate populations at risk, and insufficient follow-up time to account for latency from in-country veterans. exposures that might have been unique to Also, by including deaths from as early as 1968, the present study may have been biased against finding an excess occurrence of cancers with long latency periods. This study only suggests the possibility that the risk of death from soft tissue sarcomas, Hodgkin's disease, and testicular cancer are elevated among veterans who served in Vietnam. We are currently awaiting the records of the in-country veterans who died from these tumors in order to speculate about possible exposure histories and to generate hypotheses that may have some biologic plausibility. To take advantage of latency periods, cancer-specific proportionate mortality studies could be repeated in several years. Also, by excluding deaths that occurred in the late-Vietnam and early post-Vietnam period, and by improving ascertainment of exposure histories, studies can 28 �focus more sharply on etiologic hypotheses relating to possible exposures in Vietnam. On the other hand, since proportionate mortality studies are more useful to explore than to confirm hypotheses, it is recommended that more precise risk-assessment studies of Vietnam cohorts be performed using national data to further test the hypothesis that Hodgkin's disease, testicular malignancies, and soft tissue tumors may be important causes of cancer mortality among veterans who served in Vietnam. 29 �BIBLIOGRAPHY Dienstfrey, Stephen J., and James J. Bryne. Veterans in the United States; A Statistical Portrait from the 1980" Gensus. Washington, D.C.: Veterans Administration, 1985. "Final Toll for U.S. in Indb-China." (Sept. 24, 1973): 73. U.S. News £ World Report Kogan, Michael D., and Clapp, Richard W. Mortality among Vietnam Veterans in Mas sachuse t1s, 1972-1983. Boston: Massachusetts Department of Public Health, 1985. Lawrence, Charles E. et al. "Mortality Patterns of New York State Vietnam Veterans." American Journal of Public Health 75 (March 1985): 277-79. ' Shottenfeld, David, and Joseph F. Fraumeni, Jr., Cancer Epidemiology and Prevention. Philadelphia: W.B. Saunders Company, 1982. 30 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1868 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Shepard, Barclay M. Date A point or period of time associated with an event in the lifecycle of the resource February 4 1986 Title A name given to the resource Critique of West Virginia Mortality Study Subject The topic of the resource state-funded Vietnam veterans study mortality trends study criticism study protocol ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/beed241e785b94fc9bd023e5a06109dc.pdf 3523666342d3d5bb26133cf78991dd4d PDF Text Text ItomlDNunber °1867 Author Anderson, Ron J. Corporate Author Texas Veterans Agent Orange Assistance Program, Tex Report/Article Title Annual Report Journal/Book Title Year 1985 Month/Day Au ust Color n Number of Images 91 9 Descrlpton Notes Wednesday, July 11, 2001 Page 1868 of 1870 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH AUSTIN, TEXAS A N N U A L August Ron J. Anderson, M.D. Chairman Texas Board of Health R E P O R T 1985 Robert Bernstein, M.D., F.A.C.P. Commissioner of Health Texas Department of Health �1036-1986 Texas Department of Health Robert Bernstein, M.D., F.A.C.P. Commissioner Robert A. Maclean, M.D. Deputy Commissioner Professional Services Hermas L. Miller Deputy Commissioner Management and Administration 1100 West 49th Street Austin, Texas 78756-3199 (512)458-7111 August 23, 1985 Members of the Board Ron J. Anderson, M.D., Chairman Laurance N. Mickey, M.D., F.A.A.P., ViceChairman Bob D. Glaze, D.C., Secretary Johnnie M. Benson, F.A.C.N.H.A. Sister Bernard Marie Borgmeyer, R.N., F.A.CH.A. Frank Bryant, Jr., M.D., F.A.A.F.P. Joaquin C. Cigarroa, Jr., M.O. Barry D. Cunningham, D.O.S. Ben M. Durr, M.H.A. Dennis K. Mclntosh, O.V.M. Robert D. Moreton, M.D., F.A.C.R. Joe N. Pyle, P.E. Arthur L. Raines, M.D. Isadore Roosth Barbara T. Slover, R.Ph. Max M. Stettner, D.O. Edward H. Zunker, O.D. The Honorable Mark W. White Governor of Texas State Capitol Austin, Texas 78711 Dear Governor White: Enclosed is the Annual Report of the T e x a s V e t e r a n s Agent Orange A s s i s t a n c e Program. Pursuant to Section 3 of Article U447w, VTCS, this report is being distributed to the Legislature, V e t e r a n s Administration, T e x a s V e t e r a n s Affairs Commission, veterans' organizations, and interested individuals. It reflects the work of the Texas Department of Health Agent Orange Program to date. The report contains research findings on the effects of exposure to chemical defoliants or herbicides or other causative agents, including Agent Orange, and statistical information compiled from reports submitted by physicans, hospitals, and veterans. I hope you find this report both useful and informative. Sincerely, Commissioner of Health Enclosure �18J6-I986 Texas Department of Health Robert Bernstein, M.D., F.A.C.P. Commissioner Robert A. Maclean, M.D. Deputy Commissioner Professional Services 1100 West 49th Street Austin, Texas 78756-3199 (512)458-7111 Members of the Board Ron \. Anderson, M.D., Chairman Laurance N. Nickey, M.D., F.A.A.P., Vice-Chairman Bob D. Glaze, D.C., Secretary Johnnie M. Benson, F.A.C.N.H.A. Sister Bernard Marie Borgmeyer, R.N., F.A.C.H.A. Hermas L. Miller Deputy Commissioner Management and Administration Frank Bryant, Jr., M.D., F.A.A.F.P. Joaquin C. Cigarroa, Jr., M.D. Barry D. Cunningham, O.D.S. Ben M. Durr, M.H.A. Dennis K. Mclntosh, D.V.M. Robert D. Moreton, M.O., F.A.C.R. Joe N. Pyle, P.E. Arthur L. Raines, M.O. Isadore Roosth PREFACE Barbara T. Slover, R.Ph. Max M. Stettner, D.O. Edward H. Zunker, O.D. From 1962 to 1971 during the Vietnam conflict, 152,000 Texans serving in the m i l i t a r y forces were exposed to v a r y i n g amounts of herbicides used to kill or d e f o l i a t e plants. Since t h a t t i m e v e t e r a n s have a t t r i b u t e d a n u m b e r of illnesses to Agent Orange which c o n t a i n e d a c o n t a m i n a t i n g chemical (TCCD); known to be highly toxic to animals, yet not well understood in its effects on humans. The T e x a s V e t e r a n s A g e n t O r a n g e A s s i s t a n c e P r o g r a m set into m o t i o n a cooperative program between the Texas Department of Health and the U n i v e r s i t y of Texas System to assist these veterans in establishing claims through pilot clinical studies designed to establish the cause and effect relationship of exposed v e t e r a n s and s u b s e q u e n t h e a l t h p r o b l e m s . The U n i v e r s i t y of Texas Agent Orange Project has selected 248 for study from whom 927 specimens have been a n a l y s e d in the v a r i o u s protocols. To date no f i n a l r e s u l t s of the s t u d i e s have been released since i n t e r p r e t a t i o n of the i n d i v i d u a l s t u d y reports requires correlation with controls and the results of the project as a whole. Activities at the federal level have increased, as evidenced by the activities of the Agent Orange Epidemiological Study at the Centers for Disease Control, the VA Chloracne Task force and completion of the morbidity study phase of the Air Force R a n c h H a n d Study, and the r e l e a s e of the B i r t h D e f e c t S t u d y in Atlanta by the Centers for Disease Control. Robert Bernstein Commissioner of Health �TABLE OF CONTENTS TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH . ANNUAL REPORT August 1985 Status Report and Data Sheet, July 31, 1985 Summary of Pilot Studies Protocols (FY 84-85 studies) Report on "Development and Preliminary Results of Pilot Clinical Studies, March 26, 1984 (FY 82, 83, 84 studies) Analysis of Major Demographic Statistics, May 3, 1985 (FY 82, 83, 84 studies) Herbicide Status Report by Department of the Army Veterans Health Survey—Report on Agent Orange studies conducted by the Centers for Disease Control, July 1985 �Texas Department of Health 1836-1986 Robert Bernstein, M.D., F.A.C.P. Commissioner 1100 West 49th Street Austin, Texas 78756 (512) 458-Trtr 7251 Robert A. Mac Lean, M.D. Deputy Commissioner Professional Services Hermas L. Miller Deputy Commissioner Management and Administration DATE: TO: FROM: RE: August 5, 1985 INTERESTED INDIVIDUALS AND ORGANIZATIONS HARRIET FRANSON, Program Manager Agent Orange Program TEXAS AGENT ORANGE PROGRAM STATUS REPORT FOR PERIOD ENDING JULY 31, 1985 Enclosed is the Texas Agent Orange Program Status Report for period ending July 31, 1985. This report is cumulative and reflects program activities since the inception of the program on September 1, 1981. As you may be aware, the Texas Legislature this year did not approve continued funding for the Agent Orange Program. Therefore, funding will expire on August 31, 1985 with resulting curtailment of program activities. Program data analyses are anticipated and study results published. It is our understanding that a nationwide search is underway for individuals to assist in the distribution plan for the $180 million settlement fund approved by the New York State Court in the class action suit against the seven chemical companies. Appointments will be made to an Advisory Group for the payment program, an Executive Director, and a Board of Directors for the Foundation. Names with resumes can be forwarded to Kenneth R. Feinberg, Suite 1150, 1575 Eye Street, N.W., Washington, D.C. 20005. The resumes should reflect relevant background and experience (see attached request). �^•-KAYE, SCHOLER, FIERMAN, HAYS & HANDLER 1575 EYE STREET, N.W. NEW YORK OFFICE 4«« PARK AVENUE NEW YORK. N.Y. IOOJI (til) 4 O 7 - 8 O O O FLORIDA OFFICE 125 WORTH AVCNUC PALM BEACH. FLA. J34* WASHINGTON, D.C. 2 O O O 5 CA1LE ADDRESSES KAYEMACLCR WASHINGTON KAYEMACLER NCW YORK (2O2) 783-I2OO TELEX HUMIERS WASHINGTON a»'*S8 NEW YORK DOMESTIC 128911 NEW YORK INTX 234860 HOMO KONG 62818 •AY NX (3O5) 8 J J - 5 I B I MONO KONO OFFICt CDINCUROH TOweft «OYH FLOOR IB OUCCN'S ROAO CENTRl HOMO KONO For Release: June 7, 1985 PRESS RELEASE Kenneth R. Feinberg, the Special Master reappointed by the Court in the Agent Orange litigation to help develop a distribution plan for the Settlement Fund, announced today that a nationwide search for individuals to assist in implementing the distribution plan approved by the Court would be undertaken as the first step in the distribution of the $180 million Fund. The settlement is between the seven defendant chemical companies and the plaintiff class, which consists of those veterans who served in or near Vietnam from 1961 to 1972, who were exposed to Agent Orange and have injuries allegedly related to that exposure. The class also includes spouses and children of the veterans. Over 240,000 claims have been filed with the Court by class members seeking to participate in the settlement distribution. The Court order requires a $150 million cash compensation program for veterans exposed to Agent Orange who are longterm totally disabled or to the families of those who have died, and a $45 million foundation to provide grants for services to the class, including those children of the class members suffering from birth defects. The Court ordered that members of the class play a significant role in the governance of all aspects of the distribution plan. To that end, the Court ordered the Special Master to take appropriate steps leading to the recommendation of names to the Court for appointment to an Advisory Group for the payment program and a Board of Directors of the foundation. Both the Advisory Group and the Board of Directors are to be comprised primarily, but not exclusively, of class members. �KAYE,SCHOLER. FIERMAN, HAYS & HANDLER - 2 - June 7, 1985 The Special Master announced today that he is soliciting names from all interested groups or individuals who would be willing to serve either as an Advisory Group member or on the Board of Directors. The names will then be submitted to the Court for final review and appointment. All Advisors and Board members will serve without compensation, other than reimbursement of reasonable travel and other per diem expenses. The Advisory Group and the Board will be as representative of the class as possible, cutting across economic, social, racial, gender, geographic and occupational lines. Persons with management, investment, budget and foundation experience would be particularly desirable as members. Resumes showing relevant background and experience should be included with any suggestions of persons for consideration. In another aspect of the outreach effort, Mr. Peinberg announced that a nationwide search would begin for an experienced professional to serve as Executive Director of the foundation. The Executive Director would administer the day-to-day operations of the foundation and would be compensated from the Fund. The Court will initially appoint the Executive Director, who will then serve at the pleasure of the Board of Directors. All inquiries or suggestions for the Advisory Group, the Board of Directors or the Executive Director should be directed, in writing with supporting data, to Kenneth R. Peinberg, Suite 1150, 1575 Eye Street, N.W., Washington, DC 20005. The final outreach effort announced by the Special Master*is the solicitation of insurance companies or other parties interested in bidding on contracts to implement the $150 million payment program. Contracts .for claims processing, investment consulting, claims adjudication, and auditing will be finalized by the Court within the next few months. Contractors interested in receiving bid specifications or in obtaining information concerning the payment program should contact, in writing, Lawrence B. Novey, consultant to the Special Master, who can be reached at the same address as Mr. Feinberg. �IfcAAbUtPAKIMtlN I Uh HtALI H AUSTIN THROUGH: CHIEF, BUREAU OF EPIDEMIOLOGY THROUGH: ASSOCIATE COMMISSIONER FOR PREVENTABLE DISEASES FROM TEXAS INTER-OFFICE THROUGH: DEPUTY COMMISSIONER FOR PROFESSIONAL SERVICES GEORGE R. ANDERSON, M.D. OCCUPATIONAL MEDICINE AND TOXICOLOGY/ AGENT ORANGE PROGRAM Robert Bernstein, M.D., F.A.C.P. Commissioner of Health TO Page 1 SUBJECT TEXAS VETERANS AGENT_ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, 1985 REFERRALS No. of veterans referred into the program this reporting period (No.-of deceased veterans—1: TOTAL 22) TOTAL TO DATE (6/1/85-7/31/85) 1,962 29 Military and medical records have been requested for all referred veterans: Medical records reviewed to date: (Include VA and civilian records— 105 reviewed this reporting period) 2,073 Military records reviewed to date: (include combat history, DD211, and/or medical—205 reviewed this reporting period) 1,795 No. of veterans referred into program and not in compliance with residency requirements—ineligible 18 CONTACTS Direct contacts from veterans this reporting period 1,352 39 By phone—31 (total to date: 981) By letter—6 (total to date: 326) By visit—2 (total to date: 51) Contact from News Media: Channel 7 TV (Austin) Bryan Eagle (Bryan) 114 Boston Globe Contact from or with other states/countries: Massachusetts (1) Orgeon (1) Washington (1) 287 West Virginia (1) Wisconsin (3) StCNB> DATi _ -CONTINUEDAugust 2, 1985 FORM NO. AG-2-A �TEXAS DEPARTMENI Oh HEALIH AUSTIN TEXAS INTER-OFFICE FROM George R. Anderson, M.D. TO Robert Bernstein, M.D., F.A.C.P. Pa 8e 2 TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, 1983 Continuing contact with Legislative offices (State Representatives Larry Don Shaw 4 Jerry Yost) Office of the Governor, Office of the Attorney General, State Auditor, Congressman J.J. Pickle, Texas Department of Corrections, Texas Veterans Affairs Commission, Texas Land Commission, U n i v e r s i t y of Texas System, V e t e r a n ' s A d m i n i s t r a t i o n , Vet Centers, Military Personnel Records Center, County Veteran Services Officers, Local Health D e p a r t m e n t s / C l i n i c s , Other State Agent Orange offices, counseling services/physicians/hospitals, veterans' organizations, Dow Chemical Company, law firms, and students 9 f o l l o w u p letters were sent this reporting period to veterans who p r e v i o u s l y inquired about the program but not yet participating. (TOTAL TO DATE: 684) Made/mailed 112 followup phone calls/letters to check on military/medical records requested but not yet received. (TOTAL TO DATE: 1,851) One feedback letter was sent this reporting period to v e t e r a n in our program to apprise him of the status of his case ( m i l i t a r y / m e d i c a l records received, pending, etc.). (TOTAL TO DATE: 540) 10 veterans in the program requested or were placed on inactive status this r e p o r t i n g period, p r i m a r i l y due to i n d i v i d u a l s m o v i n g w i t h no forwarding addressess available (TOTAL TO DATE: 127) Inactive veterans resuming participation in the program. (TOTAL TO DATE: 6) In response to our m a i l i n g to Texas v e t e r a n s on the VA Agent Orange Registry received 0 completed questionnaire (TOTAL TO DATE: 1,511) of which 0 asked to be registered with the Texas Agent Orange Program (TOTAL TO DATE: 1,217). 5 veterans requested and were sent copies of case file records, in preparation for filing a claim: (TOTAL TO DATE: 27) SIGNED DATE -CONTINUEDAugust 2, 1985 FORM NO. AG-2-A �UtrAKIMtIN I Oh HtALI M AUSTIN TEXAS INTER-OFFICE HIOM George R. Anderson, JJ.JK TO Robert Bernstein, M.D., F.A.C.P. SUBJECT TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY"31,1985 Page 3 PROTOCOL STUDIES The second phase of the clinical studies has begun, with the following studies conducted this fiscal year: Cytogenetics at UTS CANCER CENTER, Houston, by Dr. Hsu Bleomycin Test at UTS, CANCER CENTER, Houston, by Dr. Hsu Immune Profile at UT HEALTH SCIENCE CENTER, Houston, by Dr. Kerman Uroporphyrins at UT HEALTH SCIENCE CENTER, Houston, by Dr. Kerman Aryl Hydrocarbon Hydroxylase Induction at UT MEDICAL BRANCH, Galveston, by Dr. Ward The protocols were published in summary and complete format. Questionnaires received from selected veterans and proposed controls continue to be reviewed to establish proper matching of veterans with controls. 17 volunteer control questionnaires for the Agent Orange clinical studies were received. (TOTAL TO DATE: 148, of which 1 is TDH employee. Contacts made with selected veterans and controls to make appointments for the collection of specimens. Contacts made with the clinics/laboratories where specimens collected/delivered. are to be 53 appointments arranged for the collection of specimens (TOTAL TO DATE: 304). Total specimens collected for the 2nd/3rd collection of specimens for the Sperm Study (TOTAL TO DATE: 232). No reminder letters were sent re. collection of specimens (TOTAL TO DATE: 31). Collection of specimens for the Sperm Study is now completed. SIGNED DATE -CONTINUEDAugust 2. 1985 FORM NO. AG-2-A �ItAAS LJtrAKIMtlNI UMItALIH AUSTIN TEXAS INTER-OFFICE George R. Anderson. M.D. reOM SUBJECT TO Robert Bernstein, M.D., F.A.C.P. Pa 8e 4 TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING~TULY 31, 1985 111 letters were mailed to veterans concerning their participation in the clinical studies (TOTAL TO DATE: 159) and 55 to proposed controls (TOTAL TO DATE: 226). Number of specimens collected and shipped to UTS: (6/1/85-7/31/85) TOTAL TO DATE " CYTOGENETICS STUDY 23 238 IMMUNE SUPPRESSION STUDY UROPORPHYRIN AHH (Enzymes) SPERM STUDY SPECIMEN N O . 2 SPECIMEN N O . 3 23 23 13 0 237 72 58 126 FAT TISSUE SPECIMEN 0 0 9 9 0 9 5 2 Two v e t e r a n / c o n t r o l s requested and were given results of i n d i v i d u a l study specimens analyses. (TOTAL TO DATE: 156) SELECTION PROCESS FOR REFERRAL TO THE UTS SYSTEM Review of cases is an ongoing process for eventual referral to the Agent Orange Selection Committee—700 were reviewed this period for referral to the committee. To d a t e the Selection C o m m i t t e e has r e v i e w e d 1,103 cases (117 being r e v i e w e d more than once), of w h i c h 2U8 have been selected for the clinical studies (of which 126 are for inclusion in the second study phase). 95 v e t e r a n s have also been selected as possible low-risk controls. BROCHURES/POSTERS To date a p p r o x i m a t e l y 35,500 brochures and 7,726 posters have been mailed. In addition to individual requests, brochures and posters have been p r o v i d e d to v e t e r a n s ' o r g a n i z a t i o n s , c o u n t y service o f f i c e r s , clinics/hospitals, and other states. SIGNED DATE -CONTINUEDAugust 2. 1985 FORM NO A<-,-•>. A �UtrAK I /VltIN I Ur MtALI M AUSTIN TEXAS INTER-OFFICE FROM George R. Anderson^J1.JK ____ TO Robert Bernstein, M.D., F.A.C.P. SUBJtCT _ J^MO^l^liy^AGjra^ ____ STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, Page 5 MAINTAINING STATISTICAL INFORMATION I n f o r m a t i o n is compiled each m o n t h from case files concerning the following medical conditions reported and substantiated by medical records. This information is provided to the Agent Orange Selection Committee and becomes part of our data information. Such information will be compiled for other medical conditions as the need arises. Cancer in Veterans Under Age 36 Cancer in Veterans Over Age 36 Tingling/Numbness in Extremities Post Traumatic Stress Disorder (PTSD) Current Rashes Children with Leg Deformities Miscarriages/Stillbirths Schizophrenia Diagnoses continue to be coded w i t h I n t e r n a t i o n a l Code for c o m p u t e r entry. AGENT ORANGE ADVISORY COMMITEE No meetings were held during this reporting period. SPECIAL ACTIVITIES Continue review of available literature for research on Agent Orange and related topics. Continue to purchase publications for reference library. E x t r a c t i o n of statistical data from case files concerning specific military data and medical conditions, etc. Utilize word processor for the storage/retrieval of data and for multiple reproduction of originally-typed letters when form letters are not warranted. In-house t r a i n i n g on use of computer equipment for R i c h a r d Smith and Harriet Franson (d-Base and Software Users Group) continues. SIGNED DATE -CONTINUEDAugust 2. 1985 FORM NO. AG-2-A �i CA/\a i>cr/m i IVICIN i isrncs\Lin AUSTIN TEXAS INTER-OFFICE FROM George R. Anderson. M.D. _________ TO Robert Bernstein, M.D. , F.A.C.P. SUBJECT TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, 1985 _ Pa 8e _____ 6 Received "Wisconsin Vietnam Veteran Mortality Study" for review Ongoing communication with other state Agent Orange Commissions/Programs as their representative on the VA Advisory Committee on Health-Related Effects of Herbicides. One summer employee is assisting with coding and data entry for the Epidemiological Study. A senior citizen volunteer is also assisting the program on a limited basis. MAJOR ACCOMPLISHMENTS 1. Number of veterans in the program has increased to 1,962 — an increase of 1,565 since the beginning of FY 84. 2. To date 1,243 cases have been reviewed by the Subject Selection Committee, of which over 248 have been selected for referral to the U n i v e r s i t y of Texas clinical studies. A total of 906 blood/sperm specimens have been collected and shipped to the U n i v e r s i t y of Texas System laboratories and one fat tissue shipped for analysis in the V.A./E.P.A. Study of Dioxin Levels in Human Adipose Tissue. MEETINGS ATTENDED None attended or scheduled. Attachment — Data Sheet cc: Agent Orange Selection Committee Agent Orange Advisory Committee Veterans' Organizations and other • interested individuals SIGNED DATE August 2, 1985 FORM NO. AG-2-A �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH DATA SHEET (as of July 31, 1985) NOTE: Variation in totals is due to receipt of only questionnaires to date and/or lack of medical/military information. \ In some instances, the initial complaint and those listed under "Other Medical Problems" were supplied by the veteran rather than a physician. BY (When entering AGE program) 29 30 2 7 32 33 34 35 36 37 38 39 40 II 74 117 134 169 120 97 72 56 BY SEX MALE BY SERVICE Army FEMALE 4 791 Air Force 1958 118 Marines 193 BY RACE WHITE BLACK 244 HISPANIC NaVy 733 277 41 31 42 43 44 45 46 47 48 49 50 36 20 30 25 17 17 16 20 20 51 52 23 20 NO. OF DECEASED VETERANS REPORTED INTO THE PROGRAM 53 54 55 56 57 58 5 9 60 61 20 15 9 11 7 9 8 3 1 ' OTHER 9 NO. REPORTED INTO THE PROGRAM AND DETERMINED NOT TO BE ELIGIBLE ' ' ' 62 5 1 1 2 3 1 1 1 PROGRAM AND RESIDING IN ANOTHER STATE 18 NO. REPORTED INTO THE 63 64 65 66 68 70 72 22 I 26 5? �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) BYjCOUNTY Anderson 5 Andrews 1 Angelina 1 Aransas 3 Bandera 3 Bastrop 14 Bee 3 Bell 50 Bexar 101 Bosque 3 Bowie 9 Brazoria 12 Brazos 8 Brooks 1 Brown 1 Burleson 3 Burnet 5 Calhoun 2 Callahan 2 Cameron 13 Cass 5 Castro 2 Chambers 1 Cherokee 5 Collin 7 Collingworth 2 Comal 3 Concho 1 Cooke 4 Coryell Crockett Dallas Deaf Smith Denton Dewitt Dimmit Donley Duval Ector Ellis El Paso Falls Far-.nin Fayette Fisher Fort Bend Gaines Galveston 10 1 104 1 6 1 1 2 1 6 3 109 3 2 2 1 7 2 21 Goliad Grayson Gregg Guadalupe Hale Hamilton Hardeman Hardin Harris Harrison Haskell Hays Henderson Hidalgo Hill Hockley Hood Hopkins Howard Hunt Hutchinson Jackson Jasper Jefferson Jim Wells Johnson Karnes Kaufman Kendall Kerr Kimble Kleberg Lamar Lamb Lampasas Lavaca Leon Liberty Llano Lubbock Lynn Marion Matagorda Maverick McCullock McLennan Medina Midland 2 11 3 2 1 1 1 2 118 3 1 2 2 26 2 1 2 2 4 6 1 1 1 15 5 5 1 7 2 5 1 3 2 1 3 3 1 6 2 12 1 2 2 1 1 9 2 6 Milam Montague Montgomery Moore Morris Nacogdoches Navarro Newton Nueces Ochiltree Orange Palo Pinto Parker Parmer Potter Randall Reeves Richmond Robertson Rusk San Jacinto San Patricio Shelby Smith Starr Tarrant Taylor Tom Green Travis Tyler Upshur Uvalde Val Verde Van Zandt Victoria Walker Ward Webb Wharton Wichita Wilbarger Willacy Williamson Wilson Winkler Wise Wood Young Zapata 2 1 8 1 1 1 2 'I 53 1 9 1 3 1 10 5 1 1 1 3 2 12 1 6 1 71 3 5 82 1 6 3 6 4 7 38 4 6 1 11 1 1 14 2 1 5 2 1 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DUTY PERFORMED DUTY PERFORMED Accounting Specialist Administrative Specialist Administrative & Supply ADP Officer Aerial Photo Interpretator Airborne Infantry Aircraft Technician Air Crew Air Frame Repair Specialist Air Mobile Air policeman Air Operation Supervisor/Spec. Air Traffic Control Ammunition Ammo Cargo Handler Armor Unit Artillery Base Maintenance Battalion Clerk Boatswain Mate Calibration Team Technician Career Counselor Cargo Handler Carpenter Chaplain Chemical Operations Combat Cook Combat Engineer Combat Military Police Combat News Correspondent Communications Specialist Construction Controller Convoy Escort Corpsman Counterinsurgency Specialist Courier Coxswain Crane Operator Crew Chief Deck Force Demolition Expert Dining Facility Manager Engineering Equipment Repair Explosives Finance Firefighter Food Service Forward Air Control Freight Handler Grave Registration Ground Crew Guard Gunfire Spotter 1 10 5 1 2 3 42 71 1 2 1 1 2 6 2 12 62 1 2 5 1 2 6 3 3 11 20 22 1 1 30 10 1 4 7 1 1 1 1 5 2 3 2 15 4 2 3 2 Gunner's Mate Harbor Defense Infantry Inspector General Intelligence Interrogator Investigator, Narcotic Journalist Lineman Machinist Maintenance Mechanic Medic Medical Advisor Medical Clerk Medical Corps Mess Steward Meteorologist Military Advisor Military Police Musician NCO Neuropsy Specialist Nurse Operator, Heavy Equipment Paratrooper Personnel Officer Petroleum Storage Supply Photographer Pilot Platoon Leader Plumber Polelinetnan Powerlineman Printer Guard Psychological Operations Radar Operator Radio Operator Radio Repair (field) Recon. Infantry Recon. Forward Observer River Rat 3 6 2 1 4 6 1 1 7 1 456 1 18 2 1 1 4 1 20 32 24 4 1 2 1 1 2 17 1 1 1 3 11 3 4 4 2 16 6 3 1 2 1 3 4 9 3 5 11 3 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS.DEPARTMENT OF HEALTH, AUSTIN, TEXAS DUTY PERFORMED Sea Bees Security Guard Sergeant/Clerk Ship Crew Ship Engine Man Signal Corps Small Missile Repairman Social Worker Physical Specialist Special Forces Advisory Group Supply Sergeant Supply Specialist Support Battalion Switchboard Operator Tank Crewman Telephone Repair Translator/Interpreter Transportation Truck Driver Tunnel Rat Warehouseman Watercraft Operator Weapons Mechanic Wireman 3 5 2 2 1 9 1 1 6 21 36 11 1 9 2 1 23 33 1 4 1 2 5 NO OF VETERANS REPORTING MISCARRIAGES/STILLBIRTHS 329 NO OF VETERANS REPORTING CHILDREN WITH BIRTH DEFECTS ' AND/OR MEDICAL PROBLEMS PRESENT SINCE BIRTH 307 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) CURRENT OCCUPATION CURRENT ^OCCUPATION Accountant Active Duty . Administrative Aircraft Air Conditioning/Refrig. Contractor Apartment Manager Applied Research Lab Army Depot Attorney Automotive Banking Barber Bellman Biomedical Engineering Technician Border Patrol Building Inspector Cable Company Carpenter Carpet Installer Cement Company Chemical Company Child Care Chrome Plater City Employee Civil Service Clergy Clerical Computers Construction Consultant Cook Correctional Institution Counselor Cowboy Custodian Disability Examiner Disabled, medically unemployed Draftsman Editor, publication Education Specialist Electrical Supply Electrician Electrician, Naval Aviation 11 3 34 13 4 2 1 4 3 1 2 3 1 2 1 1 4 18 1 1 6 2 1 8 8 3 8 6 28 5 5 1 2 2 11 1 96 3 1 1 1 14 1 Electric Technician Electronics Technician Employment Interviewer Engineering Environmentalist Equipment Operator Executive Executive, Oil Field Fence Builder Firebrick Company Fire Dept. Fisherman Floor Finisher Food Service Funeral Home Furniture Restoration Gas pipeline operator Glazier Grocer Hair Stylist Helicopter Technician Highway Dept. Inmate Inspector Quality Control Insurance Claims/Agent Investigator, State Ironworker IRS Laborer Laundry Lawman Legal Assistant Library Lineman Lumber Mill Worker 3 14 1 6 1 15 3 1 1 1 9 2 1 7 2 1 1 2 1 1 1 1 46 2 8 5 4 1 14 2 27 1 1 4 2 Machinist 18 Maintenance Management Analyst Meat Packer Mechanic Medical Assistant Medical Lab Tech. Military Base Millwright Mobile Court Owner Musician Newspaper Carrier 19 1 1 52 1 1 1 3 1 1 1 Nurse 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31 • 1985) CURRENT OCCUPATION CURRENT OCCUPATION <;ti short Oil Oilfield Operating Room Technician Optometry Oxygen Plant Painter Parks Service Pest Control Pharmacy Tech. Photographer Physical Therapist Physician Pipefitter Planner Estimator Plant Operator Plumber Porter Post Office Printer Private Investigator Probation Officer Production Psychologist Purchasing Railroad Ranching/Farming Real Estate Recruiter (service) Refinery/Boilermaker Rehabilitation Center Repair electrical equipment Retired Sales Sanitarian Sawmill Operation Seaman Security Self-Employed Service Station Shipping Clerk Shrimper Silver Smith Slaughterhouse Speech Therapist State Employee Steel Company Stocker 3 12 1 1 1 4 1 1 3 2 1 3 5 1 4 12 1 53 5 2 3 1 1 1 13 4 3 1 5 5 1 24 48 1 1 1 24 11 2 5 1 1 1 1 1 7 1 Store Manager Student Supervisor, Computer Supervisor, Production Supply Clerk Teacher Telephone Company Tool & Dye Tree Surgeon Typewriter Repair Unemployed Upholsterer Utility Company Vehicle Driver Warehouseman Welder Woodworker Writer '"> 14 4 9 1 18 7 1 1 1 110 2 6 63 13 26 4 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) INITIAL COMPLAINT (as reported by the veteran) Abdominal Pain Acne Allergies Anxiety Apnea (shortness of breath) Arthritis Asphyxia Asthenia (weakness) Atrophy Back Pain Birth Defect, child Blackouts Blood Disorders Body Aches Cancer Chest Pain Chloracne Confusion Constipation Cysts Depression Diabetes Diarrhea Dizziness Dysphasia (speech impairment) Dyspnea (labored breathing) Edema Emotional Problems Epilepsy Fatigue Fever, recurring Gastritis, chronic Gastrointestinal disorders Hair LOSS Headaches Heart murmur Hematoma Hepatitis, recurrent Hepatomegalia Hives Hyperlipidemia Hypertension Infected prostate Infections 3 17 6 12 10 8 1 9 1 6 37 2 10 4 62 15 10 1 2 9 17 1 9 13 1 4 11 52 1 10 5 1 84 7 107 1 1 2 1 2 1 24 2 11 Itching Joint pain Kidney Lesions Lethargy Liver damage Liver pain Loss of appetite Low potassium level Low resistance to disease Lumps on body Lumps in scrotum Lung disease Memory impairment Miscarriage Multiple sclerosis Muscle spasms Nausea Nerve problems Neuralgia (nerve pain) Numbness Paralysis, extremities Personality change Pneumothorax Pruritus, intense (itching) Rages Rash Rectal bleeding Renal failure, chronic Respiratory problems Reversed sperm travel Seizures Sensorial impairments Sexual problems Skin infection Skin blistering/peeling Skin pigmentation, loss of Sleeplessness Sores/boils Sore throat, chronic Sperm count—low Stroke Sunlight allergy Tendenitis 17 28 10 10 3 17 4 2 2 3 21 1 4 8 7 3 7 2 100 1 123 4 2 1 1 2 524 5 1 5 1 5 1 35 13 36 10 55 18 3 4 1 2 1 Tingling in extremities Tumors, skin Vomiting blood Ulcer Urination frequency Visual disturbance Weight loss/gain Withdrawal regression 42 5 5 8 5 11 5 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) PIAG_NOSIS T(JDx)—as reported by physician Aberrant innervation of third cranial nerve (child) Acalculous choleystitis Acre Acre keloidalis ruchae Acrocyanosis Acrokeratosis verrucofomis Actonic keratoses Adenoma, villous Agent orange symptomatology Alcoholism Allergic rhinitis Alopecia areata Amebic liver abscess Amputation, fingers, congential (chlla) Anemia Ankylosis spondylitis Anxiety, chronic Anxiety neurosis Aortic insufficiency Apnea (cessation of breath) Arteriosclerosis, advanced (carotids & femorals) Arthralgias (joint pain) Arthritis Arthritis, cervical Arthritis, degenerative Arthritis, gouty Arthritis, poly, seronegative Arthritis, post-traumatic Arthritis, rheumatoid Arthritic changes of joints Aspermia Asthma Atherosclerotic occlusive peripheral vascular disease Atrophy of kidney Azoospermia Baker's cyst Barlow's syndrome Bell's palsy Bilateral acanthosis Bilateral internal tibial torsion (child) Bilateral rnetatarus adductus (child) Bilateral mandibular tori 1 1 10 1 1 1 1 1 2 15 2 3 1 1 4 2 17 11 1 5 2 12 16 5 12 5 1 3 2 1 1 1 1 1 3 1 .1 1 1 2 1 1 Bilaterial calycealcalculi Bilateral supernumerary fingers, non-boney (child) Bipolar disorder Bowen's disease Brain syndrome, chronic Bronchitis, chronic Bullous emphysema Buerger's disease Bursitis Calcaneovarus deformity of feet (child) Cancer (Neoplasra)-total 74 Adenocarcinoma of esophagus Adenocarcinoma of rectum stage Dukes C w/ 5/15 lymph nodes positive for Ca Adenocarcinoma of rectum, Duke C Adenocarcinoma of rectum w/seeding of pararectal fat Adenocarcinoma of sigmoid colon Adenocarcinoma of sigmoid colon with metastasis Basal cell Bladder, low grade Bronchogenic carcinoma, squamous cell Carcincoma of esophagus Carcinoma of rectum w/metastasis to liver Differentiated lymphocytic lymphoma, nodular type, Stage 4 w/widespread metastasis Diffuse bilateral adenocarcinoma w/metastases multiple areas bone/brain Embryonal cell carcinoma, Stage 1 w/teratoma, left testicle Epidermoid carcinoma of esophagus Esophagus Fibrohistiocytoma (leg) Giant cell tumor of bone Glioblastoma multiforme, brain Hodgkin's disease Larynx Malignant melanoma Metastatic carcinoma in hilar lymph node Metastatic embryonal cell carcinoma (testis) 1 1 1 1 1 8 1 2 3 1 1 1 1 1 1 4 8 1 1 1 1 1 1 1 1 2 1 1 1 2 2 3 1 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNOSIS (Dx)—as^reggrted by physician Metastatic malignant melanoma, bowel and subcutaneous tissue/ renal cell carcinoma, left kidney 1 Metastatic melanoma lesion, right parieto-occipital 1 Metastatic squamous carcinoma to scalene node 1 Mixoid liposarcoma w/chest & spine metastasis 1 Myeloma, multiple 1 Nasopharyngeal carcinoma 1 Neoplasm, malignant (transitional cell carcinoma) kidney 1 Oat cell Ca of lung w/liver & bone metastasis 1 Papillary (transitional cell carcinoma, Grade I) of bladder 1 Pituitary adenoma (brain) chromophobe type w/hypopituitarism 1 Plasmacytoma ilium, recurrent 1 Renal cell carcinoma 3 Right apiccal, large cell Ca w/ resultant Homer's syndrome 1 Right breast 1 Sarcoma, left leg 1 Semiroma, right testis 4 Squamous cell carcinoma of ear (epidermoid carcinoma) 1 Squamous cell of lung 4 Squamous cell carcinoma of anus, keratinizing 1 Squamous cell carcinoma of larynx, keratinizing, Grade I, invasive 1 Squamous cell carcinoma of pinna of ear 1 Testicular 3 Transitional cell carcinoma of bladder, Grade III 2 Undifferentiated liver carcinoma 1 Capillary hemangioma 1 Cardiomegaly 1 Carpal tunnel syndrome 3 Cataplexy 1 Cephalhematoma of foot postional deformity (child) 1 Cerebellar atrophy 2 Cerebellar tumor (child) 1 Cerebello insufficiency Cerebral convulsive disorder Cerebral palsy (child) Cervical adenopathy Charcot-Mar ie-Tooth Chest pain syndrome Chloracne Cholecystitis, chronic Chondromalacia, patella Chronic infection and subcutaneous papular eruption Chronic sclerosing glomerulonephritis Cirrhosis of liver Cleft palate (child) Club-Foot (child) Coagulopathy Colitis Collagen disorder Colon, mass in Colon, spastic Congential absence of tibia (child) Congenital athyriotic hypothyroidism (child) Congential dislocation of hip (child) Congenital heart disease, pulmonary valve artresia (child) Congenital polyneuropathy (child) Condyloma accuminata Congestive heart failure Constipation Convergence insufficiency by Hx Conversion reaction (numbness) Coronary Artery Disease S/P/ Coronary atherosclerosis Costochondritis Crohn's disease Crouzon1s disease (child) Cyst, sebaceous Cyst, vocal cord Degenerated nucleus pulposus Degenerative changes in joint Demorphic erythrocytosis Demyelination of peripheral nerves Depression atypical Depression w/anxiety Depression, endogenous 1 1 3 2 1 1 5 2 2 1 4 2 2 1 4 1 1 1 1 1 1 1 2 1 1 2 1 1 1 1 3 1 1 6 1 1 5 1 1 2 24 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) PI^JL^l^-J^l"!"3.^^reported by physician Depression syndrome, chronic Depressive disorder Depressive neurosis Dermatitis, l)f:rm-'i+,Ltis , '.i'-r'!.•>'-.: \. -,, .><• •r,;.-M MS, atopic ohroric V'r.taot <:r ythematous Dermatitis, perineal Dermatitis, photosensitivity Dermatitis, pruritis Dermatitis, scaly . _ Dermatitis, seborrheic .-., Dermatofibromas Dermatophytosis, recurrent Diabetes Diabetes mellitus Diastematomyelia (child) Dumping syndrome Duodenitis Dysethesias, diffuse Dyshidrosis (disorder of sweat glands) Dysmethic disorder Dysphasia Dyspnea Ecchymosis of legs Ecthyma Eczema Eczema, atopic Eczema, seborrheic Eczematous lesions Emphysema Encephalopathy End stage renal disease Eosinophilia Ependymoma, cerebellar (child) Epididymitis Epilepsy, idiopathic Epilepsy (child) Epistaxis, recurrent (child) Erythema multiforma Erythematous macular Erythematous papular Erythematous, resolving Esophagitis Esophoria (child) Exfoliative erythroderma . Extrarenal Wilms tumor (child) 3 3 4 5 14 6 3 1 2 3 1 11 6 3 4 17 1 1 1 1 4 6 1 3 1 2 12 4 2 5 4 2 1 1 1 7 1 3 1 2 4 1 2 1 1 1 1 10 Fatigue Fatty Metamorphosis Feet turned inward (child) Fibroepithelial papilloma Fibromas Fibromyalgia Fibromyositis syndrome Fibrosis Folliculitis Forefoot Adductus (child) Fundoplasty Furunculos.is (boils) Gastritis, chronic Gastroenteritis Gastroesophageal. reflux Globus heptericus Glomerulonephritis Granulatoma, -fit. scrotum Granuloma Granuloma Annulase Granulomatous colitis Granulomatous pulmonary disease Granulomatous skin lesions Granulomatous ulcer Guillain Barre Syndrome Gynecomastia, breast Headaches Headaches, cluster Headaches, vascular Hematoma Hematuria Hemoptysis, chronic Hemorrhoids Hemorrhaphies, bilateral inguinal Hepatitis, infectious Hepatocellular degeneration, focal Hepatocellular dysfunction Hepatomegaly Hernia Hernia, hiatal Hernia, inguinal Hernia, inguinal indirect (child) Herpes simplex Herpes zoster Hidrosadenitis, chronic, supprative (inflammation of sweat glands) 1 1 1 1 1 l 1 1 15 1 1 3 12 2 2 1 4 1 1 1 1 1 1 1 3 3 16 1 12 1 5 2 18 2 4 1 1 2 2 8 7 1 1 2 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNOSIS (Dx)—as reported by physician 1 Hilar adenopathy w/calcification Hyaline membrane disease (child) 2 1 Hydrocele 2 Hydrocephalus (child) 1 Hygroma, cystic (child) 1 Hyperanxiety 1 Hyperbilirubinemia 1 Hypercalciuria 1 Hypercholesterum Hyperlipidemia 3 Hyper pigmental scaly plaques 3 1 Hyper pigmentation 2 Hypersomnia Hypertension 59 2 Hyperthesia, extremities 1 Hyperlipemia 1 Hyperlipoproteinemia (Type IV) Hyperthyroidism (child 1) Hypertryglycerdemia (Type IV) Hyperuricemia 1 Hypochondriasis Hypoglycemia 5 1 Hypopigmented areas (face) 1 Hypoplastic breast (child) 1 Hypospadias (child) Hypotension 3 1 Hypotonia (child) 1 Hysteronic personality Infection, persistent, soft tissue (child) Infundible pulmonary 1 stenosis (child) 1 Iritis, chronic Joint disease, degenerative 2 (of back) 1 Joint pain, peripheral 1 Keratitis 1 Keratoderma 1 Left spastic hemiparesis Leukemia, acute, lymphocytic 2 (child) 2 Leukemia, myelogenous, chronic Leukocytosis w/atypical lymphocytos 1 Lichen planus 3 Lichen simplex chronicus 3 Lipoma 13 1 Lipoma, cyst in lumbar area 2 Lipoma, spermatic cord II Liver pain Lumber sprain Lung disease, severe, chronic, obstructive Lupus, discoid Lupus erythematosis Lymphodenitis, chronic Lymphoid hyperplasia Lymphopranuloma inguinale Macular melasna Maculo-erythematous (rash) Mastoiditis, chronic sclerosing Meniere's disease Meningitis, cryptococcus Meningomyelocele (child) Mental Retardation (child) Metatarsus adductus (w/medial tibial torsion) (child) Microtia of ear (child) Microcephaly (child) Missing pectoralis (left) major muscle (child) Multiple sclerosis Musculoskeletal condition Myelomeningocele, lumbrosral (child) Myocardial infarction, acute Myofacial pain Narcolepsy Nephrolithiasis Neuralgias Neuralgia w/headache and recurrent fever Neurasthenia Neuritis Neurodermatitis Neuroma Neurosis, depressive Numbness in extremities Numbness ulnar aspect upper extremities Oligohydramnias (child) Oligospermia Onchomycosis Organic brain syndrome Osgood-Schlatter's disease (knee) Osler-Weber-Rondu disease Osteoarthritis, cervical 1 1 1 1 3 1 1 1 1 2 1 1 2 1 1 2 2 1 1 1 1 1 2 1 1 1 2 1 1 1 8 1 3 14 1 1 2 5 2 1 1 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNQ3IS-(Dx)—as reported _by_ physician Osteoarthritis, degenerative Osteoarthrosis, degenerative Osteomylitis Pancreatitis, hyperlipidemia, chronic Papilloma Papular squamous rash Paralysis of vocal chords Paranoid schizophrenia disorder Paranoid state Parapsoriasis Parasthesias of extremities Paroxysmal atrial tachycardia Patent ductus arteriosus (child) Patent ductus arterosis of formen ovale cordus (child) Peptic esophagitis Peroneal palsy Peripheral neuropathy Peripheral ulnar palsy Personality disorder Peyronie's disease Photosensitivity Pityriasis alba Pityriasis rubra pilaris Pityriasis versicolor Plantar, hyperkeratosis, mild Pleural scarring Pneumothorax Pneumothorax, spontaneous Polyarthralgia Polyneuropathies Polyps, nasal/vocal cords Porphyria Porphyria cutanea tarda Posterior cervical pain Post traumatic stress syndrome Premature ejaculation Proctitis, inflammatory Prostatitis, chronic Proteinuria Pruritis Pruritus/onychomycosis of extremities Pseudofolliculitis Psoriasiform lichen simplex chronicus Psoriasis Psychosis, major 4 1 1 1 2 2 1 3 1 1 3 1 2 1 1 1 5 1 11 2 1 1 2 1 1 1 4 5 2 1 4 1 3 1 71 1 2 16 1 13 1 3 1 13 1 Psychotic depressive reaction (child 1) Pulmonary atresia Pulmonary disease, chronic obstructive Pulmonary emboli, massive Pulmonary embolism, ASC VC CVI Pulmonary nodule Pustules, recurrent Pyelonephritis Pylorospasm Radicular neuropathy Rash Rash, maculopapular Raynaud's phenomenon Reiter 1 s disease Renal glycasuria (no diabetes) Rhinitis Sarcoidosis Schizoid disorder Schizophrenia Schizophrenia, chronic, undifferentiated type Schizophrenia, paranoid Schizophrenia, schizo-affective type Schizo-type disorder Sciatica Scleroderma Scoliosis (child) Sebaceous cyst abscess Seborrhea Seizure disorder Soto's Syndrome (child) (cerebral gigantism) Spermatocelectomy Spermatoceles Sperm count, low Spina bifida (child) Spondylolisthesis Spondylosis Stenosis of larynx Sterility Stress syndrome Supple pes planus (child) Syncopy Syndactyly index w/absence and congenital absence of middle phalanx of 4 fingers (child) 3 1 2 1 1 1 2 1 1 1 7 1 2 1 1 3 4 5 19 11 31 3 4 1 1 1 4 12 4 1 1 3 3 4 5 3 1 5 1 1 1 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNOSIS (Dx)—as ^reported by physician Tardive dyskinesia Telangiectasia Tendinitis Tenosynovitis (De Quervain's Disease) Testicular mass Testis, atrophic (child) Thrombocytopenia Tibial torsion of leg (child) Tietze's syndrome Tinea corpis Tinea cruris Tinea cruris pedis w/ onychomycosis Tinea pedis Tinea versicolor Tonsillitis, acute, chronic Transurethral resection Trichophytosis Tricuspid atresia, atrial septal defect, ventricular septal defect (child) Triglycerides, high Tropical fungus Truncal dystonia Ulcer, duodenal Ulcer, peptic Uroporphyria Urticaria, giant, recurrent Varicocele Xerosis of skin (dryness) 1 1 1 1 1 2 1 5 1 12 26 4 12 21 1 1 3 1 3 1 1 15 12 1 1 1 3 /3 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) CANCER IN VETS AGE 36 AND UNDER (substantiated by medical records) Case // A§e When Dx #13 #15 30 30 #40 #54 #98 (#106 31 31 35 33 (#106 33 #107 29 #121 * 31 #151 #180 * #242 #315 33 36 36 30 (#316 (#316 #469 * 30 33 36 #474 #523 * #551 34 34 25 #603 #621 #631 #676 #1072 #1213 (#1259 (#1259 * * * * * * 23 25 32 36 35 28 36 38 (#1672 (#1672 #1684 * #1732 #1751 * #1900 35 42 32 30 36 35 Type of Cancer/ICD No. Metastatic malignant melanoma 172.9 M8720/6 Squamous cell Ca w/adenocarcinomatous components, rt. lung 162.9 M8070/3 Basal cell Ca 173.9 M8090/3 Ca of esophagus 150.9 M8010/3 Polypoid carcinoma of sigmoid colon 153.9 M8050/3 Renal cell carcinoma, left kidney (died at age 33) 189.0 M8312/3 Metastatic malignant melanoma, bowel & subcutaneous tissue (died at age 33) 172.9 M8720/6 Multiple melanomas, Stage I (died at age 31) 172.9 M8720/3 Diffuse bilateral adenocarcinoma w/metastasis multiple areas bone/brain (died at age 31) 170.9 M8140/6 Ca of esophagus (died at age 34) 150.9 M8010/3 Ca of larynx 161.7 M8010/3 Giant Cell tumor of bone 170.9 M9250/3 Metastatic embryonal cell carcinoma (testis) with pulmonary involvement (died at age 30) 186.9 M9070/6 Basal cell carcinoma 173.9 M8090/3 Seminoma of right testis 186.9 M9061/3 Squamous cell carcinoma of anus, keratinizing 154.3. M8071/3 Seminoma, testis 186.9 M9061/3 Malignant melanoma 172.9 M8720/3 Pituitary adenoma (brain) chromophobe type w/ hypopitutarism 237.0 M8270/0 Basal cell epitheliomas, nose 173.3 M8090/3 Seminoma, right testicle 186.9 M9061/3 Sertoli cell carcinoma, testis 186.9 M8640/3 Seminona, right testis 186.9 M9061/3 Nasopharyngeal carcinoma 147.9 M8010/3 Renal cell carcinoma 189.0 M8312/3 Sarcoma, left leg 170.7 M8800/3 Osteosarcoma left leg w/metastasis right lung 170.7 M9180/6 Malignant melanoma (Level III) w/cerebral metastasis 172.9 M8720/6 Renal cell Ca. 189.0 M8312/3 Plasmacytoma right ilium, recurrent 203.8 M9731/3 Undifferentiated liver carcinoma 155.2 M8020/3 Myxoid liposarcoma w/spine & chest metastasis 171.9 M8852/6 Veterans who have sought treatment at a Veterans Administration Medical facility.for their malignancies. �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH DATA SHEET (as of July 31, 1985) CANCER IN VETS OVER AGE 36 (substantiated by medical records) Case Age When Dx #16 #24 * 51 47 #30 #70 » #76 #146 * #214 53 44 40 41 48 #239 48 #249 53 #295 52 #304 * 41 #360 * 58 #535 #567 * #622 * 39 46 50 #638 #806 * 45 68 #829 46 #890 * #894 * #1041 * 47 46 60 #1053 52 #1089 (#1093 (#1093 #1178 #1182 #1421 50 50 56 60 44 52 #1477 * * * * 41 Renal cell Ca left kidney 189.0 M8312/3 IGA, Multiple myeloma-lumbar spine (died at age 50) 170.2 M9730/3 Ca of lungs, squamous cell 162.9 M8070/3 Transitional cell Ca, Grade I 188.9 M8120/3 Ca breast w/metastasis to axilla 175.0 M8010/6 Basal cell Ca of nose 173.3 M8090/3 Squamous cell Ca anterior fascialpillar 146.2 M8070/3 Neoplasm, malignant (transitional cell carcinoma) right kidney 189.0 M8120/3 Glioblastoma multiforme, brain (died at age 53) 191.9 M9440/3 Squamous cell carcinoma of larynx, keratinizing, Grade I, invasive 161.9 M8070/3 Adenocarcinoma of lung w/brain metastases 162.9 M8140/6 Adenocarcinoma of sigmoid colon metastasized to liver 153.9 M8140/6 Basal cell Ca on scalp 173.9 M8090/3 Testicular cancer 186.9 M8010/3 Bronchogenic carcinoma, squamous cell, poorly differentiated; metastatic carcinoma in hilar lymph node 162.9 M8010/6 Fibrohistiocytoma, leg 170.7 M8831/3 Carcinoma of rectum w'/metastasis to liver 154.1 M8010/6 Metastatic squamous carcinoma to scalene node 195.0 M8070/6 Epidermoid carcinoma left lung 162.9 M8070/3 Epidermoid carcinoma of esophagus 150.9 M8010/3 Adenocarcinoma of sigmoid colon and metastatic to 1 of 3 lymph nodes (Duke C) w/metastasis to liver 153.9 M8140/6 Right apical (lung) large cell Ca w/ resultant Horner's syndrome 162.9 M8012/3 Chronic myelogenous leukemia 205.1 M9863/3 Basal cell epitheliomas 173.9 M8090/3 Bronchogenic carcinoma, left lung 162.9 M8010/3 Adenocarcinoma of rectum, Duke C 154.1 M8140/3 Ca of bladder, low grade 188.9 M8010/3 Adenocarcinoma of sigmoid colon w/metastasis to liver and lymph nodes 153.9 M8140/6 Basal cell carcinoma, nose 173.3 M8090/3 •Veterans who have sought treatment at a Veterans Administration medical facility for their malignancies. �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH DATA SHEET (as of July 31, 1985) CANCER IN VETS OVER AGE 36 (substantiatedI by medical records) Case # Age When Dx #1496 48 #1578 * 50 #1582 48 #1622 #1741 37 44 # 1820 55 #1830 37 #1833 39 #1881 65 Type of Cancer/ICD ^Nq,, Adenocarcinoma of rectum stage D u k e s C w/ 5/15 lymphnodes positive for Ca 154.1 M8140/6 Adencarcinoma of rectum w/seeding of pararectal fat 154.1 M8140/6 Bladder - papillary, transitional cell, grade I 188.9 M8130/3 Adenocarcinoma of esophagus 150.9 M8140/3 Squamous cell Ca of pinna right ear (epidermoid carcinoma) 173.2 M8070/3 Transitional cell Ca og bladder, Stage II 188.9 M8120/3 Differentiated lymphocytic lymphoma nodular type, Stage 4 w/widespread metastasis 202.8 M9620/6 Oat cell Ca of lung w/liver & bone metastasis 162.9 M8042/6 Basal cell Ca 173.9 M8090/3 "Veterans who have sought treatment at a Veterans Administration medical facility for their malignancies. �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) QUESTIONABLE RANGERS (substantiated by medical records) #45 #169 24 29 Granuloma Rt. scrotum Liporna cyst in lumbar area CHILDREN WITH LEG DEFORMITIES (substantiated by medical records) Club-foot, secondary to spina bifida Feet turned inward Congenital absence of rt. tibia Cephalhematoma rt. foot positional deformity at birth Metatarsus adductus w/medial tibial torsion Congenital dislocation of hip Club-Foot/Forefoot Adductus Supple pes pianus Bilateral internal tibial torsion Bilateral metatarsus adductus Metatarsus adductus, right foot Club-foot Short leg Tibial torsion, both legs Calcaneovarus deformity of feet Bilateral internal tibial torsion Tibial torsion of left leg #25 #40 //68 #152 #188 #207 #296 #330 #571 #582 #583 #770 #872 #978 #1603 #1622 #1754 CURRENT JRASHES ^(substantiated .by jrcedical records) No. of cases 62 II �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) TINGLING/NUMBNESS IN EXTREMITIES (substantiated by tnedioal records) Case # Year Dx #14 #22 #37 #41 #85 #119 #145 #192 #195 #206 #211 #212 #224 #229 #267 #306 #338 #341 #389 #415 #422 #423 #450 #500 #872 #1315 #1417 #1758 #1808 #1858 1981 1968 1981 1977 1980 1980/1981 1981 1978 1981 1981 1982 1982 1980 1964 1980 1982 1979 1978 1981 1982 1972 1981 1982 1981 1983 1984 1981 1983 1975 1983 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) MISCARRIAGE/STILLBIRTH (substantiated by medical records) Case // #36 #38 #41 #44 #63 #67 #82 #83 #85 #86 #97 #99 #142 #156 #173 #179 #181 #183 #209 #241 #310 #323 #328 #331 #386 #494 #568 #571 #591 #608 #647 #653 #688 #699 #722 #773 #774 #822 #841 #854 #879 #926 #930 #948 #953 #954 Case # Year Dx 1970 1972 (2) 1973 (2) ? 1980 (2) Between 1974-1981 (2) 1971, 1975, 1978 1974, 1977 1974 1979, 1980 1980 1974 1976, 1978 1976 1972 1970 1971 1978, 1980, 1981 1975 1979 1971,1979 1979 1977 1975 1977, 1980 1976 1983 1976 1982, 1983 1975, 1976 1971 1973 1980 1981, 1982 9 1974 1978, 1973, 1972 1982 1982 1981 1970 1977 1974 1978 1979 1974, 1978 #978 #997 #1019 #1095 #1275 #1278 #1283 #1395 #1421 #1655 #1677 #1754 #1780 #1809 #1821 #1835 Year Dx 1971 1981 1978, 1982 1975, 1976 1975 1976, 1977 1974 1972 1971, 1978 1979 1977 1983 1983 1980 & ? 1971 1968 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) SCHIZOPHRENIA (siftstantiated by medical records) Case # #16 #3^ #43 #47 #123 1125 #128 #139 #144 #164 #190 #229 #232 #238 #245 #248 #253 #256 #294 #301 #361 #371 #378 #381 #397 #401 #405 #431 #449 #455 #463 #552 #564 #565 #571 #634 #635 #809 #838 #841 #872 #953 #967 #101? #1080 #1084 #1107 Year Dx Case # #1183 #1198 #1200 #1291 #1303 #1323 #1336 #1519 #1581 #1625 #1631 #1615 #1669 #1678 #1708 #1718 #1718 #1776 #1871 1971 1976 1980 1981 1978 1974 1981 ? 1979 1977 1983 1982 1979 1982 1982 1968 1976 1975 1970 1971 1969 1970 1976 1976 1972 1971 1973 1971 1981 1971 1972 1972 1970 1969 1971 1977 1970 1967 1982 1981 1980 1981 1982 1976 1980 1982 1981 3.0 Year Dx 1971 1982 1982 1980 1973 1983 1981 1982 1968 1968 1977 1982 1969 ? 1976 1983 1977 1978 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) POST TRAUMATIC STRESS DISORDER (Substantiated by medical records) Case // Year Dx Case # #10 #32 . #50 #60 #78 #104 #128 1141 #173 #177 #223 #229 #270 #278 #298 #310 #361 #362 #364 #365 #366 #367 #378 #388 #430 #446 #449 #456 #459 #489 #600 #603 #623 #663 #697 #775 ? 1981 1981 1982 1982 1982 1982 1982 1982 1982 1982 1982 1982 1982 1982 1981 7 ? 1982 1983 7 7 1982 1982 1983 1982 1981 1982 1983 1981 1980 #1308 #1325 #1327 #1475 #783 #784 #838 #842 #849 #872 #875 #920 #967 #971 1983 1983 1983 1980 1981 1982 1981 1981 1982 1982 1982 1981 1985 1982 1982 #1516 #1541 #1604 #1613 #1776 #1936 Year _Dx 1981 1981 1981 1981 1982 1982 1981 1981 1981 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) OTHER MEDICAL CONDITIONS (as reported by veterans and physicians) Acne 19 Acne, cystic 2 Alcoholism 8 Allergic bronchitis 3 Allergies 19 Alopecia areata (spotty baldness) 1 Anemia, iron deficiency 5 Anorexia 3 Anxiety 23 Apnea (cessation of breath) 16 Arteriosclerosis 3 Arthralgia 1 Arthritis 34 Asthenia (weakness) 35 Asthma 10 Ataxia (lack of muscle coord) 7 Back pain 29 Birth defects/medical problems—child 13 Blackouts 15 Blisters 10 Blood disorders 214 Body cramps/aches 15 Boils 18 Bones, decaying 2 Burning sensation in back/extremities 8 Calcium loss .2 Cancer 44 Chest pains 43 Chloracne 23 Colitis 4 Comedones 1 Constipation 8 Cyst 22 Cyst, retention 2 Delayed healing by first intention 2 Dementia, in remission 1 Depression 86 Dennatitis 6 Diabetes 22 Diarrhea 28 Disruption of circadian rhythms 1 Dizziness 78 Drug addiction 1 Dumping syndrome 2 Dysmorphic erythrocytosis (unusual shape of blood cells) 1 Dyspnea (labored breathing) 11 Dysesthesias, diffuse 1 Ear fungus 1 Ecxema 2 Edema 16 Emotional problems 502 Endocrine problems 1 Epilepsy 1 Fatigue 60 Fat tissue lumps 11 Fever, recurrent 9 Fungus 10 Gall bladder w/mass 1 Gastrointestinal disorders 650 Glands, swollen 4 Gout 7 Growths, skin 32 Hallucinations 3 Hair loss 27 HBsag-Carrier 1 Headaches 566 Hearing problems 29 Heart attack 7 Heart problems 20 Hematuria 2 Hemorrhoids 4 Hepatitis 6 Hepatomegalia 1 Herpes 3 Hirsutism (abnormal body hair growth) 1 Hives 2 Hyperlipidemia 1 Hypertension 80 Hypertension, essential 1 Hypoglycemia 1 Hysteria 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) OTHER_MED^AL^CpNDITIONS> (as^reportedI by veterans and[. Infections, chronic 20 Immuno suppression 3 Irritability 18 Itching 34 Joint pain 83 Kidney problems 24 Liver problems 161 Loss of appetite 11 Loss of concentration 10 Loss of smell 3 LOSS of taste 2 Low blood sugar 3 Lung problems 30 Melanomas 5 Memory loss 69 Meningitis, cryptococal 1 Moles 6 Muscle problems 37 Myocardial infarction, acute inferolateral. 1 Nails fall out 11 Nausea 24 Nerve problems 575 Neuritis, traumatic 1 Nose bleeds 1 Numbness 323 Pancreatitis, chronic 3 Paresthesias of distal arms/legs 3 Peripheral neuropathy 3 Peripheral tumescense (swollen extremities) 3 Personality change 11 Pleurisy, chronic 2 Polyps 1 Porphyria Post traumatic stress disorder Prostatitis Psoriasis Pulmonary embolisms, multiple 3 6 22 1 1 Pulmonary fibrosis 1 Rash 385 Rectal bleeding, history of 29 Renal cysts 1 Reproductive problems 90 Restricted blood flow 7 Rhinitis (nose inflammation) 2 Respiratory problems 25 Seizures 7 Sensitivity to change in heat/cold 6 Sex, pain during 1 Sexual dysfunction 268 Shingles 1 Sinus problems 24 Skin, dryness 23 Skin hyper/hypopigmentation 24 Sleep disturbance 338 Sores 12 Speech problems 1 Sterility 6 Sweating, excessive 5 Tachycardia 2 TB, subclinical 3 Teeth, loss of 3 Throat, sore, chronic 8 Thyroid problems 1 Tingling of extremities 163 Tinitus (ringing in ears) 22 Ulcer 37 Upper respiratory infections (URI) 3 Urinary infections 21 Vascular insufficiency 6 Venous thrombosis, deep 1 Vision, blurred 22 Vision, decreased 27 Vision, sensitivity to light 9 Vomiting 19 Warts 6 Weight loss/gain 43 �SUMMARY of PILOT STUDY PROTOCOLS for the TEXAS VETERANS AGENT ORANGE PROGRAM September 1984 Protocols for four pilot studies have been developed by faculty of the University of Texas for use in the Texas Veterans Agent Orange Program administered by the Texas Department of Health. They are: 1. Cytogenetic/Bleomycin Testing 2. Aryl,Hydrocarbon Hydroxylase (AHH) Assay 3. Immune Evalution of Veterans Exposed to Agent Orange 4. Uroporphyrin Testing These protocols are described in the attached documents. These studies have special subject selection requirements. They also have limitations and pitfalls that should be recognized by everyone interested in the outcome. SUBJECT SELECTION. Interpretation of data gathered by the proposed pilot studies will depend heavily on the criteria and care used in selecting study subjects. Three categories of age-matched study subjects are required: 1) Vietnam veterans (at high risk), 2) Vietnam veterans (at low risk), and 3) unexposed controls. Vietnam Veterans (at high risk). The establishment of a reliable exposure index is critical and very problematical. It may well be impossible to estimate degree, duration, and route of exposure to Agent Orange in most Vietnam veterans. However, it should be possible to identify some Vietnam veterans whose contact with Agent Orange, as reflected in personal histories and verified in military records submitted to the Texas Department of Health, was substantial and prolonged. From among this group of individuals, participants in the pilot studies should be selected on the basis of a detailed personal interview and medical history that would exclude subjects whose present or previous occupation, habits, or lifestyle might introduce obvious confounding factors into the study. -1- �Vietnam VeteransL (at 1j3W_r1_s_k). Veterans whose service records and personal histories indicate an improbable contact with Agent Orange or other herbicides. Obvious confounding factors would exclude these veterans the same as the "high risk". It would be safe to state that in assigning high or low risk that increasing probability of a difference prevails as the size of the total group increases and the number of veterans determined to be in the nonselected medium group increases. Unexposed Controjs. These individuals, selected to exclude confounding factors, will serve as the normal control group for the pilot studies. These individuals are matched for usual factors and may be civilians or non-Vietnam veterans. LIMITATIONS AND PITFALLS. The limitations of the laboratory-based pilot studies should be clearly understood. Some of these limitations are: 1. Uncertainty regarding degree, duration, and route of exposure to Agent Orange in individual study subjects is a major limitation of these studies. Efforts to cope with this uncertainty are discussed under the topic of Subject Selection. 2. Since exposure of veterans to Agent Orange or other herbicides used in Vietnam occurred more than a decade ago, any evidence or consequences of that exposure may have diminished to such an extent that it is no longer detectable. 3. The tests to be performed in these pilot studies will not detect effects that are specifically attributable to Agent Orange or any other herbicide. Chromosome damage, enzyme abnormalities, and suppressed immune responsiveness can result from any number of causes, some well-known and others yet unrecognized. Because of this, it will not be possible to conclude that disorders detected in any given individual are due to Agent Orange. However, this is not to say that populations of matched veterans whose detailed military, occupational, medical, and personal histories suggest that they differ as groups only in their exposure to Agent Orange. 4. Individuals whose test results are positive cannot be offered therapeutic manipulation or corrective intervention. There is no known way of reversing chromosome damage. -2- �5. Negative results from these tests would not be definitive. In other words, absence of overt chromosome damage in the study population would not mean that other, less easily recognized effects were absent. COSTS. The University of Texas has made every effort to minimize the costs that cannot be absorbed for tests done on veterans in these studies. For each matched set of exposed and unexposed individuals, the Texas Department of Health will cover the unabsorbable costs of $380 for cytogenetic testing, $800 for aryl hydrocarbon hydroxylase assay, arid $800 for immune evaluation and uroporphyrin testing. REPORTS. These studies will proceed at different rates. Upon completion, the investigators responsible for each study will present their data and results to the Texas Department of Health and, in addition, will prepare and'submit their findings for publication in the scientific literature. Interim progress reports will be provided according to a schedule to be decided by mutual agreement of the Texas Department of Health and the individual investigators. -3- �CYTOGENETIC/BLEOMYCIN TESTING. Peripheral blood samples are set up with the standard blood culture medium to stimulate lymphocytes to grow. Standard cytogenetic harvest method (Colcemid block for 1 hr., hypotonic solution treatment for 20 min., fix and air-dried) is used to prepare 48-hr and 72-hr culture samples. The slides are stained with Giemsa. Thus, each blood culture will have two harvest samples. Whenever possible, 100 metaphases are analyzed from each harvest sample to record chromatid-type and chromosome-type aberrations, and the aberrations are finally converted into breaks per cell for comparison. ARYL HYDROCARBON HYDROXYLASE (AHHLASSAY. The purpose of this study is to evaluate veterans for evidence of abnormalities in the levels, activity, or regulation of the cytochrome P-450 microsomal mono-oxygenase enzymes." Lymphocytes will be cultured from blood samples obtained from veterans and matched controls. The cultured lymphocytes will be assayed for levels of the enzyme aryl hydrocarbon hydroxylase both with and without a challenge by 3-methyl cholanthrene to induce the enzyme. Induction of the cytochrome P-450 associated enzymes is the most basic biological effect of TCDD, the toxic contaminant of Agent Orange. IMMUNE EVALUATION/UROPORPHYRIN TESTING. This study will examine various measured immune parameters of 1) Vietnam veterans from Texas who were at high risk for exposure to Agent Orange, 2) Vietnam veterans from Texas who were at low risk for exposure to Agent Orange and 3) matched veteran-controls who were not exposed to Agent Orange. In addition, urine specimens will be collected from these same groups and tests will be performed to measure levels of urinary porphyrins. �AGENT ORANGE ADVISORY COMMITTEE to the TEXAS DEPARTMENT OF HEALTH Development and Preliminary Results of Pilot Clinical Studies Report of the Chairman Guy R. Newell, M.D. Professor of Epidemiology and Chairman, Department of Cancer Prevention The University of Texas System Cancer Center Monday, March 26, 1984' �ACKNOWLEDGEMENTS The principal investigators, their colleagues and I wish to first acknowledge William B. Neaves, Ph.D. of The University of Texas Health Science Center at Dallas who was the first chairman of The University of Texas System Agent Orange Program Committee. It was under his skillful, thoughtful, and statesman approach that the initial pilot studies were reviewed, selected and initiated. We are all indebted to Ms. Harriet Franson, the Program Manager for the Texas Department of Health, who sees to our requests and to those of the veterans we are trying to assist with both speed and compassion. I want to thank Paul K. Mills, M.S., M.P.H. of the Department of Cancer Prevention, UTSCC, who prepared the section describing the criteria/selection methodology and analysed the criteria used in review of the first 255 Vietnam veterans. Without the unending wealth of first-hand knowledge of Vietnam and its environs provided by George R. Anderson, M.D., Director of the Texas Veterans Agent Orange Assistance Program, the task of estimating gross exposure of veterans would have been impossible. Finally, the support given to this program by Robert Bernstein, M.D., F.A.C.P., Commissioner of the Texas Department of Health has been unyielding. �Background During the Vietnam War, U.S. military personnel sprayed large quantities of a herbicide called "Agent Orange" over the Vietnamese countryside. The herbicide, named because of its shipment in orange-striped barrels, consisted of approximately equal portions of the n-butyl esters of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T). These shipments of Agent Orange were contaminated during the manufacturing process with traces of a highly toxic chemical, the dioxin dibenzo-p-dioxin (TCOD). 2,3,7,8-tetrachloro- Its concentration varied from batch to batch but averaged about 2 pom of 2,4,5-T. TCOO is known to be an exceptionally toxic chemical. Concerns have been frequently raised by Vietnam veterans that Agent Orange exposure may result in Infertility, genetic damage, birth defects in offspring, and cancer. No studies to date have confirmed these suspicions. In 1981, the Texas Legislature established a program to assist veterans who may have been exposed to certain chemical defoliants or herbicides, including Agent Orange. An important goal of the Texas Veterans Agent Orange Assistance Program was to determine 1f veterans have suffered physical damage as a result of substantial exposure to Agent Orange. The bill establishing this program called for a cooperative effort between the Texas Department of Health and The University of Texas System to conduct studies that would address the health effects of exposure to Agent Orange. Pi 1ot Studies of VIetnam Veterans Faculty of The University of Texas developed protocols for pilot studies of selected veterans in the Texas Veterans Agent Orange Program. �Three pilot studies were selected for implementation. These were cytogenetic testing, sperm evaluation, and analysis of the immune response in putatively exposed veterans and suitable control subjects. Cytogenetic testing to be conducted at The University of Texas System Cancer Center, will determine if Vietnam veterans presumed to have been exposed to Agent Orange during their military service have more genetic damage as measured by chromosomal abnormalities in cultured lymphocytes than does a suitable comparison group of veterans presumed not to have been exposed to Agent Orange. Sperm evaluation, to be conducted at The University of Texas Medical Branch at Galveston, will determine whether an association can be detected between current production of abnormal sperm and prior exposure to Agent Orange. The percentage of morphologically abnormal sperm and the incidence of nondysjunction of the Y chromosome will be assessed in this study. Analysis of the immune response, to be conducted at The University of Texas Health Science Center at Houston, will compare the immunocompetency of Vietnam veterans thought to have been exposed to Agent Orange with that of age-matched controls having no history of exposure to Agent Orange. In addition, a birth defects study was to be Initiated by the Division of Clinical Genetics of The University of Texas Health Science Center at Dallas. A summary of this study by Jan M. Friedman, M.D., Ph.D. is attached. Study Limitations Every attempt was made to explain the inherent limitations of these studies to all concerned with their outcome. These include, briefly: • Inability to establish a reliable index of exposure to Agent Orange for any individual Vietnam veteran. No exposure Index was available from the Department of Defense, Veterans Administration, or other official source. �• Control subjects could be selected on gross variables such as obvious lack of previous contact with Agent Orange. Ability to match on other variables was limited. « Because exposure occurred over a decade ago, damage or adverse consequences of such exposure may have diminished to an extent that they are no 1onger detectable. • The tests performed in the pilot studies are not specific for measuring effects of Agent Orange or any other specific agent. • Chromosome damage, sperm abnormalities, and altered immune responsiveness can result from any number of causes; therefore, it will not be possible to conclude that any abnormal findings in the group or in any individual are due to Agent Orange. « Individuals whose test results are positive cannot be offered therapeutic manipulations or corrective intervention in that there is no known way of reversing chromosomal damage or sperm abnormalities. 9 Negative results of the pilot tests would not prove the absence of other, less easily or impossible to measure, effects. Although these limitations are substantial, the laboratory-based pilot studies represent a positive step toward resolution of the Agent Orange dilemma. These studies have become part of a diverse and rapidly expanding national effort to answer pressing questions about the health effects of herbicides used in Vietnam. In addition, results of these initial pilot studies could suggest avenues for future scientific investigations of this national concern. �Agent Orange Subject SelectionCommittee Criteria/Selection Methodology The Agent Orange Subject Selection Committee was established to review evidence (military records, medical records, arid other supporting documents) which would indicate if a given veteran was Indeed exposed to Herbicide Orange in Vietnam, and if so how much exposure occurred. Seven criteria were used to evaluate a given veteran's category of exposure. Depending on the combination of exposure variables veterans were classified into one of six exposure categories. These categories included: highly exposed, medium to highly exposed, medium exposed, low to medium exposed, low exposed and disqualified. Those veterans deemed to be In the highly exposed category were then included in the Pilot Phase of the clinical studies. These studies included cytogenetic testing, immune competency, and sperm mobility and mOtility assessment. The criteria which the committee considered when reviewing the military records, medical records, questionnaire, and other supporting documents included the following. 1. Exposure to herbicides. The committee noted the amount (in gallons) of Herbicide Orange, White, and Blue sprayed in the area where the veteran was assigned during the time period he was assigned to that area. This criterion included estimated rates of exposure and exposures other than "Ranch Hand" exposures. �2. Repo rt ed symptoms A. At the time of exposure: since the chloracne rash is path- o gnomon ic of exposure to dioxin, the committee considered the appearance of a rash at exposure in evaluating the individual's exposure status. B. After time of exposure: reports of chloracne after initial exposure were also considered by the committee for evaluation of exposure. 3 * Cu r rent ned ica o b S * T"6 occurrence of current disease which could possibly be related to herbicide exposure was viewed by the committee as an important criterion for evaluating exposure status. *• Current or past^jpccufij^t0^"^L^ffUJ-Al, Jixpgsjjre. Since exposure to non-herbicide related chemicals could occur on the job outside the military, the committee regarded such occupational exposure as a potential confounding factor in the evaluation of exposure status. Such exposure could disqualify a veteran from participating in the Pilot Phase. s * Hi scarriages or sti 1 1 bi rths. The potential genotoxic effects of phenoxy herbicides, including Herbicide Orange were noted by the committee. Hence, the occurrence of miscarriage or stillbirth among the off- spring of the veterans was considered when evaluating the exposure status of a veteran. te 1n (5) "above, the phenoxy herbicides are potential teratogens in addition to being mutagens and carcinogens. Hence, the committee noted the occurrence of birth .defects in evaluating exposure status. �7 ' Dates and types of service dut^. The heaviest spraying of Herbi- cide Orange in Vietnam occurred between 1967 and 1969. operations ceased in early 1971. All spraying Hence, the committee closely evaluated the service dates in Vietnam in establishing the exposure status. duty type in Vietnam was considered. Also, Clerks, truck drivers, repairmen, and personnel assigned to base camps were not considered to be at high risk of exposure in comparison to infantrymen in the field where potential exposure was much higher. The following table {Table 1) demonstrates the relative importance of each of the selection criteria used by the committee in arriving at a judgment of exposure status. The percentages reflect the importance the committee placed on each criteria in placing veterans in a given exposure category. �8 Table 1. Percentage Summary of Criteria Considered in Exposure Classification of 255* Vietnam Veterans Exposure Status High Med./High Medium Low/Med. Low Criteria Exposure (Gallons) 96.4 100.0 94.7 Symptoms at Exposure 42.3 46.1 13.1 16.6 0.0 Symptoms After Exposure 42.3 61.5 18.4 16.6 0.0 Current Medical Problems 70.5 84.6 31.5 50.0 0.0 Occup. /Chemical Exposure 4.7 0.0 2.6 33.3 5.9 Miscarriages 18.8 15.3 10.5 50.0 1.4 Birth Defects 11.7 15.3 10.5 83.3 0.0 Dates and Type of Service 94.1 100.0 68.4 16.6 5.9 38 6 Total No. Veterans 85 13 100.0 52.2 57 *46 veterans were disqualified from the pilot phase of the study for various reasons. Veterans who had previously received chemotherapy were disqualified since such treatment would affect cytogenetic and immune parameters. In addition, veterans with occupational exposure to chemicals which could affect laboratory testing of sperm, cytogenetic or immunological parameters were removed from further consideration. �As of February 29, 1984, the Selection Committee reviewed 320 cases of which 99 were selected for the clinical studies (fifty cases were reviewedmore than once after more Information had been obtained). The goal set for the pilot studies was 50 veterans selected for having received the highest possible exposure to Agent Orange based on all available information. Thus, the study group was intentionally skewed toward exposure and was not intended to be "representative" of veterans who claimed exposure. Nor within the study group was there a gradient from high to low exposure. All veterans in the study group were selected for high exposure. A doseresponse effect was, therefore, not built in to the pilot study design. The controls, by contrast, were intentionally selected because of no possible exposure to Agent Orange in Vietnam. Matching for associated factors such as occupation or for other sources of exposure to dioxin was attempted, but was recognized to be imprecise. The intentional study design to Include maximum possible exposure among cases (Vietnam veterans) contrasted to least likely exposure among comparison subjects (matched controls) was selected because there was virtually no literature describing similar studies in humans. Since these pilot studies represented a "first," it was thought most desirable to design the study for maximum likelihood of detecting a biologic abnormality among the veterans, if one existed and could be measured by the available methods used. Collection of samples of specimens from both veterans and controls was arranged by staff of the TON and shipped to the individual investigators. Samples were coded so that the tests were performed in all three laboratories without knowledge of whether the sample was from a veteran or a control (specimens were "blinded"). After all specimens were analysed by the �10 laboratories the code was sent to each Investigator on the same day so that appropriate analyses could be performed. Preliminary Results of the Pilot Studies A summary of findings of the three pilot studies are presented. All three studies were performed on specimens from the same Vietnam veterans and controls. The total numbers in each group may vary from study to study and from specimen to specimen. These do not represent errors, rather they indicate variability among the techniques used for the studies. The investigator(s) along with their title and affiliation are given for each study. They can provide more technical details if requested. Cytogenetic Testing T. C. Hsu, Ph.D., Principal Investigator Professor of Cell Biology Sen Pathak, Ph.D., Collaborator K. L. Satya-Prakash, Ph.D., Collaborator The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute Each blood sample was set up for short-term culture with standard blood culture medium. Cell chromosomes were examined at 48 and 72 hours after initiation of cultures. This technique 1s standard and has been published by Dr. Hsu and his colleagues. Each cell speciman was critically examined for chromosome changes. These include: 1. Chromatid breaks, isochromatid breaks and exchanges. �11 2. Chromosomes showing acentric fragments, dicentrics, rings, and marker chromosomes indicating translocations. The percentage of cell specimens with chromosome breaks and chromatid breaks were recorded. The frequency of chromosome changes was calculated as breaks per cell (b/c). In previous studies of large numbers of patients, families, and population subjects the b/c ratio was found to be the most useful expression of genetic damage. The results of this pilot study of cytogenetics on veterans exposed to Agent Orange and matched controls are summarized below: Table 2. Cy toge n e t i c data_ojii j^eteranisL and_cp_nt_ro]_s_ Vietnam Veterans % cells with chromosome breaks 0.78 breaks/cell (b/c) 0.03 Matched Controls 0.62 - 0.02 �12 Table 3. Cases with Chromosome-type Aberrations and Breaks/Cell 'Cytogenetic Change Vietnam Veteran No. (*) Matched Control No. (*) 0.0 - 0.9 17 (S6.7) 22 (73.4) 1.0 - 1.9 9 (30.0) 4 (13.3) 2.0 - 2.9 2 { 6.7) 3 (10.0) 3.0 - 3.9 1 ( 3.S) 0 ( 0.0) 4.0 ~ 4.9 1 ( 3.3) 1 ( 3.3) 5.0 and over 0 ( 0.0) 0 ( 0.0) Metaphases with Chromosome -type abberrations * 30 100.0 30 100.0 0.00 - 0.02 16 (61.S) 20 (66.7) 0.03 » 0.07 7 (26.9) 10 (33.3) 0.08 - 0.12 2 ( 7.7) 0 ( 0.0) 0.13 and over 1 ( 3.9) 0 ( 0.0) Breaks/cell * 26 100.0 30 100.0 * Chi square not significantly different between veterans and controls. �13 It should be pointed out that the lack of positive results does not necessarily indicate the lack of genomic toxicity in persons soon after the Agent Orange exposure. Genetic effects induced by Agent Orange, if any, might have been sufficiently diluted by years of lymphocytic proliferation. In other words, we do not have a complete chronological study following persons, before, soon after, and long after exposure to a genotoxic agent. However, the present data, collected some 15 years after the exposure, appear negative. Sperm Tests Jonathan 6. Ward, Jr., Ph.D., Principal Investigator Marvin S. Legator, Ph.D., Collaborator Division of Environmental Toxicology, The University of Texas Medical Branch at Galveston Up to 3 semen specimens were obtained from each study subject at 2 and 3 month intervals. Upon receipt of the samples, a sperm count was determined, morphology (appearance) was classified by shape and size using standard, published methods. Reference slides were randomly included to serve as an internal control for scoring consistency. At least 500 sperm were examined per sample and the percentage of morphologically abnormal sperm was recorded. The percentage of fluorescent bodies (F-bodies) was recorded as well. �14 The results are shown in the table below: Table 4. Mean Values (± Standard Deviation) of Sperm Test Results for Veterans and Controls Sperm Characteristics Sperm Count (X 106) Vietnam Veterans (Mean ± SO) (No. Subjects/ Samples) Matched Controls (Mean ± SD) (No. Subjects/ Samples) 103.7 ± 76.0 116.3 ± 79.3 32 (76) 32 (64) P = 0.43* % Morphologically Abnormal 50.6 ± 14.8 48.7 ± 12.6 31 (73) 31 (61) 47.7 ± 2.1 47.8 ± 2.5 P = 0.78 % One F-body P - 0.96 % Two F-body P = 0.82 30 (70) 0.7 ± 0.2 30 (70) 30 (58) 0.7 ± 0.3 30 (58) *Kolmogorov-Smirnov 2 sample test used for significance of difference of mean values �15 Interpretation and Conclusion: The results of the sperm tests are reported for 32 pairs of veterans and non-veteran controls. No statistically significant differences were observed between the two groups for sperm count, abnormal morphology and 2 F-body frequency. The preliminary conclusion is that none of the three tests employed demonstrated any effect among individuals with prior military service in Vietnam where exposure to herbicide was probable. However, based on the numbers tested, large differences in sperm count could escape detection, while small differences in morphology and F-body frequency could exist, which would not have been detected. Imntjinologic Studies The immune system is charged with the defense of the body against both internal as well as external antigenic challenges. The cells which make up this system are several different types of lymphocytes - T and B cells, macrophages, and a poorly characterized cell referred to as null cell. T-lymphocytes (derived from the thymus gland, hence also called T-cells) play a central role in the overall regulation of immune responses, including both antibody synthesis and the development of cell-mediated immunity. �16 Several measures of T-cells and their functions were determined from blood lymphocytes of Vietnam veterans and matched controls. A brief descrip- tion of these is given below: Table 5. Test Performed Explanation of Test % Total T-RFC All T-cells in the peripheral blood leukocytes (PBL) as measured by sheep red blood cell rosette formation (RFC). % Pan-T cells All T-cells in PBL measured by monoclonal antibody (OKT 3). %Active T-RFC Subpopulation of T-cells which function as immune surveillance cells. % Helper/Inducer T cells "Helper T cells" required for antibody formation, measured by monoclonal antibody OKT 4. % Suppressor/Cytotoxic T cells "Suppressor T cells" Suppress antibody response after initiated, measured by monoclonal antibody OKT 8. Helper/Suppressor Ratio Ratio of T-helper to T-suppressor cells. % HNK Human natural killer cells measured by Leu 7. % OKT 9 T cell actlvational antigen measured by OKT 9. % OKT 10 T cell activational antigen measured by OKT 10. PMLC (S.I.) Panel of mixed lymphocyte culture, measures ability to respond to 3-5 peripheral blood leukocytes. �17 Table 5. (Continued) Test Performed Explanation of Test PHA (S.I.) Response to a mltogen stimulant, phytohemagglutinin S.I. = Stimulation Index Spont. Blasto. Spontaneous blastogenesis, measure of metabolic activity of round cells in peripheral blood leukocytes. The numbers of individuals tested, the mean values for the groups and the standard deviation are given in the table below: Table 6. Mean Values (± Standard Deviation) of Immune Tests Results for Veterans and Controls Immune Test Total T-RFC Pan T cells Active T-RFC Helper T cell (Inducer) Suppressor T cell (Cytotoxic) Helper/Suppressor Ratio HNK OKT-9 OKT-10 PMLC (S.I.) PHA {S.I.) Spont. Blasto. VTetnam Veterans (n*66) 38 61 20 39 24 1.8 11 3 ± 5 ± 29 ± 114 t 17.367 ± 15 13 Matched Controls (n=50) 44 ± 64 ± 15 14 ± 39 ± 11 23 ± 10 1.8 ± 08 . 6 12 ± 3± 5 11 6± 22 ± 21 90 98 ± 9.787 19,943 ± *Stati st1cal ly~TTTfer5nt~at'"P 1ess~than ~O57 19* 13 11* 10 8 0.7 7 1 7 13 78 10,136 �18 Interpretation and Conclusion; Of the 12 measures of the Immune system examined in this pilot study, the Active T-RFC was higher among the Vietnam veterans (20 t 15) than among the matched controls (14 t 11), (P less than 0.05). This test measures the % of Active T~cells which is the subpopulation of T-lymphocytes that function as immune surveillance cells. These cells are a subpopulation of the total T-RFC cells, which is reflected in a decrease of the % total T-RFC among Vietnam veterans (38 t 15) compared to matched controls (44 ± 19), (P less than 0.05). �i 19 .Summary: Because of concerns of Vietnam veterans that exposure to Agent Orange and its contaminants may have caused adverse health effects, The University of Texas System working closely with the Texas Department of Health, initiated three pilot research projects. These were (1) a study of the cellular characteristics of lymphocytes in the peripheral blood (cytogenetics), (2) a study of the number and physical appearance of sperm, and (3) several measures of the immune system. Vietnam veterans were purposely chosen who had the greatest likelihood of heavy exposure and were compared with age matched individuals with maximum likelihood of no exposure. The pilot phase called for 50 veterans and SO matched controls. Specimens were coded so that their Identities were blinded to the investigators when the laboratory tests were performed. The several limitations of these studies were made known from the beginning to concerned and interested Individuals. Preliminary r-esults of the three pilot studies are: Cytogenetlc Testing. No differences were found between the % of cells with chromosome breaks or the number of breaks per cell between Vietnam veterans and matched controls. Sperm Tests. Mo differences were found between the number of sperm, appearance of sperm, or percent of fluorescent bodies of sperm between Vietnam veterans and matched controls. Immunologic Studies. Of 12 tests performed to measure the immune system, the % Active T-RFC (which measures Immune surveillance cells) was higher among Vietnam veterans than among the matched controls (P less than 0.05). The % Total T-RFC was lower among veterans than among controls {P less than 0.05) �SUMMARY OF U.T. AGENT ORANGE BIRTH DEFECTS STUDY 26 MARCH, 1984 Data for the period 1 February, 1982 - 1 February, 1984 Center New Patients Seen 17 8 5 UTHSC Dallas UTHSC Houston UTHSC San Antonio UT Medical Branch TOTAL Disease Type Paternal Agent Orange Exposure* _2 33 = 0.6% Frequency in General Patient Population (Based on Partial Data) Frequency in Children of Agent Orange-Exposed Fathers* Possibly due to Agent Orange exposure in father (sporadic dominant or chromosomal anomaly) 15% 18% Not due to Agent Orange exposure in father (inherited dominant or chromosomal anomaly, autosomal recessive, or X-linked recessive) 18% 3% (Differences are marginally statistically significant) �Estimates of Frequency of Agent Orange Exposure* in Fathers of Children With Birth Defects of Certain Etiological Classes Class Conditions possibly due to Agent Orange exposure in father 0.75% (Difference is marginally statistically significant) Conditions not. due to Agent Orange exposure in father 0.1% CONCLUSION; Trend observed is consistent with fathers' exposure to Agent Orange causing birth defects in offspring, but numbers are very small; most fathers in the "exposed" group do not actually claim exposure; and the trend has become less clear as more data are collected. RECOMMEND; Continue data collection phase for 1 more year and re-evaluate at that time. J.M. Friedman, M.D., Ph.D. Associate Professor of Obstetrics and Gynecology and of Pediatrics Head, Division of Clinical Genetics *Defined as military service in Southeast Asia between 1969 and 1971. Most fathers were unaware of direct exposure to Agent Orange. �en c en «3> en cs> en SS.SiMlffiMiniKiTOWf^ijjlCIIIfiffiSffiWSSiaKffi- D en en cs:» KmiSqji!'Bii!i;i«fii9im KH* CJt ""^ O CO ni f ifii 1 5 Cu 11 %'"l:l; :~3l fJl ,,i. LJ "11 WIMIHtl u.» ni en rri —I LJ «.lH»m.ll " " I " " en CO CD 1 L™.* CO O nmitu, ui fn «jMc:.-wJ ANALYSIS OF MAJOR DEMOGRAPHIC STATISTICS FY 82,83,84 AGENT ORANGE CLINICAL STUDIES MAY 3, 1985 REPORT TO THE TEXAS AGENT ORANGE ADVISORY COMMITTEE BY GUY R. NEWELL, JR., M.D., CHAIRMAN �Demographic Characteristics of Vietnam Veterans and Controls Characteristic Vietnam Veterams (n-84) Controls (n=65) P Value (*) Race 0.44 Black Hispanic White Other 11.9 15.5 71.4 1.2 4.6 13.8 80.0 1.5 0.67 Language Spoken English Spanish Other 85.7 13.1 1.2 86.2 13.8 0.0 0.58 Religion Protestant Catholic Other 65.5 26.2 8.4 64.6 33.8 1.5 0.66 Marital Status Married Single Separated Divorced 66.7 13.1 2.4 16.7 76.9 9.2 1.5 12.3 0.0001 Education Through High School Through College Post College 35.7 56.0 8.3 13.8 53.8 32.3 0.0001 Income/Year <$5,000 5-<10,000 10-<20,000 20-OO.OOO 30-<40,000 40-<50,000 >50,000 13.2 17.1 21.1 23.7 17.1 3.9 3.9 0.0 3.1 10.8 27.7 27.7 18.5 12.3 �Current Consumption of Tobacco Type of Tobacco Vietnam Veterans (n=84) Controls (n=65) P-Value 52.5 35.5 0.04 20.0 20.0 17.5 22.5 20.0 28.6 19.0 23.8 9.5 19.0 1.8 98.2 3.7 96.3 0.97 8.1 91.9 5.5 94.5 0.85 8.9 91.9 3.7 96.3 0.46 Cigarettes (Pk/Yrs) Yes <9 9-<20 20-<26 26-<41 41+ Cigars Yes No I Pipe Yes No Chewing Yes No �Current Consumption of Beverages Vietnam Veterans (n-84) Controls (n=65) (X) Beverage (X) 0.24 Decaffeinated Coffee None 1-4 cups/day 5+ 76.9 18.5 4.6 84.9 15.1 0.0 Regular Coffee None 1-4 cups/day 5+ P Value 0.65 32.1 52.6 15.4 29.7 59.4 10.9 Tea 0.83 None 1-4 cups/day 36.8 63.2 33.3 66.7 0.27 Cola, Regular None 1-4 5+ 31.9 63.9 4.2 30.5 69.5 0.0 0.59 Cola, Dietetic None 1-4 85.5 14.5 80.0 20.0 0.92 Beer None 1-4 5+ 49.3 46.6 4.1 52.5 44.1 3.4 0.69 Wine None 1-4 89.1 10.9 92.9 7.1 Liquor None 1-4 0.21 89.4 10.6 79.7 20.3 �History of Drug Use Type of Drug Vietnam Veterans (n=84) (« Controls (n=65) m Medication, Regularly Prescribed Yes No 0.004 51.9 48.1 27.9 72.1 0.22 Medication, Past '60 Days Yes No 58.2 41.8 45.5 54.5 1.00 Recreational Drug Yes No P Value 8.5 91.5 7.7 92.3 �History of Exposure to Chemicals Vietnam Veterans (n-84) Exposure Controls (n=65) Routinely Exposed P value 0.85 Yes 30.5 27.7 No 69.5 72.3 Symptoms Related to Chemical Exposure 0.06 Yes 8.8 1.5 No 91.2 98.5 1.00 Solvent Yes 2.7 3.1 No 97.3 96.9 0.64 Paints Yes 10.1 14.1 No 89.9 85.9 1.00 Pesticides Yes 5.3 4.7 No 94.7 95.3 �History of Exposure to Specific Chemicals Chemical Vietnam Veteran Control P Value <« 1.00 Solvent Yes No 2.7 97.3 3.1 96.9 0.64 Paints Yes No 10.1 89.9 14.1 85.9 1.00 Pesticides Yes No 5.3 94.7 4.7. 95.3 �Miscellaneous History Vietnam Veterans (n=84) Controls (n=65) (« History w 0.76 Family History of Cancer Yes No Unknown 41.7 53.6 4.8 47.7 47.7 4.6 0.16 History of Cold or Flu Yes No 48.2 51.8 35.4 64.6 1.00 History of Vasectomy Yes No 20.2 79.8 20.0 80.0 0.001 X-Rays for Diagnosis Yes No P value 36.6 63.4 9.2 90.8 �Present or Past Employment by Occupation Occupational Titles Vietnam Veterans No. («) Professional, Technical, and Managerial 47 (04 2.) 107 (57 5.) Clerical and Sales 27 (.) H7 31 (61 1.) Services 33 (43 1.) 20 (04 1.) Agricultural, Fishery, Forestry 6 ( 26 .) 4 ( 2.1) Processing 6 ( 26 .) 3 ( 1-6) 42 (83 1.) 7 ( 36 .) 6 ( 26 .) 2 ( i.o) 7 ( 36 .) 11 ( 57 .) Machine Trades Benchwork Structural kbrk 41 (78 1.) Miscellaneous 22 ( 96 .) Total No. of Individuals No. per Individual X 2 = 80.22, P = 1.00 10 Control No. () % 230 192 83 65 2.8 3.0 �Present or Past Employment by Industry Standard Industrial Classification Vietnam Veterans No. () % Control No. () % Agriculture, Forestry and Fishing 5 ( 2.2) 4 ( 2.1) Mining 3 ( 1-3) 2 ( 10 .) Construction 20 ( 86 .) 5 ( 26 .) Manufacturing 28 (12.1) 18 ( 9-4) Transportation Communications Electric, Gas and Sanitary Services 25 (08 1.) 9 ( 47 .) 7 ( 30 .) 5 ( 26 .) Retail Trade 30 (29 1.) 22 (11.5) Finance, Insurance and Real Estate 10 ( 4-3) 5 ( 26 .) Services 36 (15.5) 60 (13 3.) Public Administration 64 (76 2.) 61 (18 3.) 4 ( 1-7) 1 ( 05 .) Wholesale Trade Not Classified 232 Total No. of Individuals No. per Individual X2 - 26.58, P = 1.00 192 83 65 2.8 3.0 �History of Major Health Problem Vietnam Veteran (n-77) History Control (n=64) Yes 32 ( 1 6 ) 4.% 13 ( 0 3 ) 2.% No 45 ( 8 4 ) 5.% 51 ( 9 7 ) 7.% = 6.3, P = 0.01 Twice as many Vietnam veterans gave a history of a major health problem as did controls. �Frequency of "Major" Health Problems « Veterans Controls No. Health Problem No. () * HBP 35.7 2.4 Hepatitis 15 1 0 0 2 1 2 0 0 0 0 0 1 1 1 3 1 1 1 1 1 1 1 1 1 3 1 1 1 Total 42 17 No. persons 32 13 Heart Irregularity LBP High triglycerides Heart disease, NOS Rh art Ulcerative colitis Low blood sugar Chronic bronchitis Hypersensitive insects High blood sugar Gout Ulcers Hidradenitis Feels sickly Anxiety Tbc Chloracne Liver cirrhosis Blood disorder Headaches Insomnia Chronic proctitis Spinal fracture Combat injury Diabetes Chronic discoid Edema Problem/person 18/42 — — — — — 2.4 2.4 2.4 7.1 2.4 2.4 2.4 2.4 2.4 2.4 2.4 2.4 2.4 7.1 2.4 2.4 2.4 1.3 Heart problems — —8 4 . 2.4 4.8 () * 7 1 1 1 1 1 0 1 1 1 1 1 0 0 0 41.2 5.9 5.9 5.9 5.9 5.9 -— 5.9 5.9 5.9 5.9 5.9 ___ 0 0 — — — __ — __ — 0 0 0 0 0 0 0 0 0 0 0 0 — — — — — __ --— 1.3 (42.9%) 11/17 (64.7%) �History of W>rk and Chemical Exposure Vietnam Veterans Controls (n=82) Exposure (n=65) Yes 25 No 57 (69.5%) X 2 = 0.14, P = 0.85 (30.5%) 18 (27.7%) 47 (72.3%) �History of Kbrk and Chemical Exposures Types of Veterans Controls Exposure No. () % No. 15 50.0 6 19.4 Radiation 2 6.7 4 12.9 Heat 4 13.3 1 3.2 Embalming fluids 0 1 3.2 Solvents 1 3.3 3 9.7 Fumes 3 10.0 1 3.2 Leaded gasoline 0 1 3.2 Paint thinner 0 1 3.2 Tylene 0 1 3.2 Phenol 0 2 6.5 Alcohols 0 1 3.2 Acids 0 1 3.2 Ether 0 1 3.2 Mold spray 0 1 3.2 Insecticides 2 1 3.2 Epoxy 0 1 3.2 Monomers 0 1 3.2 Miscellaneous 3 3 9.7 Noise/sound 6.7 10.0 Total exposures 30 31 No. exposed 25 18 Exposures/person 1.2 1.7 () % �DEPARTMENT OF THE ARMY OFFICE OF THE ADJUTANT GENERAL A R M Y AGENT ORANGE TASK FORCE ROOM 21O. 173O K STREET N.W. WASHINGTON. DC 2OOO6 R E P L Y TO A T T E N T I O N OF HERBICIDE STATUS REPORT The name Herbicide Orange comes from the identifying orange stripe painted on the drums containing a particular herbicide which contained equal proportions of the commercially-available herbicides 2,4-D and 2,4,5-T. These herbicides have been used extensively and in large quantities in agriculture and forest management in the United States (US) as well as worldwide for more than three decades. Only the 2,M,5,-T has been implicated as causing any potential health problems due to the presence of toxic contaminant - dioxin (2,3,7,8,-tetrachloro-dibenzo-paradioxin (TCDD)) - which is formed in low concentrations (parts per million) in the manufacturing process of the herbicide. At the request of the President of the Republic of Vietnam (RVN), the use of herbicides in Vietnam was approved by the President of the United States to primarily deny cover to the enemy and, secondarily, to deny food crops to the enemy. This was done only after testing in Florida, Hawaii, and South East Asia during 1961-1962, and limited operational use during 1962-1965. At that time, the herbicides used had the desired effects of improving visibility in dense jungles and were then believed to be harmless to humans. From 1965 to 1970, extensive aerial spraying was carried out over approximately 10 percent of the land mass of RVN, dispersing 11,300,000 gallons of Herbicide Orange in over 6,000 separate missions conducted by the U.S. Air Force under the code name "Ranch Hand". The missions were often carried out in remote or enemy-controlled areas as a result of the military need to improve observation of enemy activity and to reduce the potential for ambush. Each mission was carefully approved by identical staffing procedures within the US and RVN chains of command. The missions were flown under strict meteorological and operational conditions designed to minimize the drift of herbicide. Additionally, US and RVN commanders were advised to keep their troops out of the target areas at the time of spraying so that Vietcong grouncjfire might be returned by the fighter aircraft protecting the spraying missions. Nonetheless, spraying did occur over US troop positions. These missions are now recorded on computer tape (HERBS tape). In a typical spraying of dense jungle, tests have shown that only 6 percent of the herbicide reached the ground. At normal rates of application, this equals U millionths of a pound per acre of 'the contaminant 2,3,7,8-TCDD. Repeated testing reveals that 2,3,7,8-TCDD is rapidly detoxified by exposure to daylight in a matter of days, with a �half-life of approximately 6 hours. However, pure dioxin which has penetrated below the surface of the soil will persist for years, though it, too, will slowly detoxify. Dioxin is very insoluble in water and has a low vapor pressure. From 1965 on there are detailed computerized records of the dates, locations, types and amounts of herbicide used in fixed-wing "Ranch Hand" spray missions. The enclosed copies of maps, which were drawn from the records of spraying missions, show the locations of all "Ranch Hand" defoliation and crop destruction missions from 1965 to 1971. Herbicides were used, additionally, to clear the perimeter areas around US and RVN bases and along routes of communications to deny the enemy concealment capability and were applied with hand sprayers, and from tank trucks, riverine boats, and helicopters. While there are records of over 3.000 of these smaller scale applications, a complete compilation and computerization has not yet been accomplished, as documenting the instances and locations of firebase perimeter spraying is a painstaking, time consuming process. The DOD, however, considers this as another possible source of exposure and we are, therefore, continuing to search the records to determine the locations, dates, and magnitude of this type of perimeter herbicide spraying. The RVN armed forces are known to have used aerially "dispersed herbicides; however, no records exist of this usage. Finally, a small amount of herbicide was applied during 196? - 1969 in the Demilitarized zone (DMZ) in Korea. This was applied by hand spray apparatus and from trucks operated by Korean Army personnel. No US troops are known to have been involved or exposed in Korea. A study by Monsanto Chemical Company, of an accident which occurred at their Nitro, West Virginia facility in 19^9 has not shown an excess of deaths, cancers or heart disease among the 122 male workers who were conclusively proven to have been exposed to dioxin, in this incident when compared to the general US population. A similar study by Dow Chemical Company of 61 males exposed during a 1964 accident failed to establish a cause and effect relationship. However, because of the small population size in each of these studies, there is an acknowledged limited capacity for detection of normally infrequently occurring abnormalities or effects. Reflecting worldwide interest in the subject, studies of other similar accidents, including the one at Seveso, Italy, in 1976, are being conducted. Recent studies from Europe on forestry, agriculture and railroad workers suggest that two kinds of cancer, lymphoma and soft tissue sarcoma, may result from chronic, high exposure to dioxin. In animal studies, dioxin has been shown to be capable of acting as a promoter of cancer, 'fetal death and congenital defects but, to date, these effects have not been confirmed in humans. The reproductive effects have so far been observed only in pregnant rats and mice from large doses of dioxin, but not in rabbits, sheep or monkeys. There are marked species differences in sensitivity to dioxin1s effects. A recently completed study of male mice exposed to dioxin did not show any increase in fetal deaths or fetal abnormalities in the mated �females thus reducing concern about male-transmitted congenital abnormalities. An extensive study of the use and effects of herbicides in Vietnam was conducted by the National Academy of Sciences (NAS) and was reported to Congress in 1971. That study did not identify any specific health problems. Present interest in Herbicide Orange use in Vietnam centers on a wide range of exposures, from very low to high, actual and potential, htach of the present difficulty with the herbicide issue stems from the lack of concrete information about exposure and its consequences, expecially at low dose levels. There are no known, proven effects on health or reproduction from exposure to low levels of 2,4,5-T or dioxin. Nor do the health complaints voiced by those who believe they may have been exposed to Herbicide Orange fall into any discernible pattern. There is no significant marker or unusual condition such as chloracne, the rare skin condition which is a uniform sign of large, acute exposures to dioxin, to serve as a specific clue that low level exposure may have occurred. For example, with exposure to polyvinyl chloride or asbestos the remarkably consistent high incidence of otherwise very rare cancers substantially hastened an association of exposure to these substances and subsequent ill health. However, such a causal relationship has not been the case with dioxin. Thus, to date, there is no scientifically proven evidence that exposure to dioxin in very low doses leads to ill health or genetic defects. However, the matter is not being allowed to rest on that conclusion. There are many studies presently being carried on, both in and outside the Government, which are designed to investigate many of the unknown aspects of herbicide exposure. The lack of definitive information has heightened public and private concern about the possible human effects of exposure to dioxin. Within the DOD, the Air Force is conducting a study of the 1,200 men from "Ranch Hand" who performed the fixed-wing spraying of herbicides in Vietnam. The Ranch Hand study has been projected over a 20-year period and will be studying the long term health of the members of the "Ranch Hand" crews. The conclusions for the initial phase of this study, which was released in July 1983, were not Indicative of a cause and effect relationship. The conduct of an epidemiology study, originally to be by the Veterans Administration, has been assumed by the Centers for Disease Control (CDC) in Atlanta, and will examine the health of ground troops who were likely exposed to herbicide, as well as those who were likely not exposed to herbicides. Additionally, there will be considered the broader question of health effects of service in Vietnam in general, as it is possible that troops in Vietnam may have been exposed to other potentially toxic substances and exotic diseases. In addition to this large scale study (30,000 soldiers), the Centers for Disease Control is conducting a study to examine the possibility of increased incidence of congenital abnormalities among the offspring of Vietnam veterans. These studies will take several years to complete; however, �they offer the best possible hope of definitive answers to questions which at present have no answers. Critical to these studies, and to concerned individuals, will be information about whether a given individual was actually exposed to Herbicide Orange. In 1980, the Department of Defense initiated an intensive search of Army and Marine Corps unit operational records, morning reports/unit diaries, Combat After Action Reports, and other related troop movement records to determine if it would be possible to correlate locations of battalion and company size units with the Ranch Hand spray missions. We have found it is possible to identify certain selected companies as having been within close proximity of fixed-wing herbicide spray missions. The legislation of PL 96-151 mandated the Veterans Administration to conduct a study of possible health effects related to Agent Orange exposure. Following subsequent Congressional hearings, it was determined, since the majority of personnel who served in Vietnam were Array affiliated, that the Array would play the foremost role in providing the Department of Defense related data to support the VA's and related studies. Consequently, on 21 May 1980, The Adjutant General of the Array established the Array Agent Orange Task Force, drawing on the expertise of staff members already experienced in research methods and intensely familiar with the organization of the Vietnam War records collection. The Army Agent Orange Task Force, originally three full-time and two part-time members, now has a complement of 29 personnel and includes representation from the Air Force, Navy, and Marine Corps, comprising a joint services staff effort to support the veterans. The role of the Task Force involves in-depth research into the Vietnam War records of all branches of the services to locate units, identify those in relation to known herbicide spray missions, identify personnel within units, record incidents of herbicide sprays found in the records and previously undocumented, and to provide support to state and federal agencies conducting Agent Orange related studies. The records searches have demonstrated that there are significant differences in the quality, completeness and accuracy of the data contained in the records of the many units involved. It was never envisioned that these records, compiled and organized under combat conditions, would ever have to serve as th'e basis for scientific studies in determining exposure probabilities. Hence, some of the information needed is simply not available. During 1981, while DOD personnel were researching troop movement* records, another possible source of exposure to herbicides was uncovered — aircraft mission incidents. Records found to date indicate that over the years during which Ranch Hand missions were carried out, there were 155 incidents. These incidents were necessitated for a variety of reasons - engine failure, bad weather, radio malfunction, �navigational errors/problems and, in some instances, battle damage to aircraft. A mission incident did not necessarily mean that the pilot "dumped" the herbicide; however, the herbicide could be rapidly jettisoned through an emergency dump valve in less than a minute, to lighten the aircraft. To date, we have documented that emergency releases of herbicides took place 126 times, 58 of which definitely involved Herbicide Orange. The majority of these releases occurred at high altitudes, over the sea, or in remote areas in the vicinity of enemy held targets. A few, nonetheless, did occur near our bases. Those individuals who have unresolved health concerns from possible exposure to herbicides while serving in Vietnam may contact their nearest Veterans Administration hospital or regional office. Those persons still serving on active duty in the military services should contact their service medical facility. We remain dedicated to seeking answers to questions relative to Herbicide Orange and other dioxin-contaminated substances. �AGENT ORANGE STUDIES IN PROGRESS Compiled by the Veterans Administration STUDY AGENCY DESCRIPTION PROJECTED COMPLETION DATE Vietnam Veteran Mortality Study Veterans Administration To compare mortality To be Determined patterns and specific causes of death between those veterans who served in Vietnam and those veterans without Vietnam service. *Vietnam Veteran Identical Twin Study Veterans Administration To compare mental and physical health status of identical twin veterans, one who served in Vietnam and one who did not. 1986 Survey of Patient Veterans Treatment File Administration To identify morbidity patterns among Vietnam veterans from VA inpatient files. Retrospective Study of Dioxins and Furans in Adipose Tissue Veterans Administration To devise a method for 1985. determining levels of dioxins and furans in adipose tissue of Vietnamera veterans from samples in EPA's Survey of Human Adipose Tissue, to identify Vietnam veterans among the tissue samples and to analyze samples. Case-Control Study of SoftTissue Sarcoma Veterans Administration To determine whether Viet- 1985 nam service, Agent Orange exposure and other factors increase the risk of softtissue sarcoma. Department of Health A Human Services, Centers for Disease Control To evaluate possible longterm health effects of Agent Orange exposure on ground troops in Vietnam and to assess possible health effects of Vietnam service; 30,000 veterans expected to participate. *Epidemiological Study of Ground Troops Exposed to Agent Orange Initial 1983 1987 �Birth Defects and Military Service in Vietnam Department of Health & Human Services, Centers for Disease Control To determine possible Early association between Viet- 198U nam service and subsequent fathering of congenitally malformed children; based on Birth Defects Registry in Atlanta area which includes families of approx. 5,^00 case babies and 3iOOO '• control babies. Soft-Tissue Sarcoma . Investigation National Institute for Occupational Safety & Health To study tissues from Indefinite seven cases of soft-tissue sarcoma in U.S. (H who had been exposed to dioxin and 3 who may have been) in order to identify patterns of cancer that may be unique among those exposed to dioxin. Investigation of Leukemia in Madison County, KY National Institute for Occupational Safety & Health To determine possible association between cases of leukemia and exposure to wood ammunition boxes treated with hexadioxins. Dioxin Registry National Institute for Occupational Safety & Health To analyze causes of death 1985 among workers at 12 production sites where dioxincontaining products were manufactured. Internationa] Registry of Persons Exposed to Phenoxy Acid Herbicides & Contaminants National Institute of Environmental Health Sciences, with International Agency for Research on Cancer To establish an interIndefinite national registry of workers in some 20 plants where phenoxy acid herbicides were manufactured; mortality study planned when enough workers have been added to registry. Case-Control National. Cancer Study of Lymphoma Institute and Soft-Tissue Sarcoma Fall 1983 To compare herbicide 198U exposure among cases of soft-tissue sarcoma and lymphoma with controls of the same age, sex and Kansas county of residence. �Air Force Health Study Department of Defense To compare mortality and morbidity of Air Force personnel involved in Agent Orange spraying in Vietnam with a group of Air Force personnel who were not exposed •to the herbicide. Agent Orange Registry of Vietnam Veterans Biopsy Tissue Armed Forces Institute of Pathology To determine disease Indefinite patterns in biopsy tissue from Vietnam veterans; 1,200 specimens thus far show no unusual patterns,; especially of cancer. Preliminary Mortality 1983 Complete 1999 * Indicates those studies which are being supported through records research and review by the Array Agent Orange Task Force. . �Science Panel of the White House Agent Orange Working Group Represented by the following agencies: Department of State Department of Defense Department of Health and Human Services Department of Agriculture Department of Labor Environmental Protection Agency Office of Management and Budget Office of Science and Technology Veterans Administration Office of Technology Assessment Council on Policy Development of the White House �' VETERANS HEALTH SURVEY' Page l CDC continues to get inquiries regarding the status of its Agent Orange studies. Following is an update, which includes: Background Description of the CDC Research Project Agent Orange and Vietnam Experience Studies Selected Cancers Study Investigation Results h********4HH BACKGROUND Between August 1965 and February 1971 approximately 11.3 million gallons of the herbicide 'Agent Orange' (so named because of the orange markings on the drums in which it was shipped) were sprayed over much of South Vietnam in military operations designed to deprive the enemy of cover and food. A chemical contaminant, 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin, more often called TCDD, or simply dioxin, was created during manufacture of and contained in the Agent Orange which was sprayed. Dioxin has been shown to be a highly toxic substance. In January 1978 the Veterans' Administration (VA) received the first of what was to become many claims from veterans who felt that their current health problems had resulted from their being exposed to Agent Orange while serving in Vietnam. In January 1979 the U.S. Congress enacted legislation (Public Law 96-151) directing the VA to design and conduct an epidemiologic study to determine if exposure to Agent Orange had caused long-term adverse health effects in Vietnam veterans. In November 1981 the scope of the study was expanded (by Public Law 97-72) to include other factors in the 'Vietnam experience,' including medications and environmental hazards or conditions. In January 1983 the responsibility for designing and conducting the investigation was transferred from the VA to the Centers for Disease Control (CDC). In May 1983 CDC scientists completed detailed guidelines (protocols) for the Agent Orange and Vietnam Experience studies, recommending that a third investigation be conducted at the same time to determine the risk of Vietnam veterans developing selected types of cancers. Public 'Notice of Research Project Initiation' was published in the Federal Register on March 13, 1984. DESCRIPTION OF THE CDC RESEARCH PROJECT The study includes three separate but related components: 1) 2) 3) Agent Orange Study. (Study of the* long-term health effects of exposure to herbicides in Vietnam. ) Vietnam Experience Study. (Study of the long-term health effects of military service in Vietnam.) Selected Cancers Study. (Study to determine the risks of specific cancers among Vietnam veterans. ) July 1985 �Page 2 DESCRIPTIONi"AGENT"ORANGE'AND"VIETNAM'EXPERIENCE'STUDIES « Although both of these historical, or ''retrospective,1 studies are in some respects similar, each has a separate purpose. The Agent Orange study is designed to find out if troops who were exposed to the herbicide during service in Vietnam have suffered long-term adverse health effects as a result of that exposure. The Vietnam Experience study is designed to demonstrate whether or not there is any difference in the health of veterans of the Vietnam era who served in Vietnam compared to the health of veterans who served in other countries during the same period of time. The studies require the cooperation of a large number of Vietnam era veterans willing to be interviewed about their health status and experiences before, during, and after those years. TO ENSURE STATISTICAL ACCURACY, NO VOLUNTEERS CAN BE ACCEPTED AS PARTICIPANTS IN THE STUDIES. Participants are selected following scientific guidelines established by the research protocols. With the help of the Department of Defense and other agencies, CDC will identify a minimum of 30, 000 qualified veterans to participate in the studies: 6,000 in each of five separately defined groups or 'cohorts.1 The five cohorts are to be made up of veterans who: 1) Served during 1967-68 in a specified area of Vietnam, and were likely to have been exposed to Agent Orange. 2) Served during 1967-68 in the same area of Vietnam as cohort 1, and were less likely to have been exposed to Agent Orange. 3) Served during 1967-68 in another area of Vietnam than cohorts 1 and 2, and were not likely to have been exposed to Agent Orange. 4) Served in Vietnam during 1966-71. areas. 5) Served during 1966-71 in countries other than Vietnam. Randomly selected from all Data for the Agent Orange investigation will be gathered from cohorts 1, 2, and 3. Cohorts 4 and 5 will provide data for the Vietnam Experience study. PARTICIPATION IN THE CDC STUDY IS ENTIRELY VOLUNTARY. AGREEING OR DECLINING TO PARTICIPATE IN THE STUDY WILL HAVE NO EFFECT UPON BENEFITS A VETERAN MAY BE RECEIVING OR TO WHICH HE MAY BE ENTITLED IN THE FUTURE. �Page 3 fill information given by each veteran will be held in complete confidence. The names of the participants will never be associated with their answers in the statistical summaries studied by scientists. Names and other identifying information, such as addresses and social security numbers or service numbers, will be kept in a separate file that no one will have access to but the U.S. Public Health Service and the private research firms working on this study. No other researchers or government agencies, including the Veterans Administration and the Department of Defense, will be able to learn if a veteran participated or what his answers were. This promise of confidentiality is guaranteed by Federal laws—42 U.S. Code 242(b), (k), and (m). Unless the veterans gives written permission to CDC to release personal information, no one, including the veteran1 s family, will ever be ible to get the personal information provided by the veteran. The interview takes about 45 minutes and is conducted by telephone by CDC's contractor, Research Triangle.Institute (RTI), Inc. Veterans who are selected to be called by RTI receive a letter from CDC telling them to expect the call. From those being interviewed, approximately 2000 veterans from each cohort will have been preselected for the medical examination component of the study. The RTI interviewers have no control over which veterans will be asked to take the medical exams. Only veterans who have already been interviewed by RTI will be selected to be asked to take the medical exams which will take 3 days to complete. Several weeks after being interviewed, each veteran selected will receive a letter explaining the examinations and a telephone call from Lovelace Medical Center asking when he can come to Albuquerque. Veterans can select dates convenient to themselves. The 10,000 medical examinations are being conducted at non-hospital clinical facilities specially constructed for this project by another CDC contractor, the Lovelace Medical Foundation, in Albuquerque, NeW Mexico. All examinations are being done at the same place to ensure that standard testing procedures are used. The examination includes about 60 physical, psychological, and laboratory tests. Blood and urine samples are required, but no tests are included that most persons would find painful. Participants can refuse to take any test or to answer any question. Veterans who complete all the tests receive a $300 stipend. Veterans* expenses for travel to and from Albuquerque, food and lodging, etc., will be paid by!the government. Veterans will stay in private rooms at a first-class downtown hotel and have their evenings free. Each room will accommodate up to four persons without1 cost to the veteran. (The government cannot pay for family members travel or food.) Physicians and other health providers working on the CDC studies will not provide any treatment for individuals. If a veteran1s medical examination indicates the possible existence of a problem of any sort, the veteran will be advised immediately and encouraged to seek treatment from the VA, private, or other sources of medical services. �Veteran interviews for the CDC study began in September 1984, and M i l l continue until about October 1987. The first medical examinations were conducted in March 1985. fill examinations are expected to be completed by about January 1988. RTI, Lovelace, and other non-government research firms have been contracted to collect the data for these studies. These firms are monitored closely by CDC officials, fill analysis and interpretation of data is done by CDC. (((((((«((((((((((((((((«((((((((((((((((((((((((((((((((((((((( DESCRIPTIONS SELECTED CfiNCERS STUDY There is some scientific evidence that exposure to herbicides may increase the risk of several serious, but relatively rare, cancers in workers in industries which manufacture or use similar products. Because these cancers are so infrequently seen, the 30,000 veterans in the other study cohorts do not offer a large enough sample population upon which to base this investigation. Instead, two other groups w i l l be studied in a * case-control* investigation. Because of the design of this study, veterans and non-veterans will be included in both the case and control groups. The tumors selected for the study aret lymphoma, soft-tissue sarcoma, nasal and nasopharangeal cancer, and primary liver cancer. Other types of tumors may be added to the study later. The first (case) group in the Selected Cancers Study w i l l be made up of male patients who have actually had these tumors, and who could have been in the military during the Vietnam conflict. The second (control) group will include men of the same age and from the same current geographic area as the case cohort, but without the tumors. Using information from interviews and military records, CDC w i l l determine which men in both groups are veterans, which veterans served during the Vietnam era, and which veterans may have been exposed to figent Orange. Comparison of data collected from both groups may indicate significant differences in their risk of these cancers which could be associated with military service, service in Vietnam, and exposure to figent Orange. INVESTIGATION RESULTS » The exact rate of progress of epidemiological studies of this size cannot be forecast. Collection and analysis of the large amounts of data needed for scientifically valid findings takes time; particularly when so many thousands of veterans must be identified, located, interviewed, and examined. CDC w i l l report on each component of the study when it has been completed. Final reports on the figent Orange and Vietnam Experience components are expected by September 30, 1988. The final report on the Selected Cancers Study component is expected by September 30, 1989. CDC hopes that these studies w i l l provide answers to many of the important questions being asked about figent Orange and other factors related to service in Vietnam. But, as in every epidemiologic investigation — no matter how carefully designed and professionally conducted--the possibility exists that definitive answers to some questions may never be found. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1867 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Anderson, Ron J. Robert Bernstein Description An account of the resource <strong>Corporate Author: </strong>Texas Veterans Agent Orange Assistance Program, Texas Department of Health, Austin, Texas Date A point or period of time associated with an event in the lifecycle of the resource 1985-08-01 Title A name given to the resource Annual Report Subject The topic of the resource state-funded Vietnam veterans study cancer risk assessment PSTD morbidity trends ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1866 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Lawrence, Charles E. Andrew A. Reilly Phillip Quickenton Peter Greenwald William F. Page Amy J. Kuntz Source A related resource from which the described resource is derived American Journal of Public Health Date A point or period of time associated with an event in the lifecycle of the resource 1985-03-01 Title A name given to the resource Mortality Patterns of New York State Vietnam Veterans Subject The topic of the resource state-funded Vietnam veterans study mortality trends cancer risk assessment ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/403236bd326cf1a04a59a070dbaa0943.pdf 3029d54552eaac96712704282c810623 PDF Text Text Item ID Number °1865 Author Greenwald, Peter Corporate Author state of New York Department of Health, Office of Publi ROpOrt/ArtiGto TltlO Epidemiological Study of Soft-Tissue Sarcoma Journal/Book Title Year 1981 Month/Day Januar Color v n Number of hnaoes 28 DOSCrlpton NotOS project period: February 1,1981 - March 31,1983. Item includes 1) State of New York Senate Assembly May 6,1980 establishing a temporary state commission on dioxin exposure, etc. 2) Sample New York State Department of Health Certificate of Death Wednesday, July 11, 2001 Page 1866 of 1870 �\. STATE OF NEW YORK DEPARTMENT OF HEALTH ^ OFFICE OF PUBLIC HEALTH VOWER BUILDING • THE GOVERNOR NELSON A. ROCKEFELLER EMPIRE STATE PLAZA . . . - - . < . , . DAVID AXELROD. M.O. Ccwr.-11/../on.r ' "61.ENN E . HAUGHIE. M.O;-- - . „ - - . , , . , - --. ' " - . 0,,«c.or c( PubHe ««««"« ALBANY, N.Y. 12237 ™w- jp ...y.---*f-'-*" 1 -*-• wv?j'' ' -OIVI«Ofc| Of; EPIDEMIOLOGY-, " '"'*' ^'i ' . - "•? "'• ' -"^V^r^ ' ' ' • "Wte •(•>•;< « . . - • . . PETER CREfcNw*l-t). M.O., OR. P.H. ..- . . . Epidemiological Study o£ Soft-Tissue Sarcoma Peter Greenwald, M.D., Director, Division of Epidemiology N.Y.S. Department of Health, NARESP - Tower Bldg. - Rm. 503, Albany, New York 12237, (518) 474-2353 Project Period: Performance Site: February 1, 1981 - March 31, 1983 New York State, Exclusive of New York City January 1981 �Page 2. Abstract Military experience of men in upstate New York reported with" soft-tissue sarcomas will be studied epidemiologically for Vietnam service with potential herbicide exposure. Case ascertainment will be via the New York State Cancer Registry of men 18 through 29 years of age at any time from 1962.through 1971 and followed through December 31, 1980. Age and area- matched control groups will be selected from death certificates and drivers license files. Military service experience will be obtained from notations on death certificates, hospital records, telephone interviews, and Veterans Administration or Department of Defense records. Other factors previously sus- pected as being associated with soft-tissue sarcoma also will be studied. In addition, occupation and industry of -all men age 20 and over dying with soft-tissue sarcomas as residents of upstate New York from January 1, 1970 through December 31, 1980 will be examined. Matched controls will be selected from death certificates. The purpose of this study is to determine whether any occupation or industry is over-represented among the case group, thus raising a question of/whether occupational or industrial exposure in New York State may contribute to soft-tissue sarcoma. �Page 3. Specific Aims ' " "' »' ~- """'' " " " * -i'" " '' ' " ...... ' *" :; > '.""• '. c -.' ?':.'.;'•••• *'^l'" "ftr-^^ vr •• ' • ^ . u. • • ' •«.'•-"< i - ' - ^ ^ . " ^ . ^ ^ V 'a"''-^.-^^^ -,.,,.,. : - *'",'•'•&}.• :.. ^ - • . v . . J M M ..yiwiit 1) To determine if men in New York State exclusive of New Ydrk VJ '"' '" " ......<•••'-:-•-'•"•*--.•'•"•'-.-*'••••. b- «>*• ---.«,.« ,-«v.,,,-,i »,»•.. .-«i^..,............'-••''^•..^'-^^1,.-.;,.^x.>r.**.i^k™»B.VVAsV'^^^---'-»'.>.>-^.-^ ' City of draftable ages during the Vietnam War and reported to the New York State Cancer Registry as having soft-tissue sarcoma through December 31, 1980 were more likely to serve in Vietnam than an age-matched control group. 2) To compare areas of service within Vietnam by case and control veterans who served in Vietnam, in order to attempt to assess potential for herbicide exposure. 3) To compare the histopathology and anatomic site of soft-tissue sarcomas amongst Vietnam veterans to the site and pathology of sarcomas in non-Vietnam veterans and non-veterans. 4) To determine whether deaths from soft-tissue sarcoma are associated with occupations or industries in New York State, as identified through death certificate reports. �Page 4. Legislative Mandate .,,.,.........._„..,,.,,,,,,,...„.,.-«,, •,>„.. .- .. ,,.-•>,.,.,,. - \!/"j;;f;l?i;gl|fc?:^ .. ...... ••-."*.....v«V.*.w..x... ^ Y * * ! ^*,*^ The New York State. Legislature, determined that there-is a public >- fc- j^':tjf -f^ • need to know the health effect's of exposure to herbicides containing dioxin for residents of the State of New York, including those Vietnam era veterans who may have been exposed to these substances during their period of military service. The New York State Public Health Law was amended effective September 1, 1980 to require the Commissioner of Health to ''initiate an Epidemiological Study of the health effects of exposure to herbicides containing Dioxin." This project is developed as part of the response to this new legislation. �Page 5. Preliminary Studies .,-:.,.•«,«„, ... ... , . , . . „ . •;. •...,, "' „• .. •'.„ -- .i'(... ! _ . , i,- ;,;>«; ,,..»* . . . , A4>tfi«'t.>' ..,. i,-;v,,.,^,«»v. '.,«>•* ti'.ij"<>hnv*i%- '•.» J-V- *•»»*#..'••-• ^. '.. '.(, •.• In a report from Sweden, Hardell and Sandstrom (1979) reported a six-fold increase in the risk for soft-tissue sarcomas in workers exposed in phenoxyacetic acids or chlorophenols. Phenoxy herbicides have been used to control unwanted hardwoods in Swedish forests and commercial preparations nearly always are- contaminated with dioxin. The Hardell and Sandstrom study explored potential for exposure among 52 men with soft-tissue sarcoma and reported "•"•••" that 19 of the 52 men may have had exposure compared to 19 of 208 control men. Soft-tissue sarcomas are a broad category of tumors derived from different types of cells and the authors did not provide information about which specific histologic types were studied. Nevertheless, a striking conclusion necessitates independent study of this reported association. • • The New• York State Cancer Registry was- searched for soft-tissue sarcomas among men born between January 1, 1933 and December 31, 1953 who had attained the age of 18 years or more. This cohort includes men 18-29 during the years 1962-71. The sites of cancer selected and International Classification of Disease codes (9th revision) are as follows: Connective and Other Soft Tissues (171) Head, Face and Neck (171.0) Upper Limb, including Shoulder (171.2) Lower Limb, including Hip (171.3) Thorax (171.4) Abdomen (171.5) Pelvis (171.6) Trunk, Unspecified (.171.7) Other (171.8) e Unspecified (171.9) �Page 6. In addition, malignant neoplasms of the retroperitoneum arid ; : • . . , . . ' ' • • - • • ,••;..".'. -. ii. ££•,•'.# '.;..;', .•• - :-' - /:••"- 'tty<?;> • •• .- *• w -peritoneum* (-iS8) 'as'-well- as -those <o£~'the thymus , • heart and......— mediastinum (164) will be reviewed ini order to locate all possible soft tissue tumors. The number of men in the Vietnam era cohort reported to the Registry, classified according to the American Cancer Society's 1968 Manual of Tumor Nomenclature and Coding (MONTAC) , are as follows: * *.*• ICB 171 Connective and Other Soft Tissues Total = 250 800 Neoplasm, Malignant 18 807 Squamous Cell Carcinoma, NOS 1 869 Nonchromaffin Paraganglioma, Malignant 1 880 Sarcoma, NOS 12 881 Fascial Fibrosarcoma 2 882 Fibrosarcoma, NOS 42 883 Fibroxanthoma, Malignant 13 884 Myxosarcoma 1 885 Liposarcoma ' • 41 889 Leiomyosarcoma 17 8.90 Rhabdomyosarcoma, NOS 11 891 Embryonal Rhabdomyosarcoma 4 ' 892 Alveolar Rhabdomyosarcoma 1 899 Mesenchymoma, Malignant 6 904 Synovial Sarcoma 28 905 Mesothelioma, Malignant ' 1 912 Hemangiosarcoma 4 913 Hemangioendothelioma, Malignant 2 914 Kaposi's Sarcoma 4 915 Hemangiopericytoma, Malignant 6 922 . Chrondrosarcoma 1 937 Granular Cell Myoblastoma, Malignant 6 939 Ependymoma, Malignant 1 949 Ganglioneuroblastoma 1 950,' Keuroblastoma, NOS 2 954 Keurof ibrosarcoma 9 956 Neurilemoma, Malignant 15 The following tables show the distribution of these tumors by > anatomic site and by geographic area within New York State: �Page 7. Table 1 Connective and Other Soft-Tissue Tumors Among Men in Vietnam Era Cohort New York State Cancer Registry Anatomic Site 171 Connective and Other Soft Tissues Total * 250 171.0 Head, Face and Neck 19 171.2 Upper Limb, Including Shoulder 26 171.3 Lower Limb, Including Hip 171.4 Thorax 2 171.5 Abdomen 2 171.6 Pelvis 6 Trunk, Unspecified 33 . 171.7 171.8 Other 171.9 Site Unspecified 101 61 �Connective and Other Soft-Tissue Tumors Among Men iri^ Vietnajn Era Cohort New York State Cancer Registry ; Histologic Type by Anatomic Site Table 2 JQ 0> u ; Anatomic Site & Histologic Type 3 . • =' ^ . • ^ 300 Neoplasm, Malignant 307 Squamous Cell Carcinoma, NOS 369 Nonchromaffin Paraganglloma, Malignant B80 Sarcoma, NOS 581 Fascia! Fibrosarcoma 882 Fibrosarcoma, NOS 883 Fibroxanthoma, Malignant 884 Myxosarcoma 885 Uposarcoma 689 Leiomyosarcoma 890 Rhabdomyosarcoma, NOS .891 Embryonal Rhabdomyosarcoma 892 Alevolar Rhabdomyosarcoma 899 Mesenchymoma, Malignant 904 Synovia! Sarcoma 905 Mesothelioma, Malignant 912 Hemangiosarcoina 913 Hemangioendothelioma, Malignant 3514 Kaposi's Sarcoma 915 Hemangiopericytoma, Malignant 922 Chrondrosarcoma •r- C. J. •r- U <J*-> . <u o *z z • • O f — fo "o r— r^ (U C ac ro*-* E o> -O -O CM i 3 i— « . ttl r— f*» f— O O O 3 . Q C JC r— . C "O £• 13 CO • G f^ ) T~~ "&. u a.r-» O C «r- ^~ x^? 10 • J- rO f^ JZ r— cu in C'— 6 • O f— •a r>. JO r— t— v> vo •r- • > i— ^™" J ^ ^ QJ r"^ a.«— 7 2 3 1 4 * o r^. ^£ <u - • C CX»— u 1/1 r-^ -. 1 J^ 'oo • 'Z Q* (U C ( r— U r* fx^ 4-> r— <=>-" fc. C i— 4 ^ IS" vo r; •f- C 15 2 - 5 1 1 2 2 1 1 2 1 1 14 4 1 28 6 8 1 1 1 16 1 1 1 2 1 2 1 1 = ' 3 ;; 2 3 4 i i} ij 2 4v 2 ;1^ z 1 ' 2 t ;1 .. i \ - I j j V t s - I *• ; ' X • 1 1 3 v 26 6 2 :i: "' • 5j 11 4 1 8! •f ; 1 19 U- ; 2! 8 All Histologic Types • r— ; 2 4 4 Ependymoma, Malignant Ganglioneuroblastoma Meuroblastoma, NOS Neurofibrosarcoma Neurilemoma. Malionajit a> • -r" i ^-^ 2: 1 1 1 937 Granular Cell Myoblastoma, Malignant 939 949 950 D54 956 ; •%} . a E en i 2 • • 6 ' 10 ] ' . 1 ; 1 ; i 101 2 2 6 33 f ' i -• ^ 61 - - 00 -. �Page 9. ' Table 3 Connective and Other Soft-Tissue Tumors Among Men in Vietnam Era Cohort New York State Cancer Registry Geographic Distribution New York State, exclusive of New York City Buffalo Region 37 Rochester Region 27 Syracuse Region 37 Binghamton Region 8 Albany Region 45 Westchester Region 49 Long Island 45 Unknown Residence 2 Total = 250 �Page 10. Epidemiological reports on soft-tissue sarcomasi are "scant." '""""" Several factors have, been hypothesized^to be.^important*to^*«w«-^-*--etiology but little evidence has been 'provided in support'sof"" these ideas. The main factors are as follows: 1) Trauma. Fibrosarcomas occasionally develop in scar tissue (Stout, 1961). It is doubtful that sarcomas develop from contusing blows although this has not been ruled out. Local sarcoma of the rat may be induced by the subcutaneous injection of many substances. In particular'"implants of a variety of plastic or metal discs or films can induce sarcomas in rats and mice. The relevance of this to man is uncertain (Lancet editorial, 1969). Greenberg (1976) reported four cases of sarcoma of the buttocks following intramuscular iron injection. Morman, et al (1979) reported a locally aggressive dermatofibrosarcoma in a soldier who had received multiple immunizations for plague, yellow fever and tetanus. sarcoma developed at the injection site. The Five months after the injection a small nodule was noted, and eight years later gradual enlargement was first observed. 2) Infection.Morton (1974, 1969) outlined the observations which suggest the close association of a viral agent with human sarcomas. Morton writes: �Page 11. "1. ,..,.,„.. Type C viral particles, morphologically similar to the avian, murine,and feline sarcoma,,,viruses, have been seen in human sarcomas. "2. All different types of human skeletal and soft-tissue sarcomas contain a common sarcoma-specific antigen to which patients with these neoplasms form antibody. Since all animal neoplasms induced by the same virus contain a common virus-specific tumor antigen, the finding of a common antigen in human-sarcomas suggests viral etiology of these neoplasms by analogy. "3. Relatives and close associates of sarcoma patients also possess a high incidence of antibody to the sarcoma-specific antigens...." Kaposi's sarcoma has been reported in association with lymphoreticular malignancies (Safai, et al, 1980). These investigators note clustering of Kaposi's sarcoma in endemic areas and .cytomegalovirus culture cell line. isolation from a Kaposi's sarcoma A mechanism is hypothesized by which cytomegalovirus can lead to the development of multiple primary malignancies in Kaposi's sarcoma patients. Soft-tissue sarcomas are said to be common in Afghanistan, ranking third among cancers (Sobin, 1968). Sobin believes that sarcomas could be related to arthropod vectors. He contends that subepidermal connective tissue is particularly exposed to mosqu'itos and other arthropods which pierce the �Page 12. epidermis. The hamster reticulum cell sarcoma has been , v.=.,transmit.ted..by. a mosquito by transfer of -tumor cells and - ~ - the Shope fibroma virus can be transmitted By bites of ""fieas and mosquitos. Sobin further speculates that the distribution of bites from crawling arthropods, for example, fleas, ticks and bedbugs, may relate to the common location of soft-tissue sarcoma on lower extremities, and finally, he believes that the age incidence is compatible with an arthropod vector. Unfortunately, little data are provided to support these contentions. No difference in family exposure to domestic cats, dogs and parakeets was found by Hanes, et al (1970) in a survey of households which included 127 persons with sarcoma.• 3) Radiation. Eleven patients with postirradiation sarcoma have been described by Hatfield and Schulz (1970). These followed radiation treatment of primary carcinoma of the breast, three after megavoltage therapy. Other reports also indicate that radiation may induce sarcomas. 4) Familial Occurrence. Li and Fraumeni (1969, 1969, 1975) reported several families with more than one member having rhabdomyosarcoma and other soft-tissue sarcomas or other cancers. Mieraii and Favara (1980) felt that all childhood forms of rhabdomyosarcoma are essentially embryonal tumors based on ultrastructural �Page 13.' study. In one series four of twenty children with soft- tissue sarcomas had associated-congenital anomalies (Sloane and Hubbell, 1969). the simultaneous occurrence of sarcomas in a husband and wife was reported by Goldenberg, et al (1974) 5) Chemicals. The possible association with dioxins raises questions about the induction of sarcomas by other chemicals. As noted above, intramuscular iron and multiple immunizations have been suspect. In this study, the main effort to obtain a lead on other potential chemicals will focus on occupation and industry. �Page 14. Methods I. Cancer Study '• (a) . - , . - . . , . , .. „ _ ,. •!,„,. ..WAarJl..-!!..-..- Case Ascertainment "- The case group will be all male residents of New York State exclusive of New York City who were 18 to 29 years old anytime from 1962 - 1971, and who were reported to the New York State Cancer Registry as having soft-tissue sarcoma first diagnosed at any time through December 31, 1980. The New York State Department of Health maintains one of the worlds largest cancer registries. By law all physicians, hospitals, and laboratories must report newly diagnosed patients with cancer to the New York State Cancer Registry. We believe this Registry to be about 90% complete. A copy of the cancer registry report form is shown below. New York State Cancer Registry Report — CO*** •&( *tfTlAi NAM( Dote •* t+Mt Report O' * AT 11 NT OATI or ADtXttU • O S ACC OlCW wt,*, SD i.c »OC"-l UCUIITr CO >D TI ew IKX** die ' » O UM »^ »C . JtATui I • O * C * — 5<»T1 M COUNT! r or tcntM DIAGNOSIS IM*«V sue Vn i.O STAG! Of DlUASC c if C A l l l V C> HOS*ITAl Ot. 1kiMO> •IG:S' f l f t M Oft No : 3 « 3 �Page 15. (b) Control Group Selection - Two overlapping control groups will be used, each having a control to"case '"* ".""" * ratio of 1:1. The first group of controls will be selected from drivers license files matched on 5-year age group and zip code (see appendix). The method is based on that developed by P.C. Nasca and J.O. Moore. Alternate controls also will be selected and stratification during analysis shall include race. The ••"•• sarcoma case group will be matched against drivers license files to see the extent to which the case group have drivers license. This will provide an indication of how representative the control sampling frame is of the case group. As most of the case group would have been expected to live had they not developed sarcoma, «. this live control group is considered most representative of the general population and thus the appropriate control group for this 'study. In order to take into account the possibility that informants for dead cases may not be able to provide equivalent information to that for live controls, a dead control group will also be selected for dead cases. Controls found to be ineligible for military service because of a condition which lead to their subsequent selection as a control will be excluded. Together with the matched controls for the live cases, these will provide a second -.</* �Page 16. control group for analysis. For each dead case two . death certificates will be selected for men.of,the same 5-year age group, years of education, race and health systems area. Health systems areas contain about 10 counties each. Persons dying from all causes except cancer will be eligible to serve as a control. Positive Control - In addition to the "negative con-, trols" noted above, we will attempt to -obtain an age-matched group of "positive controls" -- that is, men known to have served in Vietnam. These controls will be selected only for sarcoma cases with a Vietnam service history. Information on dates of service, battalion company, etc. for these two groups will be collected and compared. (c) Tumor Comparisons - Pathology slides will be borrowed from hospital pathologists for review by Dr. Doris Collins of the Division of Labs and*Research. Dr. Collins will use a standardized classification form, and be blinded as to the military service experience of the case under study. The distribution of histolopic pat- terns of Vietnam veterans then will be compared to nonVietnam veterans and non-veterans. Hospital records w i l l be abstracted for anatomic site of the tumor, diagnostic procedures, and historical infor' • nation. "^ Again, Vietnam veterans K i l l be compared to non- �Page 17.' Vietnam veterans and non-veterans. (It should be noted that this section relates only to comparisons - with the case group rather than case-control comparisons.) (d) Interview - Cases and controls, or a close relative or friend if the study subject has died, will be interviewed using a standardized questionnaire. The interview will be done by trained interviewers who have pilot tested the questionnaires. A 10 percent callback will be done by a different interviewer to check on reliability. The survey will be conducted by telephone, or if the study subject prefers, in person. Data will be collected about conditions known or suspected of being associated with soft-tissue 'sarcoma or which might relate to the possibility of exposure. Thus, in addition to military service his- tory, we will gather data on smoking, alcoholism, occupation, other activities that might be associated with exposure to toxic chemicals, and on questions which relate to the various hypotheses discussed in the background section. Validation of interview responses relating to military service and further information will be collected by checking against Veterans Administration records. This �Page 18. procedure will be kept blinded as to case or control status insofar as possible. .- (e) Analysis - Results will be analyzed using traditional epideroiological and biostatistical methods, including current raultivariate statistical techniques. This will include the linear logistic model for matched analysis as described by Holford et al (1978) and Breslow et al (1978). The logistic model allows for the direct consideration of continuous risk variables' and for multivariate analysis. Further when a single un'ivariate binary risk factor is considered, this model reduces to the method of Miettinen (1974). Statistical power will be shown through the use of confidence limits or other methods. Associations between selected diseases and putative exposures may arise through a number of biases which affect the collection and interpretation of data from epidemiological studies. The following attention will be given to these potential biases: (1) Associations may be based on systematic bias due to non-response. We will attempt to reduce non-response to minimum. Past experience of the Division of Epidemiology shows that we can anticipate a response rate of better than 80% �Page 19. in both the case and control groups in interview """"studies. We also plan to compare respondents and '• non-respondents among both cases and controls according to the variables which are present in the record systems used for case and control ascertainment. (2) Bias might be the result of preferential recall on the part of case or control subjects. To minimize "••"• this potential bias wherever possible we will use established records to identify or validate military service experience. We also will compare the absolute frequency of military service experience in our study to the data reported from other similar investigations. (3) Bias may occur as a result of a systematic differences between cases and controls in terms of access to medical care. We do not expect this to be a major problem for patients with the conditions under study. However, we will collect information about diagnostic procedures and analyze for this possibility. (4) An artifactual association or absence of association could occur if eligibility for military service varied between cases and controls. avoid this, To controls found to be ineligible for �I. Page 20. military service because of a condition which lead to their death' and subsequent selection as a control will be excluded. We do not know if other causes of death; for example, motor vehicle accidents, are more or less likely to occur among veterans. We . feel the best way of handling this type of possibility is to select the controls broadly from all disease categories except those under study. (5) Confounding by other variables is"one of the most frequent sources of bias. We will attempt to minimize this possibility through matching,subject restriction, and multivariate analysis. Attention will be paid to the distinction between variables which are true confounders and those which are part of a causal network. NOTE THAT A MAJOR LIMITATION OF THIS STUDY MAY BE AN INABILITY TO MAKE A DEFINITE STATEMENT ABOUT DIOXIN EXPOSURE EVEN IF CASES TURN OUT TO HAVE MORE MILITARY EXPERIENCE THAN CONTROLS. Part II Study - Part II Study will be an analysis of occupation and industry as reported on death certificates. \ Study subjects will be all male residents of New York State exclusive of New York City listed on death certificates as dying of soft-tissue sarcomas during the period January 1, ]970 through December 31, 1979. Controls will be selected �Page 21. • from death certificate * files matched on date of birth, years of education, race "and health systems area, decupation'' and industry from the certificates will be analyzed in order « to see if any particular occupations or industries are overrepresented in the case group. x This is considered a hypothesis generating study that may yield a lead for further investigation. III. Human Subjects - Risks, if any, from epidemiologic studies of this type are minimal. The use of telephone interviews to collect epidemiologic data seems reasonable in light of the number of interviews to be completed. This method does, of course, preclude the procurement of personally signed participant informed consent forms. to serve this purpose. A substitute method has been developed Prior to the interview we will read a standardized text which explains the purposes of the research and the rights of participants. This method has been reviewed and approved by the Human Subjects Committee of the New York State Department of Health under the Federal rules and regulations governing the protection of human subjects (Subtitle A of Title 45, Section 46.10(c)). Signed informed consent will be obtained in the event of a personal interview or medical procedure. confidential. Individual records will be kept Division of Epidemiology employees are trained in confidentiality procedures and the offices protected by security measures which help to assure this confidentiality. �REFERENCES Breslow NE, Day NE, Halborsen KT, et al. Estimation of multiple relative risk functions in matched case-control studies. Am J Epidemiol. 1978.; 108:29.9-307. .. . . ... . Goldenberg, GJ, Spurll GM, Hogg GR. Simultaneous occurrence of sarcomas in a husband and wife. Can Med Assoc J. 1974; 110:49-50. Greenberg G. Sarcoma after intramuscular iron injection. Br Med J. 1976; 1:1508-09. Greenberg G. Sarcoma after intramuscular iron injection. Br Med J. 1976; 2:233-34. Hanes B, Gardner MB, Loosli CG, Heidbreder G, Kogan B, Marylander H, Huebner RJ. Pet association with selected human cancers: a household questionnaire survey. J Natl Cancer Inst. 1970; 45:1155-62. Hardell L, Sandstrom A. Case-control study: soft-tissue sarcomas and exposure to phenoxyacetic acids or chlorophenols. Br J Cancer. 1979; 39:711-17. Hatfield PM, Schulz MD. 1970; 96:593-602. Postirradiation sarcoma. Radiology. Holford T, White C, Kelsey J. Multivariate analysis for matched case-control studies. Am J Epidemiol. 1978; 107:245-256. Li FP, Fraumeni JF. Soft-tissue sarcomas, breast cancer, and other neoplasms - A familial syndrome? Ann Intern Med. 1969; 71:747-52. Li FP, Fraumeni JF. Rhabdomybsarcoma in children: epidemiologic study and identification of a familial cancer syndrome. J Natl Cancer Inst. 1969; 43:1365-73. Li FP, Fraumeni JF. Familial breast cancer, soft-tissue sarcomas, and other neoplasms. Ann Intern Med. 1975; 83:833-34. Mierau GW, Favara BE. Rhabdomyosarcoma in children: ultrastructural study of 31 cases. Cancer. 1980; 46:2035-40. Miettinen OS. Confounding and effect-modification. Epidemiol. 1974; 100:350-353. Am J Morman MR, Lin RY, Petrozzi JW. Dermatofibrosarcoma protuberans arising in a site of multiple immunizations. Arch Dermatol. 1979; 115:1453. Morton DL. Soft tissue sarcomas. In: Holland JF, Frei E, ed. Cancer medicine. Philadelphia: Lea, Febiger, 1974:1845-61. �-2- Morton DL, Malmgren RA, Hall WT, Schidlovsky "Gr virus s-tudies with human sarcomas. Surgery. 1969; 66:152-61. Relevance of animal tumours to man. Lancet. 1969; 2:418-19. Safai B, Mike V, Giraldo G, Beth E, Good RA. Association of Kaposi's sarcoma with second primary malignancies - possible etiopathogenic implications. Cancer. 1980; 45:1472-79. Sloane JA, Hubbell MM. Soft tissue sarcomas in children associated with congenital anomalies. Cancer. 1969; 23:175-82 Sobin LH. Sarcomas in Afghanistan. Nature. Stout AP. Sarcomas of the soft tissues. Ca. 1968; 217:1072-73 1961; 11:210-31. �Male Soft Tissue Sarcoma Study Live Control Selection Procedures Request a selected 5-year age group distribution of male licensed drivers by selected zip code areas of New York State, excluding Hew York" City from the New York State Department of Motor Vehicles. Using these data, determine what percentage.of those-files must be sampled and put on-tape—• in order to .generate the appropriate number of controls. Ask the New York State Department of Motor Vehicles to sample licensed drivers using "the'""""""" following procedures: 1. Select all male licensed drivers between the ages of twenty-five and forty-nine inclusive who reside in selected zip code areas. 2. Stratify each 5-year age group by zip code and using a random starting number between 1 and _ _ (to be based on predetermined percentage), choose every th driver in each zip code area until the appropriate number of controls has been selected. 3. Create a tape file consisting of the individuals selected in the systematic sample. Our programmer will then prepare a program which will allow us to print out the information on the tape in a form enabling us to select the controls by random number order. One primary control and five alternate controls will be chosen for each case. They will be matched with the case by sex, year of birth or if necessary, year of birth within a 5-year age group, and zip code at the time of diagnosis. This will be done for each case in the following manner: 1. From a case list including year of birth and zip code .at time of diagnosis find year of birth and zip code for the case. 2. Locate the same zip code on the Motor Vehicle printout and the year of birth that matches that of the case. 3. Using the random number generator on the calculator, choose the first six controls that can be used. 4. Fill in a control selection form in duplicate. 12/11/CO �APPENDIX STATE OF .NEW YORK S. 9722—A ' A. 11729—A ENATEW: Hay 6, 1980 IN SENATE—Introduced by' Sens. COOK, LOMBARDI. BABBUSH, BARTOSIEWICZ, BERMAN, CONNOR, DUNNE, FLYNN, LACK, LAVALLE, LEVY, PISANI, TAURIELLO, VOLKER—read twice and ordered printed, and when printed to be connit. ' ted to the Committee on Health—reported favorably from saj^d cocssittee and committed to the Committee on Finance—committee discharged,-bill amended, ordered reprinted as amended and recocsitted to said cocaaittee ' . • ••"• IN ASSEMBLY—Introduced by COMMITTEE ON RULES —(at request of M. of A. Tallon, Behan, Robach, Conners, Grannis, Hinchey, Kidder, Z firmer, Casale; Hannon, • McCabe, Schioiminger, Larkin, Saland)—read once and referred .to the Cosaittee on Health—reported end referred to the Coonittee on Ways and Means—committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee• •* * * ' i • < • AN ACT creating'a temporary state commission on dioxin exposure and to amend the public health lav, in relation to health effects of exposure to herbicides containing dioxin and naking an appropriation therefor * • • • The People of the State of New York, represented in Senate and Assembly, do enact as follows; ' • " 1 •2 3 A. 5 6 7 8 9 10. 11 12 Section 1. A tenporary state commission on dioxin exposure is hereby created to obtain information relating to the health effects of exposure to herbicides containing dioxin for residents of the state of New York, including those Vietcaa ere veterans who- nay have been exposed to these substances during their period of military service. The commission shall direct its attention to at least the following: (a) Deter.-3ir.iag vhat ccedical, adrainistrative and social assistance is r.eeded for victias of dioxin exposure and submit its recommendations to the legislature for its consideration; (b) Conducting an extensive outreach program to inform Vietnam era veterer.s who 52}- hava been exposed to herbicides containing: dioxin of any federal or st£:e assistance available to then;, and EXPLANATION—Mstter ir. italics (underscored) is new; matter in brackets ( ] is old law to be omitted. LBD02120503A �S - " " " A " '" '" 2 '" " • " - " - 'T : I1729--A' 1 (c) Acting as the official agent of the state for disseminating in2 fornation to Vietnam'era veterans about epideraiological or other studies 3 relating to dioxin exposure which are being conducted by the federal or. . 4 state governnents. 5 § 2. The commission shall consist of nine members; each to serve for a 6 tern of two years, to be appointed by the governor. Five members shall . 7 be honorably discharged Vietnam era veterans, with at least one froa 8 each judicial department; one shall be a representative of a public ea9 ployees union; one shall be a 'representative of a private employees 10 union; one shall be a representative of the business community; and, one 11 nesber shall be the state health commissioner, or his representative. 12 .-The commission shall elect .a chairman from among its members. Vacancies 13 in the membership of the commission and its officers shall be filled in 1^ the oanner provided for original, appointments; The commission shall oeet 15' on the call of the chairman at least four tines per year. However, the 16 coasissioner of health'shall call the initial meeting of the commission 17 not later then December first, nineteen- hundred eighty. . . . 18 § 3. The coranission may employ and at pleasure remove such personnel' 19 as it'nay deea necessary, including an executive director, for che • per20 foraance of its functions and fix their compensation within the amounts 21 oade, available therefor. • , '• " " ' . 22 § 4. The cenb.ars of the commission shall receive no compensation for 23 their services.but shall be allowed, their actual and necessary expenses .24 incurred in the performance of their duties hereunder. "_ . ' 25 § 5..-To the naxinua extent feasible, the coxoission shall be entitled 26 .to*request and rective and shall utilize and' be provided with such 27 facilities, resources and data of any court, department, division, .25 bqerd; bureau, ccsaissioa-ox agency .of .the state or any political . sub29 division thereof as it nay reasonably request-to carry out properly its 30 powers' and duties hereunder. The commission shall not disclose jLnforma31 tion received pursuant to this act so as to divulge the identities of 32 the persons to whoa it relates except as is necessary to carry out the. 33 purposes of this act. • . .; • 34 § 6. The coraission shall make a preliminary report'to the governor ^35 and the legislature of its findings, conclusions, and recommendations ^ ' - not later than March first, nineteen hundred eighty-one, and a final 3^ 37 report of its findings, conclusions and recommendations not later then 33 March first, nineteen hundred eighty-two. . ' 39 § 7. Ths public health lav is aaended by adding a new article twenty40 four-B to read as follows: 41 ARTICLE 24-B 42 INFORMATION PROGRAM ON DTOXIN 43 Section 2475. Special policies with respect to dioxin exposure. 44 § 2475. Special policies with resoect tc dioxin exposure. 1. For 45 the purpose o~f idem: fying persons who were exposed to an herbicide cors46 lair.inz dicxir. ar.d for the purpose of co?npilir.z data on the health ef47 fee's of this »xpcsura, she commissioner of health shall: 43 (a) establish, prsr.ote and maintain' a public information program on 49 dioxin. S'jc'n progr:- shall include, but way not be limited to, an ef- 50 for: ro c-jri'.;.: V:o:r..'.-j «;ra veterans nnd ccptoyces of the public and 51 private scc'ors wi::hir. the state .who were exposed to an herbicide con5 2 io|r. ir.g dioxin; 53 O')^_.'r.j.-is'-". ... cpitjcniolo^tcnl study of the ho.nlth;<-t forts of^cxpo'" 5 . :.ur<.- co hTinciiJ"'; ^.or.t.i in ins <lioxtn: ' �S. 9722--A 3 A. 11729--A 1 (c) rr.iir.iain a central data bank within-the deparcnfc.-.c for iriforrea2 rion collected or. the health effects"of exposure to dioxin and for the 3 cataloguing of existing scientific and medical literature on the health 4 effects of this exposure; and. 5 . (d) initiate education for health professionals to assist them in un6 dcrstanding the potential risks and state-of-the-arc knowledge vith 7 regard to,detection, diagnosis and treatment of acute and chronic syrop8 toss associated vlch dioxin exposure. 9 2. The cor-raissioner may request and shall receive from any deaart10 oer... division, board, bureau, commission or agency of che state or of 11 F.r\y political subdivision thereof such assistance and dgta as vill ena12 ble him to properly carry out his activities hereunder and effectuate ' 13 the purposes herein set forth. The comgissioner may also enter into. 14 any contract for services as he deems -necessary vith a private^,agency or 15 concern upon said terns end conditions-as he deeps appropriate. -Infortna- •16 tion concerning oatient and medical data provided to the eo.-aaissioner 17 pursuen; to this subdivision shall be kept confidential according to the 13 provisions of paragraph (\) of subdivision one of section two hundred 19 six of this chapter. . '20 3. The corrjr.issioner shall make an annual report to the legislature of 21 his findings end recommendations concerning the effectiveness, impact 22 ar.d benefits derived froia the special policies .as provided for in this •23 s act ion. Such report shell be delivered on or before the first day of. 24 .^srch and shall conteir. evaluations of the policies and any legislation 25 deeded necessary a n d proper. . . . . . 26 § 3. The sun of ~vo hundred twenty-five thousand dollars C$225,000), ' 27 or so nuch thereof as.cay be necessary, is hereby appropriated .out of 28 any 'moneys in the state treasury in the general fund to the credit of 29 .. rheostats purposes fund not otherwise .appropriated.. Of such amount, the. 30 sus of seventy-five thousand dollars ($75,000)j is appropriated and aade 31 available Co the temporary state commission on dioxin exposure and the. '32 sun of on-s hundred fifty thousand dollars (§150,000), is appropriated 33 ar.d r.ade available to the departaent of health, to carry out -the* pur34 -ases of this act. Such moneys shall be payable on the audit and war35 rant of the comptroller on vouchers certified or approved in the manner 36 prescribed by Isu. .. " 37 § 9. This act shall take effect on the first day o f September, ' 33 nineteen hundred eighty. • . /.i �». > «* m^c S RECORDED OiSlRiCI J 1 RECiSU* NUMBER 1 CERTIFICATE OF DEATH •CAL DIS">'C" I I NAVE FiAST M DOLC LAJT J St< \ All 'I 1 1 NEW YORK STATE DEPARTMENT OF HEALTH ' r 1 J» I « 1 K 1- 1 L t NUMUEF1 APPENDIX SUB' 3<l MALC u 1 EC. ES. 4 AGE IF UNDER I YEAR MONTHS IF UNDER ( D A Y DAYS HOURS I YEARS DECEDENT 1 n | MINUTES MONTH I ' •A COUNTY OF DEATH > DECEDENT BORN | OA» | I ' YEAR NO YES D OA TE OF D E A T H MONTH u » DAY 1 1 • VETERAN OF u S ARMED FORCES? .. 1 ' FEMALC 1 1 - , ' < 1 T. SOCIAL SECURITY NUMBER IF YES. SPECIFY WAP. OR DATES • O*"""1" D ' «C HOSPITAL OR OTHER INSTITUTION (If NEITHER, GIVE ADDRESS) ' «O IF IN HOSPlI ALOR INSTITUTION ICHECK »OOOA U «="»«>* Q TOWN OF 2 DEMERGING D—"°' • «E IF INPATIET ONE) ' ADMISSION Ovnoou . -ON.M | DAY | , . 2RS£«SJrM '° SSS8& ""*' 1 ' «B LOCALITY ICHECK ONE AND SPECIFY) ' &SW5M!VSS. USA, • 30 HCu" YEAR ' ', p NEVE'R'MAR^ED"'" *"" Q W.DOWEO . • : , • "' S°RV'V""i ^^ "' "''" ^ "*""" "*"" t Q MARRIED OR SEPARATED 4 Q DIVORCED 1 1 AMCR|WANT|NB-ANCK" '* S^EVoiECMSNE*4' D OT<HERCiSPECIr-Y|N' 1 O MEXICAN , Q OTHER SPANISH J •."""•XJ--^ /hESIDENCE\/ r" USUAL RESIDENCE WHERE DECEDENT LIVED. L_ Ci »Q NO l». EDUCATION INDICATE HIGHEST GRADE COMPLETED ONLY ELEMENTARY R CFNT^ALOR * 'NG?^y. 00 01 02 OS OB 07 DDDD 0* OO 10 .1 1 1 DDDD; 11 14 1 f^\ 1 1 18 1 l/^\ tl'BiCOpNTY ^"*^f-^ ,t • " j j A •^V. ' JT \. f^T : .'X<i»«-«.-vl" \ 1?e. IF CITY OR VILLAGE. IS RESIDENCE WITHIN COY OH VILLAGE LIMITST JTES NO ^EP"~™«tQ. IF NO. BPECIFYTOWN: "&-*> """ £5 ^^ J*J V < ^ _ . f"1 LAST I 1>B N C*"EOF AYuCC FATMEfi . T S. , T m I. itjAM^OF ( rt«"F»t \jr MOTHER- t-:W -•*•> -•\ L-AVDDLE * LAST :vjjt -^ 4»^?^^fc, ^. y^.*^^7T^J f 1GA.NAMEOF INFCAMANT N jjjj ^ /??' ••" MIDDLE : ' * &k'C fOCAllTY (CHECK pNErKNO.Si'.ECIFY) 3 V ! D CITYX>F { ."/ 'V / t1 .«' D ^^J* or ."7'^V?i L i '' «O vittioE OP J'^.Jf >.;^ -1"1FIRST 04 > ICC. NAME AND LOCALITY OF FIRM OR COMPANY ifo. STREET AND NUMBER OF RESIO£T?CE (INCLUDE ZIP CODE) 1»<k 03 COLLEGE ll«B. KIND OF BUSINESS OR INDUSTRY *\ 17A. STATE Sj/l tj^ *j -<t^ ff HIOH SCHOOL DDDDDDDDD *O ISuTH AMERICAN ItAw USUAL OCCUPATION (DO NOT ENTER RETIRED) " ' " TES , 1 0B. MAILING ADDRESS IINCU/DC ZIP CODE) / DISPOSITION \ 1 1 B • ~;. 20A. BURIAL. CREMATION. RSMQVAl Oft' MONTH | • • DAY JYEAR* 2OB. PLACE OF BURIAL. CREMATION. REMOVAL OR i i i i i i 21 A. NAME AND ADDRESS OF FUNERAL HOME 21 B. REGISTRATION NO. 22A. NAME OF FUNERAL DIRECTOR 1 j 23B 'MONTH! DAY (YEAR 24A. BURIAL OR REMOVAL PERMIT ISSUED 1 FILED | X | ' • • a. MONTH! DAY I YEAR CEHTiri 1 A. ON THE BASIS OF EXAMINATION AND/OR INVESTIGATION. IN MY OPINION DEATH OCCURRED AT THE TIME. OATF AND PLACE AND DUE TOTHE CAUSES STATED , I SIGNATURE r | , . i AND TITLE I C. LAST SEEN ALIVE I I I TO: I I I I I 1 I D D ^ p* - B. PRONOUNCED DEAD I I I ON I 1 I I D. NAME OF ATTENDING PHYSICIAN. IF OTHER THAN CERTIFIER I 1 m__.« ., LjCOHONl CORON! PHYSICI SIGNATURE _ t 1 AT MONTH M ' 1 t * MEDIC* EXAMIK ID. DATE SIGNED 1 C. HOUR 1 FROM. I 1 TO BE COMPLETED BY CORONER OR MEDICAL EXAMINER ONLY nR A. TO THE BEST OF MY KNOWLEDGE. DEATH OCCURRED AT THE TIME DATE AND PLACE AND DUE TO THE CAUSES STATED B. THE PHYSICIAN ATTENDED THE DECEASED 1 1 BY: TO BE COMPLETED BY CERTIFYING PHYSICIAN ONLY „ 24B. ' MONTH j (JAY j Y | ' r» c in 22C. REGISTRATION NO. 1 22B. SIGNATURE OF FUNERAL DIRECTOR: 21A. SIGNATURE OF REGISTRAR * 1 2OC LOCATION (CITY OR TOWN. STATE) ' " DAY I 1 i | YE,' I 1 i E. SIGNATURE OF CORONER'S PHYSICIAN. IF OTHER THAN CERTIFIER i >• 26 NAME AND ADDRESS OF CERTIFIER (PHYSICIAN. CORONER. MEDICAL EXAMINER. CORONER'S PHYSICIAN, MEDICAL DIRECTOR! \ it. DEATH WAS CAUSED BY ^ cc!<oiTi:<(: if • *NT. W1.Cr< CAVf F.:«:TO IMW£OliI£ C^US! a S1S7ISG T«r fs:^ir:s: ctujf u;t APPROXIMATE INTERVAL ENTER ONLY ONE CAUSE PER LINE FOR 1*1 (BL ANDICI BETWEEN ONSET AND DEATt PART 1 IMMEDIATE CAUSE f 'A: DUE TO. OR AS A CONS£CUE>'CE OF. IB: i : i Out 1O CR AS A CONSEQUENCE Or. CAUSE ( •c> *"•- It OTM'H VG;."'(-»sT rf}li[)IT<O"-, CONDITIONS CONTRIBUTING TO L"l*fH BUI NO' R l L A I C O IO CAUSE GIVEN IN PAOI 1 (A. • VJ'iirH U'^^'ETEHVINitJ PLNLJIIJC; D t ' DJO DATE Of INJURV •' MONIM 1 1 |N,UI<» A l y.i^^f V£s ' tit if.(1(«y IF Al'.iSEr.T M.O'/iC'Cr Vit "A AUtOPSrl OA» , ' 1 3(,f Pl»L'E OF IIJIIIMY HOM£ J I AClOfiv.Cin HC OlOo . trc f . 1 - NO CD 2 'IOC HOUil OF YEAR ' ; | IF YES »VCHt FINDINGS CONSIDER! O 1 N g) DETERMINING THE CAUSE OF DEATH' i D ves 2 D NO 2» WAS C A S C HEFERHE TOCORONEaOR MCniCAL EXAMINER T D 100 DESCRIBE HOW INJURY OCCURRED INJURY 1 ' M t . SOO IOC A1 ION ($TRC CT t NO . Cl T Y OR VILLAGE. T OWN. COUNT Y. ST AT E 1 , VES 2 D � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1865 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Greenwald, Peter Description An account of the resource <strong>Corporate Author: </strong>State of New York Department of Health, Office of Public Health Date A point or period of time associated with an event in the lifecycle of the resource 1981-01-01 Title A name given to the resource Epidemiological Study of Soft-Tissue Sarcoma Subject The topic of the resource state-funded Vietnam veterans study cancer risk assessment soft tissue sarcoma 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. 069 Folder The folder containing the original item. 1864 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Greenwald, Peter Vito Logrillo Description An account of the resource <strong>Corporate Author: </strong>State of New York Department of Health, Office of Public Health Date A point or period of time associated with an event in the lifecycle of the resource 1980-11-01 Title A name given to the resource Proportional Mortality of Vietnam Veterans, Other Veterans and Matched Controls in New York State, Exclusive of New York City Subject The topic of the resource state-funded Vietnam veterans study mortality trends cohort study ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/4d98a0d57e31f6a0c20ed1507e793b90.pdf 937afc88f2448c778e2b9b2401c65ea1 PDF Text Text ItemDNunbor °1863 Author Corporate Author Report/Article Title Conference Call Announcement, New Jersey Agent Orange Study Journal/Book Title Year 1986 Month/Day September Color n Number of hiagos 8 DeSCTlptOn NOtOS Announcement discusses the New Jersey State Agent Orange Commission press conference that announced the results of New Jersey's Agent Orange Vietnam Veterans Study. Also included in this item are several clippings, interviews, etc. on the New Jersey study. Wednesday, July 11, 2001 Page 1864 of 1870 �Conf Gcuiieu Cal 1 A tfcvi/ jkjfHoy Aqeat Orange ytivly !• 1 wish to bring to ./out attention this iwrnifjy ei isi-jan; Leant aeveiGpsiiont o<i is Agent Orange "sc^ao," an «vtwit ot: which you u.ty ali.eaci/ oo well aware au a o£ news reports or contact.;; oy the ineaia oc the jerierai public wita your. .facilities, Laat Wednesday, Seat«m:i«5£ 17, tao Me** Jet soy State Ayent Ocange Commission held a £>reua conference to announce the results oL' a .study, do.si.gna ted as tue "Point Man" Study,, to m^eujure •'U.oxin .levels in i.at. tuxj i^lood in Vietnam veterans, Thia study cxrapated the isvehj of ttioxia in tat of J.U vietnasft n)if.h tliat 01: two .cot^tcoL qt'oupa, tivat IG, (x>nur,oi,s ooiitiutlny oE 10 veterans wno tia>'i iio knon/n exjwsuc^ diiu 7 Vietnum eta vstorai'w wao nevec served in. Vietnam. tatudy'y invescicjatocs diuo.i.t)33d tisat tiie Vietnam votetaas .vaom wiiitary records «howoi3 to nave ;U-.1 hi^u «^qxj^ure to Ayjnt uran-je had ::t.jit..i.stlcaliy siojaifiGiirit hiyiior luv^Lr. of tao '^.,3,7,b .lioxiu .i.yu;<wr in tnoir uiooJ and fat than dici the contcox ijcuuoir. ai the basi.y o£ tholf tJi'Hoct., they concluded thcjt 2,3,7,8 tetcach Lof'.v-tj-viioxin GVJU be detected in i.docw an;] Lnt <it extrein-ily low leveia (pou'tr. ixcj tt.ili.ion); that c»a analysis OL' j.Lood can L>e perforce! to identify tnu ^ru3< aco ot UKJ Agent Oran^t- oiuxin LSCTIOI ; and t.iat there i;j a correlation i>,jt.i-/een exj-o-iute to Ajsnt Qcan-jo dno thy lev-cJ.s of dioxin found ia trie biOo<; r Ta^ i!iVtj3tio<»Uoca stateu tnat tney 'iad ao information concerning whether t.n??re \/&,s a relation s n i p between lovely of dioxin founa in taa i>loo;i and t.io pi ^!>enc^ of .ulvot.;c 1health. Tho second pbiiie oi: their eficoit, ..v.i unvdiiy cae .stab.} or tlow Jetot: / dgr«svjK co provide iiunoiny, v'?lil ixs to iw* -tt .thu .aicaical intoi.'iii'itijn t.v.it whs tjath^raii f.i:on ttie atucty subjects ..*nj att^iaj.>r. LO t;0t; it; .-my .-ioca <x>i:ro.Lf»f.ion tf/usts. i^K->/ J«i;atjy currently has iatroUuc^ t iegiolafioa to yu..>c\>r;t ftu.v. ou:ort. Preoont at tne news cosuu-ruaoe wore muutoera of tho >.&••.r Jer.st/ A9ent (3 Cojmu.-3JLon, RcprostiJitat ivo Plot io ftoui Now Jyisey (wuo .ias ueon .active in enyiroriioental issues aa-i j.st,ue.s relating to cotiijxuis.iti-ja Lot exoc>sure to 1 toxic substances) and Kopi'arjrvitati.veio Dasc.ily aad liUgat froi.i the fiotis<^ Vetuians Affairs Coj.imttee, Mr. 1^.01:io prwified the stuuy ai> a t i r u t effort in what could eventually have pi.abound ii^act on toxic iLti'-jntiou and leyiolation. • Mr. uaschltj and Mr. iviyai i:>otn exi'sre^eu cjr.5titvid« thuc prcxjtuys La ooiny made ai)J statcvi that tne c;x -^loujvi <jive sttoaq coasideiMticn to tne f-tew Jersey eftoit before nvui;iri'j a^r/ i'iajj (.'viternunatiods* conwvni.iiy the totiuia-Atloa of the Ag^nt Orange stuoy* -j'ht' C'onyr.^.s Lonal Ofiico o-. 'LVofinoloj/ Awaossmetit (OTA) will be asked to c;. Ltj.caiiy rwicw tne ctu-jy. Copiets of Hew Jersey's ;>ta<iy aavii not yet been iiude av.-ulablo to OTA, tii^ VA, or for that matter, to -my gcoup or orcjcuuzation. Wo ate in the process of attempting to obtain a copy tor: ouz own inter.naL rt;7j\iw. The study nas been puesentc-c'i at che International synpcxiiun on Di.oxin n<jw going on in Japan. In tae meantijnc you w i l j us-.cioabtociiy rwcoivc* a^.Ua <HKI other Lajuiries on this late breaking dovelopneut. ite uavo oaon .iUvisoJ oy i-bs. Doana St. John in tno VA'a Office of PuoUc unJ Curioumer Affairr, that you saould rot'ei ili i!>e<'iia contacts to your tea^ctive Rogiondl Public Ai �received within VA Central Office are owing routinely referred to Ms, St. John. Public and Consumer Affairs is in tno process of providing uach of their regional offices with information relative to the proas conference at>d the study. Essentially, tne VTv'.'i otauot.1 is tint we ..u«-.; inter:e.yt.'i(.i in tu^ stu>.iy au-J tto have >.t reviowed ny a.,'Af tue VA'S Auviyory Committee on liivd.th-i'iej.atua Eff<;ct3 oi ilettnciUc^ «n..i tiw VA'.s Bnvitouiayutai ila/,«uofi Coinsui tt.ee. It woulti be preinatare to cojiunent oa the ccvsulta of tlici .stuay, or of the ciJ.i.-iijility and validity or its inetiiouoiogy, until suou teviews ,-ux1 corn.iucteu . I'll Koyp you fully eJcJvis<2J 3iioaltJ anything further tian.ypire which needy to be brought to your attention. If you have tiny ^uestiontJ concerniny what I've just covered I'll be yiad to r:esj.:>ond to than at t'us �UPI, 9/17/86 Panel: High dioxin levels found in Agent Orange victims By JOSEPH MIANOWANY WASHINGTON (UPI) - The New Jersey Agent Orange Commission said Wednesday it had found abnormal dioxin levels could be detected in the blood of Vietnam veterans exposed to the herbicide t a possible breakthrough in learning if exposure caused health problems. Commission members, releasing in Washington the results of a three-year study, cautioned that the findings did not prove the dioxin levels found in the veterans were the cause of health problems. However, they stressed that the fact the dioxin levels were detected 11 years after the end of the Vietnam War could be a crucial step in determining if exposure to Agent Orange, a defoliant used during the war, was responsible for a variety of health problems suffered by some veterans years later. Reps. Tom Daschle, D-S.D., James Florio, D-N.J,, and Bob Edgar, D-Pa., said they would ask the congressional Office of Technology Assessment to review the New Jersey study, labeled "The Pointman Project." Daschle, a member of the House Veterans Affairs Committee, said officials from the Centers for Disease Control, which is conducting its own Agent Orange study, told Congress three weeks ago that it seemed impossible to determine if exposure to the herbicide had caused health problems. They said the biggest problem was that there was no way to differentiate positively between dioxin the veterans may have in their bodies because of exposure to Agent Orange and background dioxin to which they may have been exposed elsewhere. The New Jersey study, done in conjunction with the University of Texas Medical School and the University of Umea in Sweden, tested 27 people from three groups: Vietnam veterans who were likely heavily exposed to Agent Orange, Vietnam veterans who were not exposed and Vietnam-ear veterans who did not serve in Southeast Asia. Toxicologist Ralph Fogleman, who worked on the study, said the findings showed the level of dioxin in the blood was much higher for the veterans exposed to Agent Orange than it was for the other two groups. He said the results were similar for fat samples taken from the veterans. He stressed that the blood tests were simpler and less expensive. Commission Chairman Allen Falk said he hoped the results could help change a May 1984 settlement of an Agent Orange lawsuit. That settlement, he said, was based on the presumption that there was no litmus test for determining if exposure to Agent Orange had caused health problems. Florio called the New-Jersey study "an historic medical research event" which he said could also help in dioxin exposure cases other than those related to Agent Orange. "Agent Orange victims are the first cousins of prisoners of war," added Daschle. �BY SGB NCHU6H WASHINGTON (flP) -- A GROUP OF VIETNAM VETERANS? SCIENTISTS AND CQNGRESSHEN ON HEBNESBftY ANNOUNCED RESULTS OF fi STUDY THEY SfiJB PROVES HI LAST THE DEADLY EFFECTS OF THE WftRTINE HERBICIDE flGENT-ORANGE. SCIENTISTS SAIB THE RESEARCH*' FINflNCEB BY THE STfiTE OF NEW JERSEY, SHOWS FOR THE FIRST TIKE fi BIOLOGICAL "FINGERPRINT" LEFT IN VETERANS' BLGGB BY BIQXINi fi KEY AGENT ORfiNGE INGREDIENT, SCIENTISTS AND SPOKESMEN FOR THE N.J. <NEW JERSEY) AGENT ORfiNGE COMMISSION, THE STUBY'S SPONSOR? SftID THE NEW TESTING TAKES THE CftSE RGENT ORfiNGE TWO CRUCIAL STEPS FORWflRD. T THEV SRIB THE RESEflRCH SHOWED TELL-TflLE TRflCES OF BIQXIN CfiN ST i l I IE SUCCESSFULLY SEEN YERRS AFTER EXPOSURE. FURTHERMORE? THE TESTS FOUND LEVELS OP JIGXIN 10 TINES HIGHER IN EXPOSED VETERANS THftN IN OTHER UlETNrtH-ERA SERUlCEflEN. THE RESERRCH.ON 10 HIGHLY EXPOSES VETERftNS? HOWEVER? STOPS SHORT OF LINKING THEIR HEfiLTH PROBLEMS BIRECTLY TO THE WIDELY USED BEFOLIANT, TH£ SCIENTISTS ftCKNOyLEBGEB, BUT THEY ftSSERTEB RT fl CfiPITOL HILL NENS !_'_ CONFERENCE THRT THE STUDY REPRESENTED fl "BREflKTHROUGH" IN EFFORTS TO LEnRN THE TRUE EFFECTS OF THE HERBICIDE. • THE RESULTS OF THE STUDY? THEY SHIB? SHOULD PROHPT THE FEBERRL GGU-ZRNREKT TO DROP ITS LONG3TRNBING CL8IM THfiT THERE'S NO KflY TO PftDUE fi CfiliSE-RhL-EFFECT RELRTIONSHIP BETWEEN fiGENT ORRNGE RNB POOR HEflLTK. :? T H £ UIETNfl-1 UETERHN HfiS BEEN IN fi LONG? BBRK TUNNEL? fiNB HRYBE NQU ^ SEE TME L I G H T ? " SRIB CHARLES KRRUSS? fl MfiYNE? N.J.? RflN WHO HfthDLED •SGENT QRAftGE IN UIE T NflH ftN3 UOLUNTEEREB TO BE TESTED. UETERnKS HNB THE GOUERNHENT HfiUE BEEN DERDLOCKEIJ IN THE BEBRTE BBOuT T H£ DEFOLlHNT USED TO CLERR UIETNBH'S DENSE JUNGLES, THE UETERBNS CLfllH flGENT ORfiNGE IS THE CflUSE OF HEftLTH PROBLEHS TO THEN RNB THEIR FftMILIESi RANGING FROM SERIOUS fiCNE TO CfiNCER, GQUERNHENT OFFICIALS COUNTER THfiT NO SUCH LINK HfiS BEEN PROUEN — A CLHlll THRT PREVENTS UETERRNS BENEFITS FOR THE ILLNESSES. fi LflHSUIT FILED PGfllNST SEUEN flGENT ORANGE HRNUFflCTURERS'BY METERflNS FRGK fi^ERICh? fiUSTRRLIfi flNB .NEM ZEHLft^B RESULTED IN fi $200 HILLION S£ T TIEKENT IN 1S34. THE LITIGflTION? CURRENTLY UNDER ftPPERL? INCLUDES 2 4 5 ? m CLfllNS OF HERLTH DfiHRGE, K R A U S S - f l N D NINE OTHER UIETNfifl VETERflNS WITH fi HISTORY, OF HANDLING TME BEFGLISNT SERUED fiS PfiTIENTS IN "THE POINT NflN PROJECT?" NftHED FOR THE SOLDIERS MHO DREW ENEHY FIRE AS LEftDERS OF THEIR UNITS, THE VETERANS I^ERE STUDIED ALONG yiTH 1? "CONTROL" .CBSES? INCLUDING liETERHNS NHG SERUEB IN MlETNflH WITHOUT DIRECT ftGENT ORfiNGE EXPOSURE? AND VETERflNS OF THE ERfl MHO BIB NOT 5ERVE IN SOUTHEAST ASlfl. LEVELS OF fi BIOXIN FORM KNOWN-AS TCDD ftVERftuEB ABOUT 4.8 PRRTS PER TRILLION IN EXPOSES VETERflNSi CONPflREB TO RBOUT 4 OR 5 PfiRTS PER TRILLION IN THOSE'MHO SAW NO VIETNflN SERVICE* SffIB TOXICOLOGIST RftLPH FQGELHRN, fiP-HX-*}3~l?-86 1432EBT . ; �Dioxin Found in Vietnam Vets * Los Angelas Times on a new high-technology method of , A medical study released yester- measuring tiny amounts of dioxin in day verifies for the first time that tissue. Samples of blood and fat ; Vietnam veterans who were ex- were taken from three groups of | jposed to the herbicide Agent veterans: 10 who the Pentagon con| prange still carry high levels of firmed had handled Agent Orange . poisonous dioxin in their sys- regularly, 10 who served in Vietnam but had little or no exposure to tems. The report is considered a break- the defoliant, and seven Who were • through in the difficult effort to link not stationed in Vietnam. The study found that the average veterans' ailments to the wartime dioxin level in the high-exposure herbicide. "We have found some startling group was seven times higher than evidence that we believe will re- the low-exposure group and 10 open the Agent Orange issue," said times higher than the group outside Allen Falk, chairman of a New Jer- Vietnam. Dioxin has been linked scientifsey commission that organized a three-year investigation of selected ically to cancer, and veterans have veterans by U.S. and Swedish sci- claimed they also have suffered entists. from nerve defects, skin conditions The New Jersey study was based and defects hi offspring. 1 �CBS Morning News, 9/17/86 Faith Daniels: Agent Orange — It's one of the most bitter legacies of the Vietnam War. It's been at the center of controversy and medical confusion ever since the troops came home. There is still no direct medical l£nk between Agent Orange and the diseases that afflict so many Vietnam vets. But today scientists are now seeing an important step toward finding that link. Dr. Bob Arnot is here to tell us about it. Good morning. Dr. Arnot: Good morning, Faith. When Agent Orange was first produced for the Vietnam War a highly toxic biproduct called dioxin appeared during the manufacturing process. Now until recently it was assumed that if you were exposed to dioxin it disappeared within several years. Now for the first time researchers announced they have found large,, quantities of dioxin still present in soldiers exposed to it in Vietnam. These are not the findings of government researchers, but that of a private research group headed by Vietnam veterans and funded by the State of New Jersey. Wayne Wilson, New Jersey Agent Orange Commission: I wish that Vietnam veterans were healthy. I wish that all of us were able to put this Vietnam War behind us, and that we can get on with our lives. But the fact is there appears to be large numbers of Vietnam Veterans who are sick. They turned for their government for some understanding and for some help. And the federal government turned its back on them. Dr. Arnot: So Wilson and his colleagues at the New Jersey Agent Orange Commission launched their own research under the help of the Vietnam Veterans. That was two years ago. Twenty-seven carefully selected men checked into a New Jersey hospital. Ten of the men were known to have been heavily exposed to Agent Orange in Vietnam. Seventeen others were not. The men were subjected to two days of testing and a surgical procedure, parts of a new technique to measure dioxin in fatty tissue and blood. Charles Price: In 'eighty-one I had a tumor removed from my jaw. 'Eighty-two, had a huge one under my arm that was removed. Dr. Arnot: Charles Price was part of the study. He, like many vets, believes Agent Orange has made him sick. Price was a flight engineer for the Air Force. From 1969 to 1970, he flew the Ranch Hand mission, spraying gallons and gallons of Agent Orange on the dense Asian jungle. Price says the chemical defoliant sprayed in his face through the open cargo doors, soaked his clothing -- and he even waded through it on the ground. Now he knows his body is full of dioxin. Price: If I thought about it, a lot of it would probably drive me nuts. So I just go along every day and just try to remove it from my mind. Dr. Peter Kahn: And look at spray handlers, men who handled the spray on a regular basis throughout their time in Vietnam. And we matched them against unexposed, control veterans. Dr. Arnot: Dr. Peter Kahn was the principal organizer of the experiment. A biochemist at Rutgers University, he supervised the surgical procedure to remove the sample and some preliminary lab work. The samples were then sent to the laboratories of Dr. Christopher Rappisch(sp), in Umea, Sweden. He pioneered the new dioxin test. -1- �-2- Dr. Rappisch: What we aimed at was to see whether chemical analysis could be used to identify exposed Vietnam veterans. And when the studies were complete, I think we could have an answer on that — yes or no. Dr. Arnold: And the answer was yes. Dr. Rappisch found high levels* of dioxin stored in the fat of all but one exposed veteran. But most alarmingly, he also found that dioxin continued to leak out of fat into blood twenty years after exposure to Agent Orange. The highest blood concentration? 180 parts per trillion. Dr. Kahn: The normal values are typically around 5 and may run as high as 10. And for the heavily exposed men the mean is, I can't remember exactly, but it's around 40. Dr. Arnold: Now that the dioxin has been found, what does it mean? The vets claim that it has caused cancer, liver damage, nerve disorders and birth defects in their children. Dr. Kahn: There is a growing body of literature linking exposure to chemicals that contain dioxin as contaminants to a number of forms of cancer, with incubation times on the order of 15 to 20 years. Malignant lymphoma, soft tissue sarcomas have all been mentioned. Dr. Arnold: But so far, dioxin has only proven to be cancer-causing in animals, not in humans. And yet another question has been raised. What if a Vietnam Veteran returned to the United States, and lived and worked in an area with high dioxin emissions? How can we be sure of the source of his exposure? The New Jersey study claims to have the answer. With a technique so sensitive it can differentiate between Agent Orange dioxin and other dioxins. And this gives him a big boost in future research. Dr. Kahn: If you are concerned about your personnel health, don't think Agent Orange, think dioxin. And in that regard, Vietnam veterans have been, as Dr. Arnold suggested, the point man for every citizen of this country. Dr. Arnold: Now there are only 1275 "Ranchhanders" who were exposed to the high concentration of dioxin during the war. But there are over 200,000 claims made by veterans and their families. This check will now make it possible to identify which ground troops were exposed to high levels of dioxin in the fields. That then can help scientists to link dioxin levels with instances of cancer and other illnesses. And it also will help to follow exposed veterans with signs of disease in the future. Faith Daniels: Bob, dioxin is believed to be a cancer-causer. proven? Why isn't it Dr. Arnold: The reason is that the incidence of these kinds of cancers is so low — you know, one or two per hundred thousand -- and an increase of three or four per hundred thousand wouldn't be seen unless we studied huge numbers of people. This test will now allow the government and other researchers to study those huge numbers of people to try and find that link. Not that it doesn't exist, they just couldn't look for it before. Faith: All right. Thank you very much, Dr. Bob Arnot. �THE NEW YORK TIMES, THURSDAY, SEPTEMBER 18, 1986 Researchers Report Finding Telltale Sign of Agent Orange WASHINGTON, Sept. 17 (AP) - A The veterans say Agent Orange is group of Vietnam veterans, scientists the cause of health problems for them and members of Congress today an- and their families, ranging from serinounced the results of a study they say ous acne to cancer. Government offimay finally prove the deadly effects of cials counter that no such link has been the wartime herbicide Agent Orange. proved, a position that prevents the Scientists said the research, financed veterans from receiving benefits for by the State of New Jersey, snowed for the illnesses. the first time a biological "fingerprint" »W Million Settlement left in veterans' blood by dioxin, a key A lawsuit filed against seven Agent ingredient of Agent Orange. Scientists and spokesmen for the Orange manufacturers by veterans New Jersey Agent Orange Commis- from the United States, Australia and sion, the sponsor of the study, said the New Zealand resulted in a $200 million research showed that traces of dioxin settlement in 1034. The litigation, now could still be successfully seen years under appeal, included 245,000 claims after exposure. Furthermore, the testa of health damage. found levels of dioxin 10 times higher in Mr. Krauss and nine other Vietnam exposed veterans than in other service- veterans with a history of handling the defoliant served as patients in the men of the Vietnam era. The research on 10 highly exposed study. veterans stops short of linking their Levels of TCDD, a form of dioxin, health problems directly to the widely averaged about 48 parts per trillion in used defoliant, the scientists acknowl- exposed veterans, as against about four or five parts per trillion in test edged. ' subjects who saw no Vietnam service, said Ralph Fogelman, a toxicologlst. Findings Termed Breakthrough But they asserte/at a Capitol Hill The cost of the research, about news conference tjftat the study repre- $400,000, was paid for through legislasented a "breakthrough" in efforts to tion passed by the New Jersey Legislalearn the tme effects of the herbicide. ture. The tests were begun laet year at They said the results of the study Barnert Memorial Medical Center in should prompt the Federal Govern- Paterson, N.J. ment to drop its longstanding contention that there was no way to prove a cause-and-effect relationship between Crossroads for Agent Orange and poor health. "The Vietnam veteran has been in a soltorsend long, dark tunnel, and maybe now- we see the light," said Charles Krauss, a resident of Wayne, N.J., who handled Arii Agent Orange in Vietnam and volunTheWtowlfortc teered to be tested. Veterans and the Government have Ttesas been deadlocked in the debate about the defoliant used to clear Vietnam's dense jungles to deprive the enemy of cover. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1863 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/. Date A point or period of time associated with an event in the lifecycle of the resource 1986-09-01 Title A name given to the resource Conference Call Announcement, New Jersey Agent Orange Study Subject The topic of the resource state-funded Vietnam veterans study popular press 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. 069 Folder The folder containing the original item. 1862 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Bangert, Joseph V. Title A name given to the resource Letter: to Charles H. Hubbs from Joseph V. Bangert, January 30, 1987 Subject The topic of the resource state-funded Vietnam veterans study adipose tissue testing dioxin Air Force Health Study ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/bc54fa583efffdef8051d9f49a71404e.pdf 208c08c339cf33fd3b1a079fcdbc1162 PDF Text Text ItomDNunber °1861 Author Bangert, Joseph V. Corporate Author Commonwealth of Massachusetts Agent Orange Progra RdDOrt/ArtldO TltlO Health Survey of Massachusetts Vietnam Veterans, Summary Journal/Book Title Year 1986 Month/Day June Color 0 Number of Images 12 Descrlpton Notes Wednesday, July 11, 2001 Page 1862 of 1870 �COMMONWEALTH OF MASSACHUSETTS AGENT ORANGE PROGRAM Office of the Commissioner of Veteran's Services 100 Cambridge Street Boston, MA 02202 "Health Survey of Massachusetts Vietnam Veterans" SUMMARY June, 1986 �FOREWORD The Commonwealth of Massachusetts Agent Orange Program, a program of the Office of the Commissioner of Veterans' Services, was provided funding by the 1983 Massachusetts Legislature for the purpose of conducting, "medical and scientific testing related to the possible health effects of Agent Orange on Massachusetts Vietnam Veterans." In January, 1984, the Agent Orange Program, Office of the Commissioner of Veterans' Services (OCVS) was implemented to survey programmatic, medical and scientific options. The Agent Orange Program instituted the Agent Orange Medical /Scientific Advisory Board to provide technical recommendations, oversight and review of proposals and implemented medical and scientific programs and studies. In January, 1985, the Massachusetts Agent Orange Program, in cooperation with the Massachusetts Department of Public Health published the "Mortality Among Massachusetts Vietnam Veterans, 1972-1983" written by Michael Kogan, M.A., and Richard Clapp, M.P.H., as the first step in the Commonwealth's attempt to find some answers to the complex questions surrounding the issue of Agent Orange. This mortality study provides a stable foundation for our continued ongoing efforts to provide scientific, technical, verifiable data regarding the effects of Agent Orange where none had been previously available. The Massachusetts Agent Orange Program's "Health Survey of Massachusetts Vietnam Veterans, 1986" is the second step in our program's continuing efforts to determine the needs of Massachusetts Vietnam Veterans and their families. This survey utilized the "American Legion," or "Stellman questionnaire," with minor modifications. The survey results, contained within, are the result of over 2,000 Massachusetts Vietnam Veterans and their families, and dependents who took the time out to complete a rather detailed and complex form. Only 1,500 of the 2,000 questionnaires were included in the Massachusetts survey as they were chosen on the completedness of the questionnaire, and those filled out by Massachusetts veterans who had not been in the Vietnam theatre were excluded. The analysis of the data collected by the Massachsuetts Agent Orange Program was compiled and analyzed by Mr. Frank J. Bove, M.S., an epidemiologist and PhD candidate with Harvard University School of Public Health. We are indebted to the hard work of this young scientist. The Massachusetts Agent Orange Program also acknowledges the leadership role of Governor Michael S. Dukakis of Massachusetts as well as that of Commissioner of Veterans' Services, John Halachis in their ongoing committment to this program and its importance for the more than 50,000 Massachusetts Vietnam Veterans. We also acknowledge the General Court of the Commonwealth of Massachusetts, and in particular to Senator Fran Doris, Representative Thomas Vallely and former Representative Tom Lynch who took the leadership in bringing the Massachusetts Agent Orange Program into being. We would be remiss if we did not acknowledge the pioneering role of Mr. Christopher Gregory, the former Director of the Agent Orange Program in getting the program on line. We shall continue first and foremost to aggressively and independently survey and test Massachusetts Vietnam Veterans who bore the brunt of battle and will never be forgotten. Jsefob/V. Bangert, Director Massachusetts Agent Orange Program r �SUMMARY Fifteen hundred Vietnam veterans in Massachusetts completed health questionnaires in January 1985. The respondents were those who filed a claim against the $180 million proposed out of court settlement reached by attorneys' representing the seven chemical manufacturers of Agent Orange and Vietnam veterans. Although not a random sample of the more than 50,000 Massachusetts Vietnam veterans, the findings indicate a considerable amount of illness among the respondents including tumors, neurobehavioral problems, reproductive difficulties and birth defects among their offspring. These findings are consistent with the observed symptoms and disease found among those exposed to 2,4-D, 2,4,5-T and 2,3,7,8-TCDD (Dioxin) in the workplace or the environment. INTRODUCTION Concern about the long-term effects of exposure to Agent Orange is widespread among Vietnam veterans in the U.S. and Australia, as well as among the citizens of Vietnam. In southern Vietnam, recent studies report a variety of persistent clinical problems including recurring bouts of headaches, depression and anxiety, asthenia, loss of libido, GI disorders and adverse reproductive outcomes. Studies of workers exposed to dioxin contaminated substances have found elevated rates of lymphomas and soft tissue sarcomas. Neurologic and liver effects have also been reported. Table 1 lists the findings of some of these occupational studies. Table 2 lists the findings of a Massachusetts Departments of Public Health and Veterans Services study of mortality among Vietnam veterans. This study found elevated rates of soft tissue sarcomas, kidney cancer, motor vehicle accidents and suicides. Table 3 lists findings from other studies of Vietnam veterans. This survey of the health of Massachusetts Vietnam veterans is part of an on-going research program that was sparked by the findings of previous studies as well as the concerns raised by veterans. The results of this survey are consistent with those in the studies mentioned above. METHODS AND SUBJECTS In January, 1985, The Massachusetts Agent Orange Program instituted a large-scale media campaign to alert Vietnam veterans �of the court-imposed deadline for filing a claim against the proposed $180 million settlement reached by attorneys for the seven manufacturers of Agent Orange and Vietnam veterans. About 2,000 veterans filed claims during a two day period at the state's Office of Veterans Services. The American Legion health questionnaire was distributed to those filing claims. In addition, some 300 questionnaires were mailed to veterans who phoned the Agent Orange Program requesting to participate in the health survey. Approximately 1800 questionnaires were returned to the Agent Orange Program, fifteen hundred of these were selected based on the criteria of completedness and actual service in Vietnam. Staff of the Agent Orange Program as well as trained volunteers, all of whom were Vietnam veterans, assisted respondents with any questions or difficulties they encountered with the questionnaire. Concerning the birth outcome data requested by the questionnaire, if the veterans were not sure of the information being asked, they were provided with a self-addressed envelope and permitted to take the questionnaire home to consult with their spouses. RESULTS Analysis of the questionnaire data was performed using DBASE III. Over a quarter of the respondents stated that they were diagnosed with tumors (cancerous, benign, fatty or other). Nine were diagnosed with Hodgkins Disease. Nearly 22% of the respondents indicated that one or more of their children had birth defects. Out of 1907 live births reported in the questionnaires, 462 (24%) had at least one birth defect and 160 had more than one defect. Thirty-seven spina bifida, other brain or spine defects were reported. Table 4 presents the data on other congenital malformations. Nearly one-third of the respondents indicated a decrease in libido and 22% reported fertility difficulties (see Table 4). Nearly two-thirds of the respondents indicated persistent problems with tiredness, over half reported persistent headaches and difficulties with memory or concentration, and almost half reported nervous disorders (see Table 5). Seventy-three percent of the respondents answered yes to the question: "Have you or your family ever noticed a personality change?". Eighty-two percent of the respondents claimed they regularly had at least one of the following problems: depression, violent rage, anxiety and irritability. Most had more than one problem. Two hundred and seventy-five respondents reported suffering from mental Illness or a breakdown. Symptoms of peripheral neuropathy in the lower or upper extremities were reported in over two-thirds of the veterans. Indications of asthenia were found in over half of the questionnaires (see Table 5). �Many respondents reported GI disorders. Over a third stated they had repeated nausea without flu or other sickness. Over 25% reported repeated bouts with diarrhea. One-third indicated that they regularly experienced loss of appetite and 20% reported weight loss. CONCLUSION We reemphasize that the questionnaires were not randomly distributed and were completed on a volunteer basis by a selfselected group of MA veterans. This means that we cannot base a valid, scientific study on the information contained in these questionnaires. However, the questionnaires clearly indicate considerable disease and suffering among a relatively young group of people (93% under age 45, 80% under age 40). The symptoms and disease found are consistent with findings from other studies of people exposed to dioxin, 2,4-D and 2,4,5-T. REFERENCES Ashe WF, Suskind RR (1949,1950)tReports on chloracne cases, Monsanto Chemical Co., Nitro, W.VA. Baader EW, Bauer AJ (1951):Industrial intoxication due to pentachlorophenol. Indus Med Surg 20:289-290. Barr MM (1982) :letter to editor. ANZ J. Psych. 16: 88-89. » Barr MM (1983): Apparent progressive axonal dying back neuropathy in Vietnam veterans. Neuroscience Letters, Abstracts suppl. ll:s.29. Dugois P, et.al. (1956): Acne chlorlque au 2,4,5-T. Lyon Med 88:446-447. Erickson JD, et.al. (1984): Vietnam veterans1 risks for fathering babies with birth defects. JAMA 252:903-912. Goldman PJ (1973): Schwetst akute chlorakne, eine massenintoxikation durch 2,3,6,7-TCDD. Der Hautarzt 24:149-152. �Moses M, et.al. (1984): Health Status of workers with past exposure to 2,3,7,8-TCDD in the manufacture of 2,4,5-T: Comparison of findings with and without chloracne. Am J Ind Med 5:161-182. Pazderova-Vejlupkov J, et.al (1980): Chronic poisoning by 2,3,7,8-TCDD. Prac Lek 32::204-209. NIH Library Translation. Pazderova-Vejlupkov J, et.al (1981): The development and prognosis of chronic intoxication by TCDD in men. Arch Env Health 36:5-11. Poland AP, et.al. (1971): Health survey of workers in a 2,4-D and 2,4,5-T plant. Arch Env Health 22:316-327. Stellman S, Stellman J (1980): Health problems among 535 Vietnam veterans potentially exposed to toxic herbicides. Am J Epi 112:444 (abstract). Susklnd RR (1953): A clinical and environmental survey, Monsanto Chemical Co., Nitro, W.VA.. Report of the Kettering Laboratory, July. Suskind RR (1977): Chloracne and associated health problems in the manufacture of 2,4,5-T. Report to the NIEHS/IARC Joint Conference, Lyon, France. January. Telegina KA, Bikbulatova LJ (1970): Affection of the folllcular apparatus of the skin in workers employed in the production of the butyl ester of 2,4,5-T. Vestnik Derm Ven 44:35-39. �TABLE 1 REPORTED OCCUPATIONAL EXPOSURES TO DIOXIN-CONTAMINATED SUBSTANCES RESULTING IN HUMAN ILLNESS* Year,place & chemical(s) Type of exposure & number of cases Neurological effects Other effects References 1949 W.VA TCP, 2,4,5-T explosion 117 production 111 nervousness, irritability, insomnia, personality change,depression, headache,pain & weakness in lower extremities, per ipheral neuropathy fatigue, [Ashe & weight Suskind, loss, 1949, weakness, 1950; decreased Suskind, libido,im - 1953; Suskind, potence 1977] . 1949 Germany TCP production, industrial lab 17 pain & weakness,paresthesia,polyneuritis in lower extremities fatigue, decreased libido, impotence 1952 Germany TCP production 31 pain & weakness,paresthesia in lower extremities, memory & concentration deficits,sleep disturbances, apathy,dulled emotional response fatigue, [Susmyocardial kind, damage 1977] 1953 Germany TCP explosion 55 hearing impairment, peripheral neuropathy fatigue, [Golddrowsiness, man, myocardial 1973] damage 1956 France TCP production 17 peripheral neuropathy 1964 USSR TCP 2,4,5-T production 128 headache,memory loss, sleeplessness [Baader & Bauer, 1951] [Dugois, et.al., 1956] fatigue, [Telejoint pain gina & Bikbulatova, 1970] �TABLE 1 (continued) Year,place & chemical(s) Type of exposure & number of cases Neurological effects Other effects References 1965-68 Czechoslovakia TCP 2,4,5-T production 80 pain & weakfatigue, [Pazderoness in lower weight va-Vejlupkov, loss extremities/ somnolence, et.al., 1980; headache, insomnia,peri19811 pheral neuropathy, emotional & psychiatric disorders 1969 NJ TCP 2,4,5-T 2,4-D production 73 weakness in lower extremities,hypomania *adapted from Moses/et.al.,1984 [Poland, et.al. ' 1971] �TABLE 2 Standardized Proportional Mortality Ratios for Selected Causes of Death for Vietnam Veterans Compared with Either Non-Vietnam-Veterans or Non-Veteran Males ICO NO* CAUSE OF DcATH OBSERVES VIETNAM VETERAN DEATHS All Causes COMPARISON GROUP NON- VIETNAM VETERANS PMR 95% C.I. NON-VETERAN MALES PMR 95% C.I. 840 140-239 All Neoplasms 153-154 Colo-Rectal 162 Lung, Bronchus 171 Connective Tissue 9 880 189 Kidney 9 183 (96,348) 353 (191,651) 139 88 (75,103) 87 (74,102) 28 111 (77,160) 138 (96,199) • 129 95 (78,115) 112 (94,134) 8 113 (56,228) 85 (42,172) 98 (66,146) 102 (72,145) 25 (513,1510) 473 (262,855) 390-429 'Circulatory System 439-459 (except Cerebrovascular) 430-438 Cerebrovascular Disease 571 Cirrhosis of the Liver 29 94 (65,136) 90 (61,132) • E800-E999 All external causes 428 108 (98,119) H3 (103,124) E810-E825 Motor vehicle accidents 169 110 (95,127) 127 (106,152) E950-E958 Recorded suicides 102 93 (77,112) 118 (98,143) 799.9, Estimated suicides*1* E850-E869, E950-E958, 163 113 (96,132) 140 (120,163) 31 80 (56,114) 66 (46,94)' E980-E982 E960-E969 Homicides International Classification of Diseases, 9th Revision, code number. **See reference (6) for discussion of this category. Note that there were 13 deaths in the category 799.9. �TABLE 3 REPORTS ON THE HEALTH STATUS OF VIETNAM VETERANS Reference Exposed Health Effects Stellman & Vietnam Veterans 535 congenital malformations, GI disturbances,pain in joints,sleep and psychological disturbances Barr/1982; 1983 Vietnam Veterans Australia, 120 peripheral neuropathy, insomnia,depress ion, Irritability,lassitude, memory loss,headaches, attempted suicides Erickson, et.al. 1984 Vietnam Veterans 696 congenital malformations: spina bifida,cleft lip, impaired hearing,clubfoot Stellman, 1980 �TABLE 4 CONGENITAL MALFORMATIONS Total Number Birth Defect Prevalence * BDMP Incidence Rate * Spina Bifida,other brain or spine defects 37 195 18.4 clubfoot 24 126 24.5 cleft lip/palate 17 89 13.4 missing, deformed or extra toes/fingers 31 163 Down's Syndrome 11 58 7.9 hip abnormalities 21 111 27.0 heart defect 60 defect of the digestive system 35 hearing disorders 63 cerebral palsy 27.2** 6 other skeletal defects Condition requiring special education or care 46 122 * per 10,000 live births ** polydactyly and syndactyly OTHER REPRODUCTIVE PROBLEMS Problem Number % Loss of libido 487 32.4% Infertility 330 22.0% Infertility and saw physician 246 16.4% low birth weight children 162 8.1% (under 5.5 Ibs.) �10 TABLE 5 NEUROBEHAVIORAL DYSFUNCTION Problem Number % persistent tiredness (saw physician) 957 270 63.7% 18.0% persistent headaches (saw physician) 773 338 51.5% 22.5% nervous disorders (saw physician) 684 356 45.5% 23.7% difficulty with memory or concentration (saw physician) 786 165 52.3% 11.0% mental illness or breakdown (receiving some disability) 275 132 18.3% 8.8% 1233 1015 82.1% 67.6% 321 21.4% regularly depressed, get into a violent rage, anxious or irritable (more than one behavioral problem) Sensory symptoms of early stage peripheral neuropathy asthenia (need hands to rise from chair, can't climb stairs without holding onto railing, unable to do tasks requiring holding arms at shoulder level, difficulty grasping tools) 775 51.6% � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1861 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Bangert, Joseph V. Description An account of the resource <strong>Corporate Author: </strong>Commonwealth of Massachusetts Agent Orange Program Date A point or period of time associated with an event in the lifecycle of the resource 1986-06-01 Title A name given to the resource Health Survey of Massachusetts Vietnam Veterans, Summary Subject The topic of the resource state-funded Vietnam veterans study mortality trends congenital birth defects industrial exposure ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/a453917f7a51f0f18267e95ca0786ef8.pdf 61a90fa0c03be0e01424397a4b0e757f PDF Text Text Item ID Number 018GO Author Newell, John Corporate Author Report/Article Title New Research Links Agent Orange With Cancers JOUmal/BOOk Title New Scientist Year 1985 Month/Day February? Color n Number of Images ' DOSCrlpton Notes Article refers to the Massachusetts Department of Health Study. Handwritten notes on back. Wednesday, July 11, 2001 Page 1861 of 1870 �/PH Saenvs; 7 Februaiy 1985 New research links Agent Orange with cancers DEFOLIANT Agent THL veteransthe the Vietnam war.Orange could be major cause of cancer among of This is absorbs large volumes of liquid, which makes it vulnerable to dissolved carcinoJohn Constable, of the Massachusetts gens. the conclusion of a study by the Massachu- General Hospital, said: "The study is A research programme, headed by setts Department of Health, published last significant because it compares veterans Professor Kenneth Newell, was set up to week. The study contradicts three earlier who were in Vietnam with those who were study the sheep cancers, and to see if it was studies which had found no increase in not. In this case there was not much differ- related to human cancers. Newell now cancers among Vietnam veterans. ence between the two groups except that works at the School of Tropical Medicine, Last week's announcement follows a they were exposed to defoliants." in Liverpool. separate investigation in New Zealand New Zealand has the world's highest The research revealed a strong conwhich linked the two herbicides in Agent incidence of cancer of the large-bowel nection between the incidence of smallOrange with cancer of the small bowel among humans, but there is considerable bowel cancer in sheep and the intensity oi in sheep. This study clears dioxin, a variations across the country. In 1977, a the use of herbicides that are based on common contaminant of Agent Orange, of conference on large-bowel cancer was told phenoxy or picplinic acid. The variation in causing the cancers. The main constituents that similar variations existed in cancer of the use of herbicides explained 98 per cent of Agent Orange are the herbicides the small bowel among sheep. The small of the cases of small-bowel cancer in sheep. 2,4,5-trichlorophenoxyacetic acid and 2,4- bowel in sheep performs much the same Farms which had recently sprayed the dichlorophenoxyacelic acid. The Tesults function as the large bowel in humans. It herbicides had more cases of cancer than from New Zealand point to the those farms where the spraying herbicides and not the conhappened some time ago. taminants as being carcinogenic. Both types of herbicide arc The researchers from Massaliable to become contaminated chusetts analysed the death with dioxin during manufaccertificates of 800 Vietnam ture. Because dioxin was veterans. They compared the suspected as being the cause of cause of death with a similar cancers in Vietnam, Newell control sample of 2500 compared the likely dioxin servicemen, all of whom had content of the herbicides with been in the armed forces, but the incidence of cancer, and was had not served in Vietnam. surprised to discover that there was no link. The research does Nine of the Vietnam veterans had died of tumours in the not prove any connection muscles, fat or other soft tissue, between human bowel cancer compared -with an expected and the herbicide. Nonetheless, death rale of 1 -9. Although the the results are causing considnumbers of cancer deaths are erable interest among lawyers in small, the probability of such a the United Stales, where several result occurring by chance is one cases are pending against the US in 10000. Victims of Agent Orange: now there is a link with cancer Air Force. n John Newell Reagan's budget squeezes America's civil science HONEYMOON between THE community has come to anReagan's administration and America's civil science end this year. For the first time, Reagan has cut into funding for basic civil research, allowing it to grow by only one per cent (against inflation's four per cent) during the next financial year. Delivering the 1986 federal budget last Monday, Reagan's science advisor Dr George Kcyworlh repeatedly cited the "extreme austerity" caused by the record deficit of $ 180 billion. He noted thai during Reagan's first four years, basic research thrived while most other government services were cut. Basic military research, however, still grows, this year by 16 per cent. That growth is at the expense of items such as: fusion research, which is cut by over 10 per cent, while "key scientific questions" arc resolved and internalional collaboration can be negotiated; oceanographic research; and agricultural research other lhan biotechnology, one of Keyworth's sacred cows. Biomedicine also fares poorly. The government plans to support only 5000, rather than the 6500, research grants expected for the nexl financial year (which begins on October 1) from the National Institutes of Health. The space programme is left relatively intact, although the space station will be put back a couple of years. As for the environmental sciences, Reagan has increased aid for cleaning up toxic wastes and study- basic, the Department of Defense's profile ing acid rain. stands even taller. The government spendThe budget for the National Science ing on R&D is $58 billion (up 12 per cent), Foundation, the ally of American univer- ' with defence accounting for almost $40 sities, will jusl keep pace with inflation. The billion (up 22 per cent). The budget for foundation will continue to support the research on "star wars" and other missile funding for computers and other scientific systems is tripled, to $3-7 billion. Binary instruments at universities, while favouring nerve gas is high on Reagan's agenda for physical, mathematical and engineering financial support. sciences. Congress has yet to decide on Reagan's When applied science is folded in with package. Q Australia injects money into space AUSTRALIAN government is THE scientific communitylocalthe develbacking demands from industry and Ihe for It is hoping for A$7 million from the government this year, and plans to spend at least 70 per cent on contracted work to opment of an indigenous commercial space industry. The remainder will be spent on industry. Money has been promised, and a consolidating CSIRO's own in-house space study from ihe Australian Academy of research, which is currently spread across a Technological Sciences is expected lo number of laboratories. recommend the establishment of an The aim is to improve the quality of Auslralian research authority in space communications, remote sensing, meteortechnology. ological surveillance and radar satellites. The government realised belatedly that CSIRO wants to participate in a number of the country was almost totally dependent overseas projects, such as the Internalional on imported space technology, and that its Polar Orbiting Meteorological Satellite. own industry was rundown. Already a conlracl has been signed for As a first move, Australia's Common- Australian industry to build the digital wealth Scientific and Industrial Research package for a British long-track scanning Organisation (CSIRO), a government radiometer, which is to be flown on board agency, has set up an office of space science the European Remote Sensing Satellite. and applications. Its express purpose is to The package will be built by British Aerobuild up skills in space research and space in Adelaide, and ihe federal government will contribute A$ 1 million. rj development in Australia's own industry. �� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1860 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Newell, John Source A related resource from which the described resource is derived New Scientist Date A point or period of time associated with an event in the lifecycle of the resource February 7 1985 Title A name given to the resource New Research Links Agent Orange With Cancers Subject The topic of the resource state-funded Vietnam veterans study popular press dioxin ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/f2c540321d7fff75fbd4b41bf057c04c.pdf a6ba1af182f3b53496f94f69023ab06e PDF Text Text Item ID Number 01359 Author Kogan, Michael D. Corporate Author Massachusetts Office of Commissioner of Veterans Ser Ronnrt/ArtldB Tltta Mortality Among Vietnam Veterans in Massachusetts, ^ 1972-1983 Journal/Book Tltte Year 1985 MOUth/Day January 18 Color ° Number of Imagos 33 DBSCrlptOD NotOS Duplicate does not include cover. Wednesday, July 11, 2001 Page 1860 of 1870 �Mortality among Vietnam veterans in Massachusetts, 1972-1983 The Commonwealth of Massachusetts Michael S. Dukakis, Governor Office of the Commissioner of Veterans' Services Agent Orange Program January 18, 1985 �FOREWORD The Office of the Commissioner of Veterans' Services was provided funding by the 1983 Massachusetts Legislature for the purpose of conducting "medical and scientific testing related to Agent Orange." In January of 1984, the Agent Orange Program of the Office of the Commissioner of Veterans' Services was implemented to survey programmatic, medical and scientific options. The Agent Orange Program instituted an Agent Orange Medical Scientific Advisory Board to provide technical recommendations, oversight and review of proposal and implemented medical and scientific programs and studies. As recommended by the Agent Orange Program and the Agent Orange Medical and Scientific Advisory Board, the attached study, "Mortality Among Vietnam Veterans in Massachusetts, 1972-1983" compiled by Michael Kogan, M.A., and Richard Clapp, M.P.H., was contacted as the first step in the Conroonwealth's attempt to find some answers to the complex questions surrounding the issue of Agent Orange. This mortality study provides a stable foundation for our continued ongoing efforts to provide scientific, technical, verifiable data regarding the effects of Agent Orange where none has been previously available. As highlighted in the study summary, "Deaths due to motor vehicle accidents, suicides and kidney cancer were significantly elevated among Vietnam Veterans compared to non-veteran males for the study period 1972-1983." As further stated, "Elevated risk of death due to motor vehicle accidents and suicide lends support to the hypothesis that Vietnam Veterans have had a greater incidence of traumatic death since the end of the conflict than other non-veteran males." This office is designing, preparing and directing this mortality study equally emphasizing the preparation of an administrative and program response to all study findings. Relative to the significant findings of elevated death due to cancer and traumatic-stress related death, I feel strongly that the Office of the Comnissioner of Veterans' Services response to the study focus primarily on the incidence of traumatic-stress related death among Vietnam veterans. Further study and research regarding cancer incidence and cancer death among Vietnam Veterans will be aggressively pursued by this office. In an attempt to appropriately respond to the traumatic-stress related deaths highlighted by the study, it is necessary to assess the needs of those living Vietnam Veterans who display stressed behavior. For this reason, the Office of the Commissioner of Veterans' Services through the Agent Orange Program has engaged McLean Hospital to provide a behavioral study of Vietnam Veterans. The purpose of the study is to examine the possible behavioral consequences of exposure to Agent Orange and to determine whether this exposure is responsible for any of the symptoms that are often referred to as Post-Traumatic-Stress-Disorder. The Office of the Commissioner of Veterans' Services feels most strongly that the priority in dealing with the Vietnam Veterans is in researching, defining and treating Post-Traumatic-Stress. It is my fear that Post-Traumatic-StressDisorder is the root of a host of problems facing not only the Vietnam Veteran but also their families, spouses, children, neighbors and employers. �ACKNOWLEDGMENTS The Massachusetts Agent Orange Program, directed by Chris Gregory, was substantially responsible for assembling a blue ribbon Medical/Scientific Advisory Board. The credentials of the board members are consistent with the highest standards of medical services found in the Boston area. Because of his sincere and unrelenting drive to seek the answers to the health predicament caused by Agent Orange, State Representative Thomas Vallely, a Vietnam Veteran himself, provided the board with his own personal experience as well as the need for public awareness of the perils of exposure to Agent Orange. This study would not have been possible without the wisdom and commitment of the General Court of Massachusetts, and, in particular, the dedicated efforts of State Senator Francis D. Doris, Chairman of the Special Commission on the Concerns of the Vietnam Veteran. The Senator's sympathetic efforts have been the bench mark for legislative support. The support of the Department of Public Health and its personnel under the direction of Commissioner Bailus Walker was significant. Dr. Walker's commitment to public issues is consistent with his concern for the potential for harm to humans exposed to Agent Orange. Many staff members of the Office of the Commissioner of Veterans' Services worked diligently in the publication of the mortality study and developed a program to generate public awareness. They are: Joe Bangert, Research Assistant for the Agent Orange Program; Martin Burke, Public Information Specialist; Linda Wiggins, Administrative Assistant, for the long and arduous hours of secretarial duties; the sound counsel of Maryann Argento, and last, but not least, Dennis O'Brien, for whatever else needed to be done. The Office of the Commissioner of Veterans' Services will continue to work to uncover the complexities of exposure to Agent Orange and its harmful effects upon Veterans of Vietnam and their families in the areas of behavior, birth defects and mortality. Expanded mortality studies to address any new hypotheses brought by this study will be forthcoming. �MORTALITY AMONG VIETNAM VETERANS IN MASSACHUSETTS, 1972-1983 MICHAEL D. KOGAN, M.A. RICHARD W. CLAPP, M.P.H. January 18, 1985 Massachusetts Office of Commissioner of Veterans Services Agent Orange Program Massachusetts Department of Public Health Division of Health Statistics and Research �Summary The patterns of death among Vietnam veterans, other veterans who did not serve 1n Vietnam, and non-veteran males from Massachusetts were studied by compiling death certificate Information. Veteran status was based on whether or not the decedent's name appeared on a 11st of Massachusetts veterans who served from 1958-1973 and received a bonus. This bonus 11st was supplied by the Office of the Commissioner of Veterans Services. Only those with an honorable discharge were eligible for the bonus. Persons whose name on the death certificate matched that on the bonus 11st were Identified as Vietnam veterans if they received a $300 bonus, or as non-Vietnam veterans if they received a $200 bonus. to be a non-veteran. If there was no match, the decedent was presumed Analyses of the mortality patterns of Vietnam veterans compared to non-Vietnam veterans and to other males who died during the time period (1972-1983) of the study were conducted. Deaths due to motor vehicle accidents, suicides, and kidney cancer were significantly elevated among Vietnam veterans compared to non-veteran males for the study period 1972-1983. Deaths due to stroke and connective tissue cancer were significantly elevated among Vietnam veterans compared to both non-Vietnam veterans and non-veteran males. Deaths due to circulatory system diseases, other than stroke, were lower among the Vietnam veterans compared to non-Vietnam veterans. Elevated risk of death due to motor vehicle accidents and suicide lends support to the hypothesis that Vietnam veterans have had a greater incidence of traumatic death since the end of the conflict than other non-veteran males. The excess cancers of connective tissue and kidney are based on only nine death's from each type. More years of follow-up would be �Introduction The Agent Orange Program 1n the Office of the Commissioner of Veterans Services (OCVS) requested that a mortality study be conducted comparing the causes of death among Vietnam veterans to those of non-veteran Massachusetts residents. non-Vietnam veterans and This study was motivated by a concern that Vietnam veterans may be at increased risk of dying from violent, preventable causes, such as motor vehicle accidents, homicide, and suicide. The list of Massachusetts veterans whose mortality experience was evaluated was supplied on computer tape by the OCVS. In August 1984, the study .was initiated using mortality information from the statewide data base collected by the Massachusetts Department of Public Health, Division of Health Statistics and Research. Using computer-record linkage techniques and manual matching, the study group and two comparison groups were assembled. The pro- portionate mortality and mortality odds ratio were chosen as the methods for comparing the mortality experience among the three groups because information on the number of years since Vietnam service was not available for the Vietnam veterans on the OCVS computer tape. were not available. In addition, the ages of the veterans This study is a first step in analyzing Vietnam veterans' experience of one particular health outcome (mortality). Therefore, it can be used only to draw very general conclusions and to develop hypotheses for further studies. �necessary to adequately assess these findings, and further Investigation, using other sources of Information, 1s recommended. These results are based on the limited Information available from death certificates. Information on such potential confounding factors as smoking and drinking habits, and complete histories of occupational exposures, was unavailable and therefore could not be controlled for 1n the analysis. Nevertheless, the results justify Intensified efforts to reduce deaths due to stress-related or self-destructive behavior among Vietnam veterans. �Methods The mortality experience of Vietnam veterans was compared to that of Vietnam-Era veterans who did not serve In Vietnam and to the general Massachusetts white male population during the period 1972-83. A computerized file of Massachusetts mortality data 1s available from the Division of Health Statistics and Research of the Massachusetts Department of Public Health (MDPH). The mortality data for Vietnam and non-Vietnam veterans was obtained by linking the statewide computerized mortality files with the computerized list of veterans who applied for a military service bonus, available from the Massachusetts Office of Veterans Services. Eligibility for the bonus was based on the following criteria: (1) veterans must have served for at least six months between July 1, 1958 and April 1, 1973; (2) they must have been Massachusetts residents for at least six months Immediately prior to entering the service; (3) they must have applied for the bonus; and (4) they must have been honorably discharged. Veterans received a bonus of $300 if they went to Vietnam, or $200 If they did not. It has been estimated that 95% of all eligible Massachusetts residents received the bonus.(l) The mortality and veterans files were linked by matching social security numbers for the years 1972-76 and 1980-83. For the years 1977-79, social security numbers were not entered on the MDPH computerized files, although they continued to be recorded on death certificates. For these three years, the computer files were linked by matching names. The resulting output was then verified by hand-checking social security numbers on death certificates with those from the veterans file. �The computer linkage provided Information on age at death, sex, race, cause of death, year of death, and Vietnam service. classified Cause of death was according to the appropriate revisions of the International Classification of Diseases and converted to the Ninth Revision Codes.(2) Systematic validation procedures were used to assess the accuracy of the computerized information on cause of death and veteran status, compared to the information from the veterans bonus applications and the death certificates. The cause of death codes on the mortality file were found to be more than 99% accurate when compared to death certificates, as were the veteran status codes on the veterans file. Because white males accounted for about 98% of the veteran decedents, cause of death data for non-whites or female veterans would be very sparse. This report, therefore, is restricted to an analysis of white male mortality patterns, although information on other groups may be pursued in further studies.1 The number of deaths from specific causes among Vietnam veterans was compared with the expected number of deaths based upon the actual mortality experience of both non-Vietnam veterans and all other males in Massachusetts. Veteran deaths were not Included in the Massachusetts white male comparison group. These numbers were derived from calculations of time-cause-specific proportionate mortality within 10-year age groups. The ratios of observed to *Appendix A lists the non-white deaths by age at death, cause of death and year of death. �expected numbers of deaths were summarized using the standardized proportionate mortality ratio (sPMR).(3) The statistical significance of the dif- ferences was assessed using the Mantel-Haenszel Chi test with one degree of freedom.(4) For cases in which the observed number of deaths was greater than five, but the expected number of deaths was less than five, the Poisson distribution was used to determine statistical significance. SPMRs were calculated for both the entire study period (1972-83) and the last six or eight years of the study period, depending upon which time frame offered sufficient numbers for statistical stability. Also, the last half of the study period was analyzed separately because any significant effect in the last six or eight years might have been diluted by looking at the whole study period only. For causes of death for which the sPMR was statistically significant, the standardized mortality odds ratio (sMOR) was also calculated according to the method described by Miettinen.(B) The sMOR was used to confirm the results of, and to correct for biases Inherent in, the sPMR method. The sMOR compares the odds for the exposed population—the number of deaths from the cause of interest compared with the number (auxiliary) causes—with the expected (nonexposed) population.(6) of deaths odds from derived selected from reference a comparison The sMOR approach 1s essentially equivalent to the case-control approach, in which cases are all deaths from the disease of interest, controls are all deaths from the auxiliary causes, and the exposure of interest is Vietnam service. (7) The sMOR analysis was carried out using all circulatory disease, except rheumatic heart disease (ICDA 390-459), as the auxiliary cause. All cir- �dilatory disease was chosen on the assumption that 1t was unrelated to the exposure of Interest (Vietnam service). There were sufficient numbers of deaths due to this auxiliary cause that statistically stable results could be calculated. Although accidents and violent deaths comprised the largest cause of death category (e800-e999), they were not chosen as the auxiliary causes of death because they had previously been found to be higher for Vietnam veterans compared to other males. Including these causes of death would have Introduced bias Into the sMOR analysis. The differences between the two ratios of observed and expected deaths were assessed by using the Mantel-Haenszel Chi test with one degree of freedom. The standardized mortality ratio (SMR) 1s another method for calculating the ratio of observed to expected deaths. It 1s sometimes viewed as a pre- ferable method to the sPMR or the sMOR because the SMR 1s calculated by taking the ratio of the mortality rate in the exposed group to the mortality rate in the nonexposed group for a comparable follow-up per1od.(3) However, in this study it was not possible to calculate SMRs because neither the calendar years of Vietnam service nor the ages of the veterans were recorded on the veterans file. Date of birth was available for approximately 67% of the veterans on the veterans file. This Information was added to the original veterans file by the Massachusetts Registry of Motor Vehicles, which matched the veterans files with a computerized 11st of Massachusetts driver's license holders in 1983. An estimated death rate using only those veterans where a date of birth was listed would have been subject to selection bias, because it would have �8 excluded veterans who died, moved out of state, or did not hold a driver's license. Therefore, age-specific mortality rates for the veterans could not be calculated from the information available on the computerized files. �Results The numbers of deaths that occurred during the study period (1972-83) among both Vietnam veterans and non-Vietnam veterans are presented, by age group and calendar year, 1n Tables 1 and 2. The distribution of deaths suggests that Vietnam veterans, as a group, are probably younger than the non-Vietnam veterans. Tables 3 and 4 present the results of the standardized proportionate mortality ratio (sPMR) analysis comparing Vietnam veterans to non-Vietnam veterans and to all other non-veteran Massachusetts white males for specified causes of death. The sPMRs and their chi values are included in the tables, and p-values are given for all statistically significant findings (p£.05). Uncommon causes of death for Vietnam veterans are not presented because statistically stable comparisons could not be made. A minimum of seven observed Vietnam veteran deaths was used as a criterion for calculating an sPMR. Two methods of accounting for suicide deaths are used. The first method includes only those deaths that were recorded as suicides on death certificates. However, it has been estimated that the actual suicide rate is three times the reported rate.(8) Therefore, a second calculation, known as an "estimated suicide rate," was used which includes all poisonings (ICDA codes e850-e869, e980-e982), recorded suicides (ICDA codes e950-e958), and unknown causes of death (ICDA code 799.9).(9) The analyses presented were carried out on 766 deaths from specific causes out of the total 840 deaths in the Vietnam veterans group. �10 TABLE 1 DISTRIBUTION OF DEATHS BY AGE AND CALENDAR YEAR FOR WHITE MALE VIETNAM VETERANS. 1972-1983 AGE AT DEATH YEAR OF DEATH 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 TOTAL 20-29 49 40 48 48 41 22 18 17 8 1 2 0 294 30-39 6 6 8 14 8 18 22 34 57 57 52 53 335 40-49 8 8 9 15 12 4 4 9 6 13 10 8 106 50-59 1 2 5 3 4 2 8 8 11 7 12 16 79 60+ 1 0 1 1 1 3 1 2 0 3 4 9 26 TOTAL 65 56 71 81 66 49 53 70 82 81 80 86 840 TABLE 2 DISTRIBUTION OF DEATHS BY AGE AND CALENDAR YEAR FOR WHITE MALE NON-VIETNAM VETERANS, 1972-1983 AGE AT DEATH YEAR OF DEATH 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1932 1983 TOTAL 20-29 52 52 42 51 60 24 14 17 20 17 7 6 362 30-39 37 68 73 83 94 52 70 59 77 66 64 67 810 40-49 19 24 24 36 40 31 26 49 75 95 105 112 636 50-59 26 22 40 39 34 30 29 37 43 38 36 46 420 60+ 3 14 12 16 15 3 11 22 36 40 55 60 287 TOTAL 137 180 191 225 243 140 150 184 251 256 267 291 2515 �11 TABLE 3 OBSERVED AND EXPECTED NUMBERS, STANDARDIZED PROPORTIONATE MORTALITY RATIOS AND CHI VALUES COMPARING VIETNAM VETERANS TO NON-VIETNAM VETERANS BY SPECIFIC CAUSES OF DEATH FOR PERIODS 1972-83 AND 1976-83 OR 1978-83* CAUSE OF DEATH ANALYSIS OBSERVED EXPECTED SPMR CHI VALUES (ICDA CODES, 9th REV.) PERIOD DEATHS DEATHS ALL CAUSES 840 ALL NEOPLASMS (140-239) 1972-83 129 136.15 95 -.52 1972-83 8 7.07 113 .34 1972-83 1976-83 25 21 25.49 22.44 98 94 -.10 -.30 CONNECTIVE TISSUE (171) 1972-83 9 1.02 880 7.89 (p<.0001) KIDNEY CANCER (189) 1972-83 9 4.91 183 1.84 CIRCULATORY SYSTEM (EXCEPT CEREBROVASCULAR) 1972-83 (390-429, 439-459) - 1978-83 139 85 158.54 106.54 88 80 -1.55 -2.08 (p-.03) CEREBROVASCULAR DISEASE 1972-83 1978-83 (430-438) 28 19 25.17 11.56 111 164 .56 2.19 (p«.02) CIRRHOSIS OF LIVER (571) 1972-83 1976-83 29 24 30.81 19.03 94 126 -.33 1.15 ALL EXTERNAL CAUSES (6800-6999) 1972-83 1978-83 428 202 396.09 181.51 108 111 1.60 1.52 MOTOR VEHICLE ACCIDENTS 1972-83 (e810-e825) 1978-83 169 74 153.17 61.38 110 121 1.27 1.61 1972-83 1978-83 102 55 109.92 55.65 93 99 -.75 -.09 (ESTIMATED SUICIDES*** (799.9, e850-e869, 6950-6958, e980-e982) 1972-83 1978-83 163 94 144.75 76.01 113 124 1.51 2.06 HOMICIDE (6960-6969) 1972-83 1976-83 31 20 38.73 18.82 80 106 -1.24 .27 153-154) LUNG, BRONCHUS (162) RECORDED SUICIDES ( e950-e958) (P-.03) *SEE PAGE 6 FOR FURTHER EXPLANATION OF STUDY PERIOD ANALYSIS. **SIGNIFICANCE BASED ON POISSON DISTRIBUTION. ***ESTIMATED SUICIDES BASED ON UNKNOWN CAUSES OF DEATH, RECORDED SUICIDES, AND POISONINGS. (9) �12 TABLE 4 OBSERVED AND EXPECTED NUMBERS, STANDARDIZED PROPORTIONATE MORTALITY RATIOS AND CHI VALUES COMPARING VIETNAM VETERANS TO THE MASSACHUSETTS WHITE MALE POPULATION BY CAUSE OF DEATH FOR PERIODS 1972-83 AND 1976-83 OR 1978-83* CAUSE OF DEATH ANALYSIS OBSERVED EXPECTED SPMR CHI VALUES (ICDA CODES, 9th REV.) PERIOD DEATHS DEATHS ALL CAUSES 840 ALL NEOPLASMS (140-239) 1972-83 1976-83 129 102 115.69 87.57 112 116 1.24 1.54 COLO-RECTAL (153-154) 1972-83 8 9.38 85 -.45 LUNG, BRONCHUS (162) 1972-83 1976-83 25 21 24.44 19.79 102 106 .11 .27 CONNECTIVE TISSUE (171) 1972-83 9 1.90 473 5.14(p«.0001)** KIDNEY CANCER (189) 1972-83 9 2.55 353 4.04 (p-.OOl)** CIRCULATORY SYSTEM (EXCEPT CEREBROVASCULAR) 1972-83 (390-429, 439-459) 1978-83 139 85 159.98 104.43 87 81 CEREBROVASCULAR DISEASE 1972-83 (430-438) 1978-83 28 19 20.25 10.95 138 174 1.72 2.43 (p».015) CIRRHOSIS OF LIVER (571) 1972-83 1976-83 29 24 32.07 23.61 90 102 -.54 .8 0 i ALL EXTERNAL CAUSES \(e800-e999) 1972-83 1978-83 428 202 377.66 166.11 113 122 2.59 (p-.OlO) 2.78 (p«.005) MOTOR VEHICLE ACCIDENTS 1972-83 (e8 10-e825) 1978-83 169 67 133.26 50.98 127 131 3.10 (p<.003) 2.24 (p-.025) RECORDED SUICIDES Ke950-e958) 1972-83 1978-83 102 55 86.16 41.80 118 132 1.71 2.04 (p«.041) ESTIMATED SUICIDES*** (799.9, e850-e869, e950-e958, e980-e982) 1972-83 1978-83 163 94 116.21 59.56 140 158 4.34 4.46 (p<.001) (p<.001) 1972-83 1976-83 31 20 46.71 28.09 66 71 HOMICIDE (e960-e969) . '. .. -1.66 -1.90 -2.30 (p«.021) -1.52 *SEE PAGE 6 FOR FURTHER EXPLANATION OF STUDY PERIOD ANALYSIS. **SIGNIFICANCE BASED ON POISSON DISTRIBUTION. ***ESTIMATED SUICIDES BASED ON UNKNOWN CAUSES OF DEATH, RECORDED SUICIDES, AND POISONINGS. (9) �13 Table 3 focuses on the proportionate mortality experience of Vietnam veterans compared to non-Vietnam veterans. Although the proportion of deaths from all neoplasms was not unusual, the sPMR for connective and other softtissue neoplasms was significantly elevated (sPMR-880). All of the nine connective tissue neoplasms were sarcomas of five different types. This finding for this cause of death had the most significant p-value in the study. There was significantly less circulatory system disease among Vietnam veterans for the six years from 1978-1983 (sPMR«80) compared to non-Vietnam veterans. Conversely, cerebrovascular disease among Vietnam veterans was significantly elevated during the same time period ($PMR«164). The sPNR for estimated suicides was significantly higher than expected for the final six years of the study period (sPMR«124). Table 4 displays the proportionate mortality ratios of Vietnam veterans compared to the non-veteran Massachusetts white male population. there were no significant differences Once again, In the proportion of all neoplasms. However, the sPMR for connective and other soft-tissue neoplasms was significantly elevated (sPMR«473), as was the sPMR for kidney cancer (sPMR*353). The patterns for causes of death found 1n Table 4 are similar to those in Table 3. There was a greater than expected proportion of cerebrovascular disease among Vietnam veterans compared to the state's white male population as a whole during the second half of the study period (sPMR»174). All major categories of violent death were significantly elevated for Vietnam veterans, with the exception of homicides (sPMR«66). These categories included motor �14 vehicle accidents (sPMR*127), estimated suicides (sPMR«140), and all external causes (sPMR-113). Recorded suicides were elevated for the final six years of the study period (sPMR»132). The standardized mortality odds ratio (sNOR) was computed for each cause of death for which the sPNR was statistically significant. The sMOR results are presented In Table 5. The sMOR for circulatory system disease was not computed because circulatory disease was used as the auxiliary cause of death for the sMOR analysis. Instances. The sMOR findings differed from the sPMR findings 1n only two Homicide was not found to be significantly lower for Vietnam veterans compared to the state's white males (sMOR«.82), and estimated suicide was not significantly (sMOR*1.46). elevated when compared to non-Vietnam veterans Table 6 summarizes the causes of death for which the findings were significant using both analytic methods. �15 TABLE 5 STANDARDIZED MORTALITY ODDS RATIOS AND CHI VALUES COMPARING VIETNAM VETERANS TO EITHER NON-VIETNAM VETERANS OR THE MASSACHUSETTS WHITE MALE POPULATION BY SPECIFIC CAUSES OF DEATH FOR 1972-83 AND 1976-83 OR 1978-83* CAUSE OF DEATH ANALYSIS COMPARISON SMOR CHI VALUES (ICDA CODES, 9th REV.) GROUP PERIOD CONNECTIVE TISSUE CANCER 1972-83 NON-VIETNAM 5.16 4.18(p<.001) VETERANS (171) MASSACHUSETTS WHITE MALES MASSACHUSETTS WHITE MALES MASSACHUSETTS WHITE MALES 5.87 4.98(p<.001) 4.04 4.27(p<.001) 1.44 2.52(p».012) 1978-83 MASSACHUSETTS WHITE MALES 1.29 1.96(p-.05) 1972-83 MASSACHUSETTS WHITE MALES 1.65 3.85(p<.001) 1978-83 MASSACHUSETTS WHITE MALES MASSACHUSETTS WHITE MALES 1.39 3.10(p-.002) 1.46 2.09(p=.037) 1.40 1.50 1972-83 MASSACHUSETTS WHITE MALES NON-VIETNAM VETERANS 1.46 1.53 1978-83 NON-VIETNAM VETERANS 1.46 1.06 1972-83 MASSACHUSETTS WHITE MALES 1.73 3.11(p-.002) 1978-83 1.69 2.43(p-.015) 1972-83 MASSACHUSETTS WHITE MALES MASSACHUSETTS WHITE MALES 1976-83 MASSACHUSETTS WHITE MALES 1972-83 KIDNEY CANCER (189) 1972-83 ALL EXTERNAL CAUSES (e800-e999) 1972-83 MOTOR VEHICLE ACCIDENTS ( 6810-6825) RECORDED SUICIDES (e950-e958) 1972-83 1978-83 ESTIMATED SUICIDES** (799.9, e850-e869, 6950-6958, e980-e982) HOMICIDES (e960-e969) .82 -1.62 .78 -.75 *SEE PAGE 6 FOR FURTHER EXPLANATION OF STUDY PERIOD ANALYSIS. **ESTIMATED SUICIDES BASED ON UNKNOWN CAUSES OF DEATH , RECORDED SUICIDES, ' AND POISONINGS. (9) �16 TABLE 6 SUMMARY TABLE FOR STATISTICALLY SIGNIFICANT CAUSES OF DEATH FOR PERIODS 1972-83 AND 1976-83 OR 1978-83* STANDARDIZED MORTALITY ODDS RATIOS AND STANDARDIZED PROPORTIONATE MORTALITY RATIOS COMPARING VIETNAM VETERANS TO EITHER NON-VIETNAM VETERANS OR THE MASSACHUSETTS WHITE MALE POPULATION CAUSE OF DEATH ANALYSIS COMPARISON GROUP SMOR SPMR (ICDA CODES, 9th REV.) PERIOD (xlOO) CONNECTIVE TISSUE CANCER 1972-83 NON-VIETNAM 516 880 VETERANS (171) 1972-83 MASSACHUSETTS 587 473 WHITE MALES KIDNEY CANCER 404 1972-83 MASSACHUSETTS 353 (189) WHITE MALES CIRCULATORY SYSTEM 1972-83 NON-VIETNAM 88 (EXCEPT CEREBROVASCUVETERANS LAR)**( 390-429, 439-459) 1978-83 NON-VIETNAM 80 VETERANS CEREBROVASCULAR DIS1972-83 NON-VIETNAM 111 VETERANS EASES** (430-4 38) 164 1976-83 NON-VIETNAM VETERANS 138 1972-83 MASSACHUSETTS WHITE MALES 174 1976-83 MASSACHUSETTS WHITE MALES 144 ALL EXTERNAL CAUSES 113 1972-83 MASSACHUSETTS (e800-e999) WHITE MALES 129 1978-83 MASSACHUSETTS 122 WHITE MALES 127 MOTOR VEHICLE ACCIDENTS 1972-83 165 MASSACHUSETTS (e81 0-e999) WHITE MALES 131 1978-83 MASSACHUSETTS 139 WHITE MALES 146 118 RECORDED SUICIDES 1972-83 MASSACHUSETTS ( e950-e958) WHITE MALES 140 132 1978-83 MASSACHUSETTS WHITE MALES 140 ESTIMATED SUICIDES*** 1972-83 MASSACHUSETTS 173 (799.9, 6850-6869, WHITE MALES 158 169 6950-6958, 6980-6982) 1978-83 MASSACHUSETTS WHITE MALES *SEE PAGE 6 FOR FURTHER EXPLANATION OF STUDY PERIOD ANALYSIS. **SMORs NOT CALCULATED FOR CIRCULATORY DISEASE SINCE IT WAS USED AS AUXILIARY CAUSE. ***ESTIMATED SUICIDES BASED ON UNKNOWN CAUSES OF DEATH , RECORDED SUICIDES AND POISONING. (9) �17 Discussion This study was carried out using death certificates as the source of the health outcome Information. Information. There are Inherent problems 1n relying on such Other studies have assessed the accuracy of death certificate Information by comparing the stated cause of death on the death certificate to either clinical data or autopsy findings.(10,11) The accuracy of death certificates has generally been about 90%. approximately 85-90% reliable Death certificates seem to be for the general diagnosis of malignant neoplasms, although there may be underreporting of malignant neoplasms of about 10%.(11) This study did not attempt to confirm cause of death using hospital or other records. However, the effect of misclassifying cause of death due to inaccuracies on the death certificate would most likely be one of diluting the magnitude of the effects seen in the comparisons. Further problems with death certificate studies Involve lack of knowledge about other factors related to the cause of death. For example, there is no information on death certificates concerning potential confounding factors such as smoking, alcohol consumption, and dietary habits. In addition, death certificate studies may be biased due to differential access to good quality medical care. In this study, Vietnam veterans may not have had as good access to medical care as the non-veteran white males to whom they were compared. On the other hand, the non-veteran comparison group includes some individuals who were unable to serve in the military because of health problems. This potential bias, referred to as the "healthy veteran effect," would tend to dilute the magnitude of the associations between veterans and non-veterans.(12) �18 The method of Identifying deceased veterans by computer file-linking represents a potential source of bias. The primary Unking method (social security number) has been found 1n other mortality studies to be more than 90% accurate in Identifying deaths In a study population.(13) However, some studies have found a 20% false negative rate (missing deaths) when matching was done using names, as 1t was In this study for the years 1977-79.(14) Nevertheless, there 1s no reason to suspect that there 1s any systematic bias between the study group and the non-Vietnam veteran comparison group. However, m1sclass1f1ed social security numbers, names, or veterans who died out of state would only reduce the magnitude of the excess mortality seen 1n the Vietnam veterans compared to the Massachusetts male population. Another potential source of bias Is that only honorably discharged veterans were Included 1n the study population. veterans were more non-Vietnam veterans. likely to It Is not known 1f Vietnam have been dishonorably discharged than Once again, this potential bias would tend to dilute the magnitude of the associations between Vietnam service and specific causes of death. The standardized proportionate mortality ratio (sPMR) as a method of analysis has been criticized by various authors.(3,5,15) The major criticisms of the sPMR approach concern the summary nature of the statistic. Because the sPMR for all causes must equal 100, the statistic cannot give any Information about the total force of mortality.(15) Secondly, the sPMRs for two or more causes are Interdependent, since the sum of the expected numbers must equal the sum of the observed numbers.(3) Therefore, any sPMR greater than the null �19 may be an underestimate If more than one specific cause of death 1s estimated. It has also been pointed out that sPMRs tend to be more easily Interpreted for uncommon causes of death, because they are less dependent upon how common are the other causes, relative to the cause of Interest.(3,5) The sMOR has certain advantages relative to the sPNR. When the auxiliary cause(s) of death 1s unrelated to the exposure, the mortality odds ratio 1s Interpretable as the observed-to-expected ratio. When standardized for age and time, the mortality odds ratio becomes the standardized mortality odds ratio and the observed-to-expected ratio becomes the standardized mortality ratio. In contrast, the sPMR can be quantitatively Interpreted as the stan- dardized mortality ratio only when the sum of the mortality rate(s) of Interest and the rate for the auxiliary cause(s) of death 1s the same for both the exposed and nonexposed.(6) In this study, the sPMR analysis Identified specific causes of death for which there were significant differences between Vietnam veterans and the comparison groups. The sMOR analysis was used to confirm these findings. The results of the study are strengthened by the fact that the sMOR analysis, using a specific auxiliary cause, differed from the sPMR analysis in only two Instances. In order to Interpret the meaning of the findings 1n this study, it Is necessary to keep two other factors 1n mind. First, the study group of Vietnam veterans was assembled from a 11st of those who received a bonus after they had presented proof of Vietnam service and honorable discharge. No �20 Information about length of service (beyond the six month required minimum), precise location of service, or specific exposures to toxic substances, such as Agent Orange, was available from these records. Furthermore, no correction was made for possible social class differences between the Vietnam veterans and the two comparison groups. However, the Vietnam veterans findings for three causes of death which are highly correlated with social class—lung cancer, colo-rectal cancer, and cirrhosis of the liver—did not, 1n this Instance, differ significantly from those of the comparison groups. Three significant findings presented In Table 6, specifically suicides, estimated suicides, and motor vehicle accidents, are all similar In that the causal factor may be a behavioral one. It may be that social stress, which could not be directly measured 1n this study, was higher for Vietnam veterans compared to non-Vietnam veterans and other non-veteran white males. Depression 1s a major risk factor for suicide (8), and previous studies of Vietnam veterans stress disorder have documented post-traumatic and associated depression, as well as elevated rates of suicide, among those who served in combat.(16,17,18) It 1s certainly plausible that the findings in this study may be due, at least in part, to Increased stress experienced by Vietnam veterans. No significant differences were found between Vietnam veterans and the two comparison groups with respect to death due to malignant neoplasms as a whole (ICDA 140-239). The significant elevation of connective tissue cancer was based on only nine deaths; all of these were sarcomas of five different types. Table 7 lists the nine cases by hlstologlcal type. Previous studies �21 have reported that soft-tissue sarcomas were associated with exposure to phenoxyacetic acids such Orange.(19,20) as 2,4-D and 2,4,5-T, the components of Agent For all of the cases with the possible exception of case 9, occupational exposure as obtained from the death certificate did not seem to be significant. A more recent study of upstate New York Vietnam veterans reported no excess of soft-tissue sarcomas diagnosed through 1980.(21) The present study was not based on either adequate numbers of deaths or adequate exposure Information to help resolve this Important Issue. Nevertheless, the highly significant excess of this rare malignancy in Vietnam veterans 1s important new Information. The latency period for soft-tissue sarcoma in adults is probably sufficiently long that several more years of observation will be necessary before any conclusive findings can be made. �22 TABLE 7 CASE-SPECIFIC INFORMATION FOR CONNECTIVE TISSUE CANCER DEATHS AMONG VIETNAM VETERANS BY HISTOLOGIC TYPE AND OCCUPATION YEAR CASE AGE AT YEAR YEAR OF HISTOLOGIC OCCUPATION ON DEATH INDUCTED DISCHARGED DEATH DEATH CERTIF. TYPE 1 30 1969 1971 1975 FIBROSARCOMA DATA PROCESSING 2 28 1967 1970 1976 SYNOVIAL SARCOMA MANAGER 3 30 1965 1967 1976 LIPOSARCOMA MENTAL HEALTH ASSISTANT 4 32 1967 1972 1977 FIBROSARCOMA MANAGER 5 30 1964 1967 1977 FIBROSARCOMA ENGINEER'S AIDE 6 32 1970 1971 1978 FIBROSARCOMA CIVIL ENGINEER 7 32 1970 1971 1982 EPITHELIOID SARCOMA GRAPHICS 8 29 1971 1974 1982 SARCOMA, NOS FIREFIGHTER 9 39 1961 1966 1983 HEMANGIOPERI- PICKER CYTOMA Kidney cancer 1s less rare than soft-tissue sarcomas and was found to be significantly males. elevated 1n Vietnam veterans compared to non-veteran white Possible confounding due to cigarette smoking, analgesic use or other known risk factors among veterans should be considered, but Information on those risk factors was unavailable In this study. Further studies may also shed light on this finding. Finally, the significantly lower number of deaths among Vietnam veterans due to circulatory system disease (excluding stroke) for the time period 1978-83 may be a reflection of the "healthy veteran effect."(12) �23 Conclusions The findings in this study support the hypothesis that white male Vietnam veterans are at greater risk of death due to self-Inflicted or stress-related conditions than the non-veteran white male population in Massachusetts. The results would support an effort to reduce early or untimely deaths among Vietnam veterans due to suicide or motor vehicle accidents, which are largely preventable. Although the numbers of cancer deaths are small, the finding of excess deaths due to connective tissue sarcoma and kidney cancer warrants further study using the cancer incidence records from the Massachusetts Cancer Registry, and, if available, Information on possible exposures to Agent Orange, as reflected in detailed military service histories, as well as histories of other exposures to potential carcinogens. �24 Acknow!edgements We would like to acknowledge the following people for their Invaluable assistance 1n various aspects of the study: Sharon L. Rosen, Ph.D.; David N. Gute, Ph.D.; Christopher Gregory; the Medical-Scientific Advisory Board of the Agent Orange Program (Louis Bartoshesky, M.D.; John McCahan, M.D.; John Cutler, M.D., Ph.D.; Robert Weiss, Ph.D.; John Constable, M.D.; Ralph Timperi, M.P.H.); Gall Grady; Lynne Whitton; Pam English; Shelley J. Allison, M.P.H.; Linda Wiggins; Susan Mullen; and Masahiru Takeuchi. Special thanks to George A. Lareau for word processing the manuscript. Drs. Harris Pastides, Letitla Davis, James Robins, Robert Dubrow and Adrian Ostfeld reviewed or commented on drafts of the report. �25 References 1. Feeney R: Personal communication. Military Archivist, Massachusetts. 2. Manual of the International Statistical Classification of Disease, Injuries and Causes of Death, Ninth Revision. Geneva: WHO, 1975. '3. Monson RR: Occupational Epidemiology. Boca Raton, FL: CRC Press, 1980. 4. Mantel N, Haenszel W: Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute 1959; 22:719-748. 5. Miettlnen OS, Wang J: An alternative to the proportionate mortality ratio. American Journal of Epidemiology 1981; 114:144-148. 6. Splegelman D, Wang J, Wegman D: Interactive electronic computing of the mortality odds ratio. American Journal of Epidemiology 1983; 118:599-607. 7. Dubrow R, Wegman D: Occupational characteristics of white male Massachusetts state cancer victims, 1971-73. NIOSH Pub No 84-109, 1984. 8. Healthy People: The surgeon general's report on health promotion and disease prevention. DHEW (PHS) Publication No 79-55071, 1979. 9. McClure GMG: Trends In suicide rates for England and Wales, 1975-80. British Journal of Psychiatry 1984; 144:119-126. 10. Alderson MR, Meade TW: Accuracy of diagnosis on death certificates compared with that in hospital records. British Journal of Preventive and Social Medicine 1967; 21:22-29. 11. Engel L, Strauchen J, et al: Accuracy of death certification in an autopsied population with specific attention to malignant neoplasms and vascular diseases. American Journal of Epidemiology 1980; 111:99-112. 12. Seltzer CC, Jablon S: Effects of selection on mortality. Journal of Epidemiology 1974; 100:367-72. American 13. Alvey W, Aziz F: Quality of mortality reporting in SSA linked data: some preliminary results. Proceedings of the Section on Survey Research Methods, American Statistical Association, Washington, DC, 1979; 275-279. 14. Roget E, Feinlelb M, et al: On the feasibility of linking census samples to the National Death Index for epidemiologic studies: a progress report. American Journal of Public Health 1983; 73:1265-1269. 15. Mil ham S: Methods in occupational mortality studies. Occupational Medicine 1975; 17:581-585. Journal of �26 16. levy C: Spoils of War. Boston, MA: Houghton-Mifflin, 1974. 17. Shatan C: The grief of soldiers. 1973; 43(4). 18. U.S. Congress, House Committee on Veteran Affairs. Presidential review memorandum on Vietnam-era veterans, H.R. 38, 10 October 1978. 19. Hardell L and Sandstrom A: Case-control study: soft-tissue sarcomas and exposure to phenoxyacetic adds on chlorophenols. British Journal of Cancer 1978; 39:711-717. 20. Eriksson M, Hardell L, et al: Soft-tissue sarcomas and exposure to chemical substances: a case-referent study. British Journal of Industrial Medicine 1981; 38:27-33. 21. Greenwald P, Kovasznay B, et al: Sarcomas of soft tissue after Vietnam service. Journal of the National Cancer Institute 1984; 73:1107-1109. American Journal of Ortho-psychiatry �27 APPENDIX A NON-WHITE VE TERAN DEATHS BY YEAR OF DEATH, VETERAN STATUS, YEAR OF DEATH 1972 1973 1974 1975 1976 1977 1978 VETERAN STATUS Vietnam Vietnam Non-Vietnam Non-Vi etnam Non-Vietnam Non-Vi etnam Non-Vietnam Non-Vi etnam Vietnam Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Non- Vietnam Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Vietnam Vietnam Non-Vietnam Non- Vietnam Non- Vietnam Non-Vi etnam Non-Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Vietnam Non-Vietnam Non-Vietnam Non-Vietnam Non- VI etnam Vietnam Vietnam Vietnam Non-Vietnam CAUSE OF DEATH AND AGE AT DEATH CAUSE OF DEATH (ICDA CODES. 9th REV.) AGE AT DEATH Motor vehicle collision (e812.0) Suicide by hanging (e953.0) Metastatic cancer without specification (199.0) Disease of aortic valve (395.9) Acute myocardlal Infarction (410) Cardlomyopathy (425) Fall out of building (e882) Homicide by knife (e966) Lymphosarcoma (200.1) Accidental drowning (e910.9) Rectal cancer (154.1) Myocardlal Insufficiency (428) Cirrhosis of liver, unspecified (571 .9) Suicide by firearms (e955.4) Homicide by firearms (e965.4) Homicide by firearms (e965.4) Legal Intervention by firearms (e970 i Sigmoid colon cancer (153.3) Brain cancer (191) Acute myocardlal Infarction (410) Motor vehicle traffic accident (e815,,0) Watercraft accident (e830.0) Motor vehicle collision (e812.0) Motor vehicle collision (e812.0) Acute myocardlal infarction (410) NoncolHslon traffic accident (e816.0) Accident by electric current (e925.9) Homicide by firearms (e965.4) Stomach cancer (151.9) Stomach cancer (151.9) Disease of mitral valve, rheumatic (394.0) Acute myocardial Infarction (410) Accidental poisoning, opiates 1.853.6, Bronchus and lung cancer (162.9) Essential hypertension (401) Atherosclerotic heart disease (414.0) Subarachnoid hemorrhage (430) Chronic nephritis (582) Unknown and unspecified cause of death (799.9) Homicide by knife (e966) Bronchus and lung cancer (162.9) 31 28 33 45 43 43 47 32 22 24 31 21 57 32 25 27 27 53 36 56 41 27 29 24 41 31 36 31 33 56 29 40 25 53 52 42 37 29 27 27 32 �28 APPENDIX A (continued) NON-WHITE VETERAN DEATHS BY YEAR OF DEATH, VETERAN STATUS. CAUSE OF DEATH AND AGE AT DEATH YEAR OF VETERAN CAUSE OF DEATH AGE AT DEATH DEATH (ICDA CODES, 9th REV.) STATUS 1979 Vietnam Volume depletion (276.5) 52 Vietnam Ischemic heart disease (414.9) 53 Non-Vietnam Chronic monocytic leukemia (206.1) 40 Non-Vietnam Pneumonitis due to Inhalation 54 of food (507.0) Non-Vietnam Passenger 1n motor vehicle collision (e812.1) 36 Vietnam Colon cancer (153.9) 42 1980 Vietnam 36 Intracerebral hemorrhage (431) Vietnam Motor vehicle collision (e812.0) 36 Non-Vietnam Bronchus and lung cancer (162.9) 45 Non-Vietnam Diabetes mellltus (250.0) 66 Non-Vietnam Epilepsy (345.9) 46 Non-Vi etnam Acute myocardial Infarction (410) 45 Non-Vietnam Chronic renal failure (585) 53 Vietnam Rectal cancer (154.1) 53 1981 Acute edema of lung (518.4) Vietnam 38 Motor vehicle collision (e812.0) Vietnam 32 43 Non-Vietnam Palate cancer (145.5) Non-Vietnam Larynx cancer (161.9) 57 56 Non-Vietnam Bronchus and lung cancer (162.9) 63 Non-Vietnam Bronchus and lung cancer (162.9) Non-Vietnam Alcohol dependence syndrome (303) 38 Non-Vietnam Acute myocardial Infarction (410) 52 37 Non-Vietnam Intracerebral hemorrhage (431) 27 Non-Vietnam Accidental drowning (e910.1) 28 Non-Vietnam Suicide due to firearms (e955.4) Atherosclerotic heart disease (414.0) 42 1982 .- Vietnam 38 Alcohol cirrhosis of the liver (571.2) Vietnam Drowning, undetermined 1f Vietnam 33 accidental (e984) 64 Non-Vietnam Bronchus and lung cancer (162.9) 45 Non-Vietnam Volume depletion (276.5) 36 Non-Vietnam Atherosclerotic heart disease (414.0) 64 Non-Vietnam Cardlomyopathy (425) 32 Non-Vietnam Acute edema of lung (518.4) Cardiomyopathy (425) 33 Vietnam 1983 35 Myocarditis (429) Vietnam 49 Non-Vietnam Acute myocardial infarction (410) 52 Non-Vietnam Acute myocardial Infarction (410) 52 Non-Vietnam Cerebral Infarction (434.9) 32 Non-Vietnam Suicide by firearms (e955.4) 40 Non-Vietnam Homicide by firearms (e965.4) � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1859 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Kogan, Michael D. Richard W. Clapp Description An account of the resource <strong>Corporate Author: </strong>Massachusetts Office of Commissioner of Veterans Services, Agent Orange Program; Massachusetts Department of Public Health, Division of Health Statistics and Research Date A point or period of time associated with an event in the lifecycle of the resource January 18 1985 Title A name given to the resource Mortality Among Vietnam Veterans in Massachusetts, 1972-1983 Subject The topic of the resource state-funded Vietnam veterans study mortality trends suicide ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/252560d2f96615aedef84b0d2d86d088.pdf f39caa3a4fda966f6b7e7d82bf31410b PDF Text Text Item ID Number 01858 Author McKinley, Thomas W. Corporate Author Georgia Department of Human Resources ROpOTt/ArtlGto HUB Geor 9'a Agent Orange Survey of Vietnam Veterans: Summary Journal/Book Title Year 1983 Month/Day Ju| Color Number of Images v || : 11 Descrlpton Notes Wednesday, July 11, 2001 Page 1859 of 1870 �v.v$? --•••£•*'* Georgia Survey of Vietnam Veterans -"'&:.: • IT: &* ;•«?» •SSfei 4^ •S" s^si^s stA^ �SUMMARY Published by GEORGIA DEPARTMENT James G. Ledbetter, PhD, Commissioner 47 Trinity Avenu® , S.W. Atlanta, Georgia 30334 JULY 1983 Prepared by Thomas W. McKintey, MPH Epidemiologist th& Direction of R. Keith Sikes, DVM, MPH Director, Office of Epidemiology James W. Alley, MD, MPH Director, Division of Public Health �flCKNQWLEDGEMENTS The Office of Epidemiology expresses grateful appreciation for the suggestions and guidance provided by the following persons who comprised an ad hoc fldvisory Committee for the Georgia ftgent Orange Study: Committee* Members Thomas W. McKinley, MPH (Chairman) Office of Epidemiology, DHR R. Keith Sikes, DVM, MPH Office of Epidemiology, DHR Douglas Huber, MD John Brady Nam Vets of Georgia •*» ^a. Dept. of Vet. Services D. S. Wilkerson Ga. D^nt. of Vet. Services Julian ft. Jarman, MD Decatur Vft Hor-p:'tal James R. Bishop Decatur VO Hosoitai Observers John D. Humphreys Division of Pub. Health,DHR Don Barrish Office of Community Inte*—Gov. Relations, and DHR �GEORGIA SURVEY The 198£ Georgia General ftssernbly passed House B i l l 1£00* entitled "Reports of Veterans Exposed to Agent Orange." ft sum of $67,525 was appropriated for the Department of Human Resources to conduct a questionnaire survey of Vietnam veterans exposed to flgent Orange during the Vietnam conflict. Recording to Veterans ndrr,inistrat ion (VO) estimates, approximately 58,008 Georgians Served in Vietnam. ft list of Vietnam veterans was not available from the Georgia Department of Veterans Services to use as a basis for the survey. Therefore, it was necess-ary to use registers of veterans who took the ficent Orange physical examination being offered by Vft hospitals and membership lists from organisations such as Nam Vets of Georgia. In addition, veterans were reached oy publicity campaigns and by placing posters, brochures. and Questionnaires in Georgia Department of Veterans Services Offices and other locations freauented by veterans throughout the state. firrancsments were also made with Ti.el.ine, the state telephone information and referral system, to allow Vietnam veterans to call toll free from anywhere in the state and request a questionnaire. ftpproximately £6, 030' questionnaires were distributed; 9.6% by direct mailing and 90.4% by placement in locations freauented by veterans. Participation was limited to Vietnam veterans residing in the state at the time of the survey. General objectives were to: 1. Obtain completed questionnaires by Marcn 31, 1383, from the largest possible number of veterans in Georgia who: (a) (b) currently reside in Georgia, (c) had known or presumed exposure to flgent Orange, and (d) £. served in Vietnam, period 196E-1974, Laos, or Cambodia during the have seen a physician for a health problem believed to be related to Agent Orange Exposure.' Verify medical histories given by veterans by querying physicians and/or hospitals identified on veteran questionnaires. *Sponsored by Representatives Eleanor L. Richardson, Joe T. Wood, Forest Hayes, Jr., Joe Frank Harris, and Paul S. Branch, Jr. �3. Analyse and summarize data from veterans, physicians, and hospitals. 4. Report findings to General flssembly. the 1384 session of the Georgia Results fls of June 30, 1983, quest ionnaires were received form 1905 veterans. These quest ionnaTres form the basis for a regTsTfry of~ Vietnam veterans in Georgia whose illnesses are allegedly due to flgent Orange exposure or who have health concerns about flgent Orange exposure. Of the total questionnaires received, 1£6S _ (67.6%) were e 1 i g i big for i >^gjLusjLon__i n the survey based on the abov"e~cr i t erTa". Questionnaires were received from 1£4 . o ^ f Georgia's 159« counties (Figure 1). " flpproxirnately 97% of the survey group were' males; 65"/« were white and 30"/. black. ftge ranged from £3-77 years; mean 39.4 years. Major findings of the survey are contained in the following statemants. Interpretation of these findings must take into consideration the fact that 1) the survey targeted veterans who had one or more health conditions which they believe to be related to flgent Orange exposure, £) a. subst ant_ial proport ion of Jnejalth conditions r^^£Il^JigL__by veterans^were not confirmed by 'thjnTr bhysi'cians^ and may have been reported on the basTsoTsUTf^ diagnosis, and 3) information regarding exposure to flgent Orange is totally dependent uoon recall of sometimes uncertain- events which occurred 10-15 years ago. 1. 1£88 Vietnam veterans in the State of Georgia reported having one or more health conditions which .they believe to be related to exposure to flgent Orange. Health conditions r_e_p_ortgd__ by more than half the veterans include s k in cond i t i ons (other than acne), emotional/adjustment problems, nervous system problems, and sleeplessness. £. Only 52?t of 'survey participants had taken Orange physical examination offered by Vfl. the flgent 3. fl substantial proportion of veterans (£9% during their first tour of duty) reported being sprayed with flgent Orange by aircraft. 4. Veterans reported 205 cases of acne with onset after service in Vietnam. Physicians confirmed £9 cases in 119 of these reports (£4. 4"/i), but there was no indication that the cases were chloracne (a specific type of acne caused by exposure to dioxin and other chlorinated biphenyls). .Vfl has acknowledged only two or three cases of chloracne in Georgia veterans. �5. Veterans who participated in Operation Ranch Hand (code name for the group who sprayed flgent Orange) reported a significantly higher prevalence of cancer, liver problems, respiratory problems, sexual dysfunction, and chronic pain than other veterans. 6. Veterans who remembered developing sorna type of illness within 43 hours of exposure to flgent Orange, reported a significantly higher prevalence of 12 of 30 medical conditions. 7. Veterans reported 99 cases of cancer, but physicians completing questionnaires on 47 of these confirmed only 13 (£1.3%). Theoretically, all Georgia Vietnam veterans (est. 58,000) could have participated in the survey if they have a health problem, including cancer, which they believe to be related to flgent Orange exposure. There are at least two ways to analyze the cancer data: (a) The first method of analysis involves a comparison of observed to expected cases. Using cancer surveillance data and assuming that the total population of Georgia Vietnam veterans has the same race, sex, and ace distribution as the survey group, Jbh_e expected number, ._._..Q.f_ cases i n . JLJlg_t ^!^gL'-!^QJ[li-ia ^ i'ietTvam^veFe'r an population _ - - . ^ 37 7. If the actual number of "cases ir\~t h e sorVey groTTp"" is 10^ this would only be three percent of the expected. If the actual number is 21, this would be six percent of expected. If the actual total is 99, this would be £3* of expected. (b) 0 second method of analysis consists of comparing the observed prevalence rate of living cancer cases in the survey group to the expected prevalence rate estimated for all Georgia Vietnam veterans. The expected prevalence rate of living cancer cases in the total population of Georgia Vietnam veterans was derived using cancer surveillance data arid the assumptions indicated in (a) above. If the actual number of cancer cases in the survey group is only 10, this would give a prevalence rate of 77S per 130,000 which is not significantly different from the expected prevalence rate of 613 per 100,000. If the actual number of cases is £1, the observed prevalence rate would be sigificantly higher than expected (p<.01; Chi-square test). However, these data must be interpreted with caution since the survey design tended to inflate the number of cases of illness in the survey group.. JJia—Sj^yjey^jdesigji,_ ijo_jHa.c_tJL__doGs not al low for a determination of whjstjier cancer rjat e s are higher i n~vTetnarn vc?tt?rans exposed to _ ~ unex posed popUIatjjgru This and similar determinations" "musTE await completion of the large population based study being conducted by the Centers for Disease Control. �8. Negative pregnancy outcomes reported by veterans were less than 6.5^ of the number expected for any negative pregnancy outcome among families of all 58,000 Georgia Vietnam veterans. Pregnancy outcomes were not confirmed by physician questionnaires or other means. 9, The rate of cancer, other than leukemia, for progeny of Vietnam veterans was not significantly different between those children born before and those born after the father's Vietnam service. Veterans reported two cases of leukemia in children born after Vietnam service, but meaningful comparisons were not possible since physician confirmation of these cases was not• obtained. 0 MORE DETAILED REPORT OF THE STUDY IS WftlLftBLE ON REQUEST �Figure STATE : .r>?st->:*zvfiv/ ^^^S iift," ^1 i *:'?i'5?!:''''"'>:''"1''';>'''"ViiJii;!!i>; CAL**OW* ! - «*<«.«» -' i /» v '-j '- ,•' /•,'--""/>" ' " vr«g^s;.sss.s«8;r' »«" ^^^^Ix ""*"' /; �RECOMMENDRTIONS This report completes the charge to conduct an flgent Orange survey which was given to the Department of Human Resources by the 1982 Georgia General assembly. The following recommendations are made as a result of that survey: 1. £. Consideration should be given to setting up an flgent Orange clearinghouse or phone center which would receive inquiries and complaints from veterans, dependents and others, and would transmit to interested persons information with resoect to flgent Orange or dioxin-related matters. •*• Veterans who have not taken.the Vfl flgent Orange physical examination should be encouraged to take the examination at the earliest time. 3. The list of veterans who indicated they participated in Operation Ranch Hand should be checked against military study records to determine whether all these veterans are enrol led in the Ranch Hand Study. 4. The Vfl should be asked to evaluate or re-evaluate, as the case may be, veterans whase physicians confirmed a diagnosis of acne after age 18 to determine whether they may have ch lor acne.. 5. figent Orange questionnaires, computer tapes' containing data on health conditions, and other pertinent files and records should be transferred to the Georgia Department of Veterans Service for safe keeping and possible use when results arc completed on the CDC epidemiologic study. S. Odditional studies regarding the question of Ogent Orange exposure and health of Vietnam veterans in Georgia should await the results of the CDC epideniiolog ical cohort study. �SUKMflRY OF HEflLTH EFFECTS OF DIOXIN EXPOSURE figent Orange consisted of an approximately equal mixture of two common herbicides, 2,4-D (£, 4-dichlorophenoxy acetic acid) and 2,4,5-T (2,4,S-trichlorophenoxy acetic acid). The latter herbicide contained a small amount (average 2 parts per million) of a chemical contaminant known as TCDD (2,3,7,8tetrachlorodibenzo-para-dioxin), also commonly referred to as "dioxin." This contaminant, which is formed if the reaction temperature becomes too high during synthesis of 2,4,5-T, has been called the "most toxic man made substance known" because of its highly lethal effects on certain strains of guinea pigs. To date__t_here ^rg__np conclusive studies which causal 1 y link TCDjD_ or 'fl"ge_nt Q*"anJe_j!JiP-gj?ure with_j?xcessive mortality or long term health effects___i-Ki—huwajas...— Information on'TfeaTth effects comes almostentirely from animal studies, which are not directly predictive of effects in hurnans, and from human occupational exposures to herbicides and other chemicals contaminated with TCDD. What is known regarding health effects is briefly summarized in the following paragraphs. Persons exposed to high concentrations of TCDD by reason of occupation or industrial accident were commonly observed to develop a painful skin, condition called chloracne. This condition usually appeared within weeks to months following exposure and persisted for one to several years, depending on the severity of exposure. Other health effects have also been observed in severely exposed persons. For example, a condition known as porphyria cutanea tarda, which is characterized by large blisters of the skin and liver involvement, was reported among at least two groups of exposed workers. In addition, Swedish investigators have recently suggested that there may be a relationship between exposure to TCDD containing herbicides and a form of cancer known as soft tissue sarcoma. However, information to date is not sufficiently completed to establish a cause and effect relationship. Birth defects were reported among children born to south Vietnamese refugees who sought sanctuary in north Vietnam. Pi higher rate of birth defects was also reported among infants born to women whose husbands fought in south Vietnam compared to those born to women whose husbands stayed in north Vietnam. Results of these observations are in doubt, however, "due to methodological problems attendant with ascertainment of information in a war-torn area. Increased abortion rates were also reported among women living in the PUsea, Oregon area where 2,4,5-T had been used for forest management. fln EPPt study tended to confirm this report, but the EPft study was later found to have serious problems with incomplete ascertainment of data. �flnimal studies have shown that rabbits and monkeys develop chloracne when exposed to subacute doses of TCDD. Subacute exposure has also been shown to produce severe weight loss and porphyria (a disorder of hemoglobin metabolism) in certain animal species. Carcinogenicity testing of TCDD in rats and mice has yielded results that are difficult to interpret. Increases were observed in cancerous tumors but only at doses which produced other toxic effects. There was a general lack of both organ specificity and linear dose response usually observed with cancer causing agents. In one study a certain strain of mice fed combinations of TCDD and S,4,5-trichlorophenoxyethanol showed a significantly higher incidence of liver cancer than controls. These observations led investigators to hypothesize that'TCDD may be a tumor promoter rather than a primary carcinogen. However, —in actual trials in rats and mice, TCDD was not shown, to be a tumor promoter. In test systems which employed TCDD and a carcinogenic polyaromatic hydrocarbon, TCDD was observed to inhibit tumor formation by inducing the production of enzymes which converted the polyarornatic hydrocarbons into non-cancer causing metabolites. In other animal studies, certain strains of pregnant mice showed fetatoxicity and birth defects in their offspring after TCDD exposure; however, exposed male mice were not shown to produce deformed offspring. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1858 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource McKinley, Thomas W. Description An account of the resource <strong>Corporate Author: </strong>Georgia Department of Human Resources Date A point or period of time associated with an event in the lifecycle of the resource 1983-07-01 Title A name given to the resource Georgia Agent Orange Survey of Vietnam Veterans: Summary Subject The topic of the resource state-funded Vietnam veterans study questionnaire morbidity trends dioxin ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/e60d6e0915a2c041b9cb88f357f1c009.pdf c26923e4beba70ccf43ac8c3d4b04e26 PDF Text Text Item ID Number 01496 Author Shepard, B. M. Corporate Author Roport/Arttehj TltlO Typescript: Chapter 6: The Risk of Soft Tissue Sarcoma in Veterans of the Vietnam Conflict Journal/Book Title °00° Year Month/Day Color n Numberoflmae.es 25 DOSCriptOD NOtflS This 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. Tuesday, May 15, 2001 Page 1496 of 1514 �CHAPTER 6 "Perhaps the greatest fear held by veterans of the Vietnam conflict was the fear of Cancer because they had been exposed to Agent Orange" THE RISK OF SOFT TISSUE SARCOMA IN VETERANS OF THE VIETNAM CONFLICT B.M. Shepard, H.K. Rang, F.M. Enzinger, L.B. Hobson Ever since the reports by Hardell and Sandstrom (1979) , Eriksson et al. (1981) and others began to appear in Sweden in the late 1970's, the concern that exposure to the phenoxy acid herbicides increases the risk of developing one of ,.the soft tissue cancers has persisted in the minds of scientists and non-scientists alike. This concern coincided with the growing fear among many veterans of the Vietnam conflict that service in that country and especially exposure to the phenoxy herbicides used for strategic purposes during that military action posed a major risk for developing a wide variety of serious health problems. It was inevitable, therefore, that soft tissue sarcomas quickly joined the growing list of adverse health effects attributed to exposure to the phenoxj? -herbicides used in Vietnam. By far the predominant Herbicide used was code named Agency Orange. It was a 50:50 mixture of 2,4-D and 2,4,5-T, the latter containing trace amounts of 2,3,7,,8-TCDD ranging between 1 and 47 parts-per-million (ppm). The average concentration was estimated to be approximately 2 ppm. The distinction �between the active herbicidal ingredients and the dioxin contaminant as being the "causative" agent of these various health problems including the soft tissue sarcomas has remained clouded, although there is little evidence to implicate 2,4-D or 2,4,5-T alone as human carcinogens. The reports of. Hardell and his associates linking phenoxy herbicide exposure with soft tissue sarcomas and related concerns among Vietnam veterans have stimulated a series of studies in the United States designed to shed more light on this perplexing and troublesome issue. Meanwhile the concerns of Vietnam veterans in this area drew considerable attention in the U.S. Congress where the issue was heatedly debated and became the subject of a number of legislative initiatives designed to mandate additional research in this area as well as to provide compensation and special medical care eligibility for Vietnam veterans who developed one of these rare types of cancer. This chapter will provide an overview of what is known generally about this group of tumors and will summarize the results of some of the studies designed to determine if service in "'y Vietnam and herbicide exposure have increased the ' 5, risk for developing soft tissue sarcomas. "V INCIDENCE, DEFINITION AND DISTRIBUTION Soft tissue sarcomas, compared to carcinomas and other neoplasms are relatively rare tumors. It is estimated that �they account for about 1% of all cancers and are responsible for about 2% of all cancer deaths. Between 5000 and 7500 new cases are diagnosed each year in the United States. It has been suggested that there is an upward trend in the incidence of soft tissue sarcomas, but it is not clear whether this represents a true increase or whether it reflects merely better diagnostic capabilities and greater interest in this type of tumor. The average annual age-adjusted incidence rate is 2.0 to 3.5 per 100,000 population, but the rate varies not only in different age groups, but also depends upon the definition of soft tissue sarcomas and the types of neoplasms that are included among these tumors. For example, in the National Cancer Survey, retroperitoneal, mesenteric and omental sarcomas are counted among the neoplasms of the digestive system and pleural sarcomas (malignant mesotheliomas) are included among the tumors of the respiratory system. Judging from the available data, incidence and distribution of soft tissue sarcomas seem to be similar in different geographic regions of the world (Tucker and Franmeni, 1982). As the name indicates soft tissue sarcomas are usually *'"'' defined as extra-skeletal, non-epithelial sarcomas that arise chie.fXy in musple, fat or fibrous connective tissue such as tendons or ligaments and less frequently in blood vessels and nerves that serve these tissues. Consequently, soft tissue sarcomas may occur anywhere in the body, but the majority �originate in the large muscles of the extremities, the chest wall, mediastinum and retroperitoneum. Excluded are sarcomas of the brain and other major organs, such as the heart, lungs, kidneys, liver and intestinal tract. Excluded also are the tumors of the hematopoietic system, such as leukemias as well as malignant lymphomas and Hodgkin's disease (Enzinger et al. 1969; Enzinger and Weiss, 1983). Soft tissue sarcomas may occur at any age: about 15% affect persons younger than 15 years old and about 35% occur in persons 55 years or older. In general they are somewhat more common in males than in females. The age and sex incidence, however, varies among different histologic types. There is no proven racial variation, even though the annual age- : adjusted incidence rates have been reported in some cases to be higher for blacks than whites. CATION AND DIAGNOSIS On clinical examination, as well as direct visualization and palpation during surgery, soft tissue sarcomas as a group tend to display a fairly uniform picture. When examined under the microscope, however, they vary greatly in appearance and actually comprise an extremely varied and highly complex group of neoplasms rather than a single entity. At present, the classification recognizes 25 major types of soft tissue sarcoma, many of which can be further divided into one or more subtypes on the basis of their 4 �histologic characteristics. Classification and diagnosis by subtypes are essential because the clinical behavior and response to therapy frequently depend not only upon the histogenetic type but also upon the degree of cellular differentiation or grade of the tumor. The various types are named according to the predominant cellular elements and the resemblance of the tumor to normal tissue or its embryonal counterpart. Malignant fibrous histiocytoma, liposarcoma and fibrosarcoma are the most common soft tissue sarcomas of adult life; together they account for more than 50% of all cases. Rhabdomyosarcoma, neuroblastoma and extra-skeletal Swings sarcoma are the most frequent types of soft tissue sarcoma in children. Correct diagnosis of these tumors is still largely dependent on incisional or excisional biopsy in order to provide the pathologist with a specimen of sufficient size for an accurate description and identification. In recent years percutaneuous needed biopsy and aspiration have become increasingly popular as a means of diagnosing many types of neoplasms. Reliance on these techniques when dealing with this group of tumors, however, should be approached with great caution, since they provide only a minute specimen which may not be representative of the entire tumor. But even with adequate material many soft tissue sarcomas present a diagnostic dilemma, and an accurate diagnosis often requires �examination with the transmission or scanning electron microscope. techniques More recently the use of immunohistochemical in the study of soft tissue sarcomas has profoundly changed the approach to the diagnosis of these tumors and has permitted an accuracy of diagnosis unheard of only a few years ago. BEHAVIOR AND THERAPY The various types of soft tissue sarcoma differ considerably in their degree of malignancy, and identification and diagnosis of the exact histologic type and subtype are essential for predicting the clinical course of the tumor as well as selecting the best method and plan for treatment (Costa et al. 1984; Mandard et al. 1981). Despite a wide variety of therapeutic modalities, it is generally agreed that surgical resection, when possible, is still the treatment of choice for primary soft tissue sarcomas. Chemotherapy and radiotherapy serve as adjunctive forms of treatment, especially in highly malignant sarcomas. When planning definitive surgery, it is important to know as much as possible about the extent of the lesion as well as the >• •'• type and grade of the tumor. Since the extent of the tumor is not always evident microscopically, it is most important that the margins of the resection be checked by the pathologist during the operative procedure. The best chance of cure is achieved with total excision during the initial surgical �procedure. Since many sarcomas develop microscopic met- astases early in the course of the disease, the ultimate outcome of these tumors must be assessed with considerable caution and long term follow-up is essential, especially in the case of high grade soft tissue sarcomas. The outcome is much less favorable with recurrent tumors and with large unresectable tumors such as many sarcomas in the retroperitoneum (Eilber et al, 1984; Enneking, 1983; Rosenberg, 1982) . Soft tissue sarcomas occurring in childhood often respond extremely well to combination therapy with some reported cure rates as high as 80%. For this reason surgery in this age group can usually be less radical when combined with •- radiation and chemotherapy. PATHOGENESIS As with other types of malignant neoplasms, the causative factors of soft tissue sarcomas, are still for the most part unknown. The development of sarcomas from benign soft tissue tumors is rare. A notable exception to this rule is the appearaftce pf malignant neural tumors arising in neurof ibromas... .In this instance it is nearly always seen in T patients with previously determined manifestations of neurofibromas. A few causative agents and predisposing factors have been clearly established and include various physical and chemical exposures such as ionizing radiation �and asbestos as well as various inherited or acquired immunologic defects. Determination of the exact cause is often extremely difficult, because of the long latent period between the time of exposure and appearance of the sarcoma. The possible effect of multiple environmental and hereditary factors during the induction period further complicates any attempt to establish the causative agent or other circumstances (Enzinger and Weiss, 1983). Considering the extensive use of radiotherapy, radiation induced sarcomas are extremely rare and therefore the benefit of radiation in the treatment of malignant neoplasms, far outweighs the risk of developing such a sarcoma. It has been estimated that only about 1% of patients who survive 5 years following intensive radiation therapy for breast carcinoma, malignant lymphoma or other types of malignant neoplasm, develop a soft tissue sarcoma in the area of radiotherapy. Almost any type of soft tissue sarcoma may arise following radiation, but the two most common types are malignant fibrous histiocytoma and extra-skeletal osteosarcoma. There is a close relationship between the total radiation dosage and the risk' of developing a sarcoma (Halperin, et al, 1984; Kim, 1978). In addition to radiation, immunodeficiency and therapeutic immunosuppression are known to be associated with the development of soft tissue sarcomas. For example virus- induced immunodeficiency such as in the case of acquired 8 �immune deficiency syndrome (AIDS) has been recognized as causing Kaposi's sarcoma in almost 1/3 of the affected patients. The profound depression of cell-mediated immunity in these patients is the result of a defect in the T-4 inducer or helper subset of T-lymphocytes. Kaposi's sarcoma carries a high mortality rate with a median survival of 18 to 20 months. Aside from their role in the development of Kaposi's sarcoma, there is no evidence that human transmissible viral agents constitute a major risk factor in the development of soft tissue sarcomas. However, using the electron microscope, particulate material, which may represent viral fragments,; has been found repeatedly in soft tissue sarcomas. The origin and significance of this material, however, have not yet been conclusively established. Various types of sarcomas also occur secondary to therapeutic immunosuppression associated with organ transplantation, especially in renal transplant recipients. Acquired immune deficiency may also be the underlying mechanism in the development of the relatively rare angiosarcomas or lymphangiosarcomas that arise in the edematous extremity, •M , ' either secondary to radical mastectomy (Stewart-Treves Syndrome) or as a consequence of other forms of chronic lymphedema. There are only a few environmental factors that are associated with the development of soft tissue sarcomas. �About 80% of patients with pleural or peritoneal mesothelioma give a history of asbestos exposure, usually 25 years or more prior to the first appearance of this tumor. As increased incidence is found in asbestos miners as well as shipyard and other industrial workers engaged in the process of manufacturing, installing or repairing asbestos containing products such as thermal and electrical insulation, brake linings and cement tiles and pipes. Important risk factors include the intensity and duration of asbestos exposure as well as the type and submicroscopic diameter of the asbestos fiber (Selikoff et al 1964; Selikoff and Hammond, 1979). Soft tissue sarcomas have also been reported as arising in scar tissue following surgical procedures or thermal burns, in fracture sites and rarely in the vicinity of plastic or metal implants. Whether trauma per se ever leads to a sarcoma has not been clearly established, but in most instances the association with mechanical trauma appears to be coincidental rather than causative. EPIDEMIOLOGICAL TECHNIQUES USED TO STUDY THE SOFT TISSUE SARCOMA ISSI Research efforts designed and conducted to shed more light on • < •' ^ * ^*St>%, • the relationship between adverse health effects in humans and 'exposure to the phenoxy herbicides and trace amounts of the '•A '• dioxin contaminant found in 2,4,5-T have usually been in one of two general categories or types of epidemiological study design. These are case/control studies and cohort studies. 10 �Each of these types has its own strengths and weaknesses, but when taken in combination they can provide a convincing body of evidence. The case/control design is well suited for the study of rare events such as soft tissue sarcomas. Two features of such a study, however, are of paramount importance: accurate diagnosis of the disease in question and assurance of non-bias in the selection of the controls. The cohort study is probably the most widely used method to determine the relationship between exposure to a particular chemical or other environmental factor (s) and a disease or group of diseases. Using this study design, however, the rarer the outcome being studied, the larger the cohort,.must be. In this type of study the accuracy of exposure data for each member of the cohort of interest is of key importance. Again, the selection of the comparison or control cohort must be carried out with great care. The mortality experience of a group can be used to look for possible cause-and-effeet relationships between an exposure of concern and adverse health outcomes. The two commonly used analytical techniques are known as the proportionate m r a i y * ' ! ' (PMR) and the standardized mortality ratio otlt^*!? i. "• • ,-,*>:'/•?* '^' (SMR) . In general, when using the SMR one determines and r'tiSj "^. .' - -Jf •"»!* ** " compares the numbers and causes of death in a particular study group and a comparison group. This method has the potential for and the advantage of providing death rates if sufficiently large cohorts are used. 11 As with the cohort �morbidity study, the rarer the outcome, the larger the cohort must be. The PMR on the other hand cannot generally provide death rates, but can provide relative frequencies by cause of death. These relative frequencies in the group of interest, as for example a group of deceased Vietnam veterans, can be compared to those in a comparison group, i.e., veterans of the same age and sex who served elsewhere. In addition the frequencies may be compared to those known to exist for age and sex specific segments of the general population. In the case of veterans, however, the latter method of comparison is generally considered less valid since veterans represent a highly selected group of individuals and their patterns of death, especially in the first half of life are somewhat ,- different from those seen in the general civilian population. 12 �REVIEW OF STUDIES OF SOFT TISSUE SARCOMAS IN VIETNAM VETERANS VETERANS ADMINISTRATION STUDY In view of the concern raised by this issue among Vietnam veterans, a case comparison group analysis of patients treated in Veterans Administration hospitals was undertaken to determine the association between previous military service in Vietnam and soft tissue sarcomas (Rang et al. 1986). A total of 418 cases with International Classification of Disease (ICD) 171 diagnosis, i.e., malignant neoplasms of connective and other soft tissues,;; were identified by computer search of the Veterans ... Administration Patient Treatment File (PTF) for Vietnam era veterans who were hospitalized between 1969 and 1983. The PTF is a large computerized hospital data base of in-patient records which includes diagnostic and demographic information. A pathology report for each of theses 418 cases was requested from the appropriate VA hospital and a total of 394 pathology reports were received. reports were reviewed by a single VA pathologist With particular expertise in this area of cancer diagnosis. He;had no knowledge of the Vietnam service status of any of the cases. A total of 234 of these cases were determined to meet the World Health Organization (WHO) classification system for soft tissue sarcoma. 13 The �comparison group consisted of 14,931 VA hospital patients who were systematically sampled from the same Vietnam era veteran patient population from which the cases were identified. Military service information, in particular the Vietnam service status, for each STS case and control patient was obtained from a comprehensive review of the military personnel records at the National Personnel Records Center (NPRC) in St. Louis Missouri. Military personnel records were located and abstracted for all of the 234 STS cases and 13,496 of the 14,931 (90%) control patients. V Eighty six of the 234 STS cases (36.8%) had served in Vietnam. ':- 5# . whereas of the sample of 13,496 Vietnam era patients who's^t ''."*• * f personnel records were located and reviewed, 5544 (41%) had served in Vietnam. On the basis of this comparison it was concluded that no significant association of soft tissue sarcomas and previous military service in Vietnam exists among Vietnam era veterans who come to the VA hospital for inpatient medical care. The odds ratio was 0.83 with a 95% confidence interval of 0.63-1.09. In order to further strengthen the study, the tissue slides • '•; -iS1 from/all the<?a$es originally coded as ICD 171 in the PTF •«' if, were requested^$rom the VA Medical Centers. The tissue specimens f.0r 1 8 cases were located and sent to Dr. Franz '1 Enzinger at the Armed Forces Institute of Pathology for his review. During the review, Dr.Enzinger knew neither the Vietnam service status of the cases nor the VA's diagnoses. 14 �Following his review a comparison was made between his diagnosis and that of the VA Pathologist who had reviewed the pathology reports. Among the 181 cases he reviewed, he concurred with the VA diagnosis in 171 cases (94.5%): cases, STS; 73 cases, non-STS. 98 However, for 10 cases he disagreed with the VA's diagnosis: 4 cases that VA classified as non-STS, he classified as STS; 6 cases that VA determined as STS, he reclassified as non-STS. Military service information was available for 96 of the 98 ICD 171 cases that both VA and AFIP agreed to be STS cases. A record of Vietnam service was indicated on 33 of the 96 STS cases (34.4%). Comparing this proportion to the proportion of Vietnam veterans in the comparison group, no significant association of soft tissue sarcoma and previous military service in Vietnam was observed. (The odds ratio was 0.75 with a 95% confidence interval of 0.49-1.15.) U.S. Air Force Health Study A group of approximately 1260 men who conducted the Ranch Hand fixed wing, aerial herbicide spraying missions in Vietnam from 1962 through 1971 is being studied for their mortality patterns and the current health status. Cumulative mortality as of December 31, 1984, in Ranch Hand personnel revealed no death from soft tissue sarcoma (Wolf et al., 1985). Although the study did not indicate any increased mortality or any 15 �unusual patterns of death, it should not be regarded as final because of the small number of study subjects and the relatively short follow-up period. STATE STUDIES OF SOFT TISSUE SARCOMA IN VIETNAM VETERANS In four states-New York, Massachusetts, West Virginia, and Wisconsin-investigators have conducted mortality studies that include soft-tiss.ue sarcomas among the causes of death. In each study there have been relatively few cases of soft tissue sarcoma and the results in this area have not been : £ consistent. In addition to the mortality studies, a case control study of soft tissue sarcoma was conducted in New York. New York Greenwald et al. (1984) conducted a case-control study in which he identified 281 soft-tissue sarcoma cases in the New York State Cancer Registry among men who were between the ages of 18 and 29 during the period 1962-1971 and who were diagnosed between 1962 and 1980. y At the time of the study, . '•* 151 of the 281 cases were still alive and 130 had died. Using the'driver's license registration files of the N.Y. State Department of Motor Vehicles, a living male control was selected to match each of the 281 cases by being within 5years of the birth date and within the same ZIP code of 16 �residence. In addition, a deceased control was selected for each of the deceased cases. The deceased cases and the deceased controls were also matched for race, sex, the year of death, 5-year age group, year of education and health system area. Of 281 cases, 10 men had served in Vietnam as had 18 men of 281 living controls and 9 of 129 deceased controls. This carefully conducted case-control study demonstrates "no statistically significant positive association between sarcomas of soft-tissues and either service in Vietnam or military service in general." Lawrence et al. (1985) undertook a mortality study involving 1,496 male Vietnam-era veterans of whom 555 or 37% served.: ' I Vietnam and all of whom died in New York State (but outsid£ New York City) during 1965-1967 or 1970-80. Among the 555 Vietnam veterans, 2 died of cancer of connective and soft tissues and 3 of the 941 non-Vietnam veterans died from this same category of cancer. This resulted in an adjusted mortality odds ratio (MOR) for connective and soft-tissue cancers of 1.09; 95% CI of 0.18 - 6.70. In addition, the study included a comparison of mortality patterns between 4558 deceased v&terans of the Vietnam era and 17,936 nonveteran males of the same age group who had died in New York State. There were 12 connective and soft tissue cancers among the veterans and 47 among the non-veterans 95% CI 0.61 - 2.17). These (MOR=1.15: data suggest that there was no significant difference in deaths due to soft tissue sarcomas 17 �between Vietnam veterans and non-Vietnam veterans as well as between veterans and non-veterans. The small number of cases, however, make the results relating to soft tissue sarcoma of limited value. Massachusetts Kogan and Clapp (1985) in the report of a mortality study conducted in Massachusetts described their results as showing "a statistically highly significant excess of soft tissue sarcoma mortality in Massachusetts Vietnam veterans." The two veteran groups, those with service in Vietnam and those who served elsewhere were identified from a list of honorably discharged service men who applied for a state bonus and whose names appeared in the Massachusetts death registry. Vietnam service status was determined from the fact that in granting the bonus a larger amount was paid to those who served in Vietnam. The cause of death was obtained from death certificates. No verification of military service beyond the discharge certificate (DD214) was attempted. Among the 840 deceased Vietnam veterans nine deaths were believed tf&JtyidLdue to soft tissue sarcoma. Statistical calculations found that 1.02 deaths from connective and softtissue cancerrwould have been expected among Vietnam-era veterans and 1.90 deaths among non-veterans. Such differences are striking. The validity of the Massachusetts study is somewhat in 18 �question however, because verification of Vietnam service status was not attempted. The DD214 often does not show the specific place of service as Vietnam. In addition when dealing with such relatively rare causes of death as soft tissue sarcoma where the diagnosis can be difficult to make it is generally agreed that verification of the diagnosis by a pathologist with expertise in this area is necessary in order to draw valid conclusions regarding this type of cancer. West Virginia The fact that reliance on the DD214 to determine service in Vietnam may be misleading is illustrated in a mortality study of West Virginia veterans conducted by Holmes, et al. (1986). The study groups were compiled from a list of 83,730 bonusfe applicants of whom 41,059 qualified as Vietnam veterans and 41,782 as non-Vietnam veterans. The DD214 was used to determine whether or not the veteran had served in Vietnam and the cause of death was obtained from death certificates. Comparison of the bonus roster with the death register revealed that 615 Vietnam and 610 non-Vietnam male veterans had died. Among these were 3 deaths attributed to soft- tissue sarcoma.;5 and all were among veterans classified as having served in Vietnam. No soft tissue sarcoma deaths were found among the non-Vietnam veterans. Subsequent to publishing the report, the military service records of the three veterans who died of soft-tissue sarcoma were examined. One veteran was in the Navy and had served 19 �aboard ship off the coast of Vietnam, a second was stationed in Thailand, and the third served with an Army combat unit in Vietnam. Thus, only one soft-tissue sarcoma death occurred in a Vietnam veteran with actual in-country service. Wisconsin Anderson et al. (1986) issued a report of a study of Wisconsin veterans in which Vietnam service status was determined from the DD214 and the cause of death from the death certificate. Two epidemiological techniques were used: "proportionate mortality ratio" (PMR) comparing the relative number of deaths from that cause expected on the basis of experience in another, e.g., Vietnam-era veterans, or ., "standardized mortality ratio" (SMR) comparing the causespecific death rates in the two groups. A comparison of the proportion of STS deaths in 923 deceased Vietnam veterans with the same proportion in 1,571 deceased non-Vietnam veterans showed no statistically significant increase in the proportion of soft-tissue sarcoma (PMR, 147; 95% CI, 62-350). There were, however, only 5 deaths tabulated £ra»J8oft-tissue sarcoma among Vietnam veterans and the tabulated information about these cases indicated that one>man;had a,"wide-spread carcinoma", apparently misclassified as a soft-tissue sarcoma. This reduces to 4 the number of soft-tissue sarcoma deaths and further diminishes the significance of any differences. 20 �An SMR analysis comparing the deaths among Vietnam veterans with the deaths among Wisconsin, non Vietnam veterans, was based on 4 STS deaths among 43,398 Vietnam veterans and 5 STS deaths among 78,840 non Vietnam veterans. Both groups had less risk of dying from soft-tissue sarcoma when compared to the entire state of Wisconsin. Vietnam veterans had a somewhat greater risk than non Vietnam veterans but the observed elevation was not statistically significant. Discussion The absence of a consistently positive association between soft tissue sarcoma and Vietnam service might be a result of insufficient observation time since Agent Orange exposure in Vietnam. In general, it takes more than a decade for cancer to manifest itself if it is induced by a chemical carcinogen. Another possibility it that even if Agent Orange or dioxin has the potential for including STS in humans, Vietnam veterans as a group, were exposed to such small amounts that the conventional epidemiologic study cannot detect the excess risk resulting from Agent Orange exposure in Vietnam. Alternatively, there is the possibility that neither Agent Orange nor clioxin has the potential for inducing STS in humans. In conclusion, studies of STS in Vietnam veterans, in general,have not revealed a statistically significant positive association between STS and previous military service in Vietnam. 21 �SUMMARY OF SOFT TISSUE SARCOMA STUDIES OF VIETNAM VETERANS AUTHORS STUDY DESIGN STUDY POPULATION Greenwald, et al (1984) Case/Control 281 STS cases, 18-29 years old anytime between 1962-1971 in NY State Cancer Registry Odds ratio = 0.53 (95% CI 0.21-1.31) Lawrence, et al. (1985) PMR 555 NY State Vietnam veteran deaths between 1965 and 1980, exclusive 1968 and 1969 Vietnam: 2 STS/555 deaths Non Vietnam: 3 STS/941 deaths, Mortality odds ratio= 1.09 (95% CI 0.18-6.70) Kogan & Clapp (1985) PMR 840 Massachusetts State Vietnam veteran deaths 9 STS deaths vs. 1.02 expected, PMR=880 (P<0.0001) Anderson, et al (1986) PMR 923 Wisconsin State Vietnam veterans deaths 5 STS death vs. 3.40 expected, PMR= 147 (95% CI 62-350) SMR 43,398 Wisconsin State Vietnam veterans, of which 927 were dead as of December, 1984 Vietnam: 615 West Virginia State Vietnam veteran deaths between 1968 and 1983 Vietnam: 3 STS/615 deaths Non Vietnam: 0 STS/610 deaths Holmes, et al. (1986) PMR 22 RESULTS 4 STS/927 deaths Non Vietnam: 5 STS/1663 deaths �AUTHORS STUDY DESIGN STUDY POPULATION Wolf et al (1985) SMR 1260 Ranch Hand Personnel who conducted aerial herbicide spraying missions in Vietnam from 1962 through 1971 0 STS/55 deaths University of Sydney (1984) SMR 10,205 Australian Vietnam veterans, of which 260 were dead as of January, 1982 Vietnam: 2 STS/260 deaths Non Vietnam = STS/263 deaths Rang, et al Case Control 234 STS cases in the Patient Treatment File Odds ratio = 0.83 (95% CI 0.63-1.09) 96 STS cases reviewed by the AFIP Odds ratio = 0.75 (95% CI 0.49-1.15) RESULTS SMR = Standardized Mortality Ratio; PMR = Proportionate Mortality Ratio; CI = Confidence Interval 23 �REFERENCES 1. Anderson, H.A., Hanrahan, L.P., Jensen, M., et al.: 1986. Wisconsin Vietnam veteran mortality study. Wisconsin Health Department. 2. Bailey, C., Baron, R.C., Basanac, E. et al.: 1986. West Virginia Vietnam-era veterans mortality study. West Virginia Health Department. 3. Costa, J., Wesley, R.A., Rosenberg, S.A.: 1984. The grading of soft tissue sarcomas. Results of a clinicohistopathologic correlation in a series of 163 cases. Cancer 53:530. 4. Eilber, F.R., Morton, D.L., Eckhardt, J., et al.: 1984. Limb salvage for skeletal and soft tissue sarcomas. Cancer 53:2579. 5. Enneking, W.F.: 1983. Musculoskeletal Tumor Surgery, Churchill Livingstone, New York, London. 6. Enzinger, F.M., Lattes, R., Torloni, R.: 1969. Histological typing of soft tissue tumors. International Histologicalj Classification of Tumors No. 3., World Health Organization. 7. Enzinger, F.M., Weiss, S.W.: 1983. The C.V. Mosby Company, St. Louis. 8. Eriksson, M., Hardell, L., Berg, N.O., et al.: 1981. Soft tissue sarcomas and exposure to chemical substances: A case-referent study. Br. J. Ind. Med. 38:27-33. 9. Greenwald, P., Kovasznay, B.,Collins, D.N. et al.: 1984. Sarcomas of soft tissues after Vietnam service. JNCI 73(5): 1107-1109. 10. Halperin, E.C., Greenberg, M.S., Suit, H.D.: 1984. Sarcoma of bone and soft tissue following treatment of Hodgkin's disease. Cancer 53:232. 11. Hardell, L., Sandstrom, A.: 1979. Case-control study: tissue sarcoma and exposure to phenoxyacetic acids or chlorophenols. Br. J. Cancer 39:711-717. 12. Rang-, H.K., Weatherbee, L., Breslin, P.P.: 1986 Soft tissue sarcomas and military service in Vietnam: A case comparison group analysis of hospital patients. J. Occup. Med. 28(12): 1215-1218. 13. Kim, J.H.:, Chu, F.C., Woodard, H.Q., et al.: 1978. Radiation-induced soft tissue sarcoma and bone sarcoma. 24 Soft Tissue Tumors. Soft �Radiology 129:501. 14. Kogan, M.D. and Clapp, R.W.: 1985. Mortality among Vietnam veterans in Massachusetts, 1972-1983. Massachusetts Department of Public Health. 15. Lattes, R.: 1983. Tumors of soft tissues. Atlas of Tumor Pathology, Second Series, Fascicle 1 (Revised), Armed Forces Institute of Pathology. 16. Lawrence, C.E., Reilly, A.A., Quickenton, P., et al.: 1985. Mortality patterns of New York State Vietnam veterans. AJPH 75(3); 277-279. 17. Mandard, A.M., Chasley, J., Mandard, J.C.: 1981. The pathologist's role in a multidisciplinary approach for soft tissue sarcoma. A reappraisal. J. Surg. Oncol. 1.69. 18. Rosenberg, S.A., Tepper, J., Glatstein, E., et al.: 1982. The treatment of soft tissue sarcomas of the extremities. Ann Surg 196:305. 19. Russell, W.O., Cohen, J., Enzinger, F.M., et al.: 1977. clinical and pathological staging system for soft tissue sarcomas. Cancer 40: 1562. 20. Selikoff, I.J., Churg, J., Hammond, E.G.: exposure and neoplasia. JAMA 188:22. 21. Selikoff, I.J., Hammond, B.C.: 1979. Health hazards of asbestos exposure. Ann NY Acad. Sci. 330:1. 22. Tucker, M.A., Fraumeni, J.F.: 1982. Soft Tissue, in Cancer Epidemiology and Prevention; Schottenfeld, D. and Fraumeni, J.F.,: W.B. Saunders Co. 23. Wolfe, W.H., Michalek, J.E., Miner, J.C., et al. 1985. An epidemiologic investigation of health effects in Air Force personnel following exposure to herbicides. Mortality update-1985. Epidemiology Division, USAF School of Aerospace Medicine, Brooks AFB, Texas. 25 1964. A Asbestos � 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. 1496 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 Shepard, Barclay M. H. K. Kang F. M. Enziger L. B. Hobson Title A name given to the resource Typescript: Chapter 6: The Risk of Soft Tissue Sarcoma in Veterans of the Vietnam Conflict Subject The topic of the resource VA/AFIP STSS Air Force Health Study state-funded Vietnam veterans study ao_seriesIII