Sunday, January 31, 2016

Impacts of Perinatal Dioxin Exposure


Dioxin concentrations remain elevated in the environment and in humans residing near former US Air Force bases in South Vietnam. Our previous epidemiological studies showed adverse effects of dioxin exposure on neurodevelopment for the first 3 years of life. Subsequently, we extended the follow-up period and investigated the influence of perinatal dioxin exposure on neurodevelopment, including motor coordination and higher cognitive ability, in preschool children

Lawmakers press VA to allow medical marijuana for veterans

A bipartisan group of lawmakers is pressing the Department of Veterans Affairs to allow veterans to use medical marijuana.
Currently, VA doctors are prohibited from recommending medical marijuana to their patients, even in states that have legalized pot.
These veterans must go to nonmilitary doctors outside their healthcare plan to obtain a prescription. The tedious and expensive process often discourages veterans from seeking access to such treatment, critics say.
In a letter to VA Secretary Robert McDonald sent Wednesday, nearly two dozen lawmakers urge the agency to abandon that policy."Since many medical marijuana states require that a doctor fill out a form certifying that a patient is suffering from a qualifying condition in order to allow them to gain access to medical marijuana through state-regulated dispensaries, this policy only encourages those VA patients who are seeking treatment to go outside of the VA system and seek a recommendation from a physician likely far less familiar with their symptoms and medical history,” the lawmakers wrote.
"It is not in the veterans’ best interest for the VA to interfere with the doctor-patient relationship."
The VA policy expires at the end of the month and lawmakers don't want the agency to renew the medical marijuana provision.
The letter was signed by Sen. Kirsten Gillibrand (D-N.Y.) and Rep. Dana Rohrabacher (R-Calif.), among others.
The controversial VA policy is part of a larger federal prohibition on marijuana, but a growing number of lawmakers are pushing to overhaul pot laws in Washington.
Medical marijuana is legal in 23 states and Washington, D.C.

Victory for Veterans in Edgewood Chem/Bio Testing Appeal

(Wash., D.C.)–“Seven years ago, in an unprecedented legal action, Vietnam Veterans of America, along with San Francisco-based veterans organization Swords to Plowshares, joined with half a dozen veterans who ‘volunteered’ to participate in experiments that tested chemical and biological agents,” said John Rowan. “We wanted to establish the ongoing responsibility of government to care for veterans whose health had been impacted because of their participation in the testing of more than 400 chemical and biological substances, including hazardous agents such as sarin and mustard gas and mind-altering drugs, including LSD.”

“Our concerns have now been validated,” said Rowan, in response to the news that the U.S. Court of Appeals for the Ninth Circuit has agreed with the trial judge, affirming an injunction ordering the U.S. Army to provide all former test subjects with any newly acquired information about the substances to which they were exposed and which might impact their health. The three-member appeals panel also concluded that the military still has an obligation to provide the test subjects with medical care.
“Under its own regulations,” said Rowan, “the Department of the Army has an ‘ongoing duty . . . to provide former test subjects with newly available information relating to their health’ and an ongoing duty to provide medical care to the test subjects ‘for injury or disease that is a proximate result of their participation in research.’ And, importantly, the full court denied the government’s petition for rehearing the appeal.’ ”

“This decision is a clear victory for veterans,” noted Rowan. “It reaffirms our position that caring for veterans is part of the continuing cost of war. It is a testament to the convictions of the late Gordy Erspamer, who took on this case pro bono for his law firm, Morrison & Foerster, that the government cannot ride roughshod over its own regulations and the rights of veterans. And this case has succeeded in exposing the breadth and scope of some of the top-secret experimentation that the military first denied and then acknowledged had been conducted to the potential detriment of the health of thousands of test subjects.

“VVA owes a debt of gratitude to Morrison & Foerster for their unwavering support of veterans in this case,” Rowan said. “And we can hope that the military takes to heart the essential message of this decision, that they have a ‘duty to warn’ future human subjects of any potential health effects associated with any testing in which they may participate.”

Vietnam Veterans of America (VVA) is the nation's only congressionally chartered veterans service organization dedicated to the needs of Vietnam-era veterans and their families.  VVA's founding principle is “Never again will one generation of veterans abandon another.



Thursday, January 28, 2016

Statement from VA Secretary Robert A. McDonald On the Need to Reform the Veterans Appeals Process

Last week I presented to the Senate Veterans Affairs’ Committee the way forward for the important transformation of the Department of Veterans Affairs—what we call MyVA.  We aim to improve our care and services to all Veterans. In order to do that, I made clear that we would need Congress’ help in legislating a fair, streamlined, and comprehensive process for new appeals, as well as providing much needed resources to address the current pending inventory of appeals.  I look forward to working with all stakeholders to design an appeals process that better serves Veterans.

VA will need legislation and resourcing to put in place a simplified appeals process that enables the Department to resolve the majority of our appeals in a reasonable time frame for Veterans.

The appeals process we currently have set in law is failing Veterans and taxpayers. Decades worth of law and policy layered upon each other have become cumbersome and clunky. Most importantly, it is now so antiquated that it no longer serves Veterans well as many find it confusing and are frustrated by the endless process and the associated length of time it can take to get an answer.

In 2012, VA made the commitment to end the disability claims backlog. It took too long for Veterans to receive a decision on their claim. Our commitment has resulted in transformational change. The disability claims backlog has been driven down to fewer than 82,000, from a peak of 611,000 in March 2013. At the same time, we have fully transitioned to a paperless, electronic processing system, eliminating 5,000 tons of paper a year.  Last year, we decided 1.4 million disability compensation and pension claims for Veterans and survivors – the highest in VA history for a single year and that comes on the heels on two previous record-breaking years of productivity.

As VA has become more efficient in claims processing, the volume of appeals has increased proportionately. While it remains true that 11-12 percent of Veterans who receive a disability rating file for an appeal, more processed claims means more appeals. This is VA’s next challenge.

The current pending inventory of appeals stands at more than 440,000 and is estimated to grow rapidly. Right now, Veterans who file an appeal wait an average of three years for appeals to be resolved by the Veterans Benefits Administration (VBA), and an average of five years for appeals that reach the Board of Veterans Appeals’ (Board), with thousands lasting much longer. That’s unacceptable.

We are applying lessons learned from the transformative change that allowed us to reduce the disability claims backlog. Like our work with the claims processing, the appeals process will need changes in people, process and technology. Upgraded technology will make changes to our mail system and paper records, and incorporate some efficiencies in the way appeals are managed and processed.  Retraining and increased staff will be necessary.  But they will not be enough.  We must also look critically at the many steps in the current complex appeals process used by VA and by Veterans and their advocates to design a process that better serves Veterans.

A new appeals process would provide Veterans with the timely and fair appeals decisions they deserve, and adequate resourcing that permits the VBA and the Board to address the growing inventory of appeals. 


McDonald Lays Out 'Breakthrough Priorities' for VA in 2016

Veterans Affairs Secretary Bob McDonald told lawmakers on Thursday that by the end of 2016 veterans who walk into or call a VA medical center will have their clinical needs addressed "that day," while 90 percent of veterans appealing a compensation decision will -- with Congress' help -- get an answer within one year.
The ambitious commitments were two of a dozen "breakthrough priorities" that McDonald detailed for the Senate Veterans Affairs Committee.
Eight of the priorities are specific to serving veterans and four are to meet department needs, but McDonald said Senators should "make no mistake -- all 12 are designed to improve the delivery of timely care and benefits to veterans .... We understand this will be a challenge, but we are committed to producing results for veterans."
The priorities also include:
-- Having all VA medical centers fully staffed up front with knowledgeable service-oriented employees.
-- Making sure vets needing to see a community provider do so within 30 days at least 85 percent of the time.
-- A disability claims backlog no more than 10 percent of inventory.
-- A more intuitive and efficient website for accessing information.
-- A well-staffed and courteous crisis hotline reachable by all veterans 24/7.
-- A more efficient and understandable compensation and pension exam process.
-- Continued progress in ending chronic veteran homelessness.
-- Ensuring all VA employees are trained to high customer-service standards.
-- Having 95 percent of all medical center directorships filled.
-- Closing 100 percent of current cybersecurity weaknesses.
-- Ensuring that half of all information technology projects are on time and on budget, with IT executives' performance goals tied to strategy goals.
-- A more efficient medical-supply chain that will result in $150 million in cost avoidances redirected to veteran programs.
One of the hurdles McDonald will face is in taming the growing backlog of appeals claims, which in some cases have dragged on for eight years as veterans continue to add evidence to their case.

Friday, January 22, 2016

Study finds link between Agent Orange and infant mortality on Guam

Infants born to mothers who lived in Agent Orange-sprayed areas were at an increased risk of infant mortality due to congenital anomalies, according to scientists who recently released the first study that examined the link between herbicides and infant mortality on Guam.

The study, published in the December 2015 issue of the Hawaii Journal of Medicine and Public Health, covered medical data between 1970 and 1989, which indicated large inter-village disparities in infant mortality.
“Because of AO's (Agent Orange) potentially long half-life, environmental studies are also required to determine if AO has persisted in the Guamanian soil, and if present, studies of the current population on Guam area needed to determine if AO continues to be a public health threat,” states the study authored by Jonathan K. Noel, Sara Namazi and Robert Haddock.
Data collected from Guam's Office of Vital Statistics were classified as Agent Orange and non-Agent Orange spray areas. “Village location was classified by usual residence of the mother. Linear regression was used to determine associations between infant mortality due to congenital anomalies and the behavioral, structural and environmental factors,” the study states.
The study indicated that the association between Agent Orange spray areas and infant mortality due to congenital anomalies “was statistically significant under univariable and multivariable conditions.”
“The study presented here is the first to identify associations between AO and infant mortality in civilian populations outside of Southeast Asia, but it is important to stress that the ecological design of the study makes causal inferences of the study results impossible,” the authors said.
Warfare program
Agent Orange was one of the defoliants – known as “rainbow herbicides" – used by the U.S. military as part of its herbicidal warfare program during the Vietnam War from 1961 to 1971. They were used to destroy bushes, trees and vegetation to deprive insurgents of cover and food crops as part of a starvation campaign in the early 1950s.
While military officials have consistently denied that the U.S. military used Agent Orange outside of Vietnam, veterans who were stationed on Guam have testified in several forums that they sprayed Agent Orange in military facilities and defense properties on Guam including tank farms, a cross-island pipe line, pump houses, hydrant pits and filtering systems at Andersen Air Force Base.
Guam veterans believe they contracted various types of diseases including type 2 diabetes mellitus complicated as a result of their exposure to Agent Orange.
During a 2003 inquiry conducted by former Congressman Lane Evans, then a member of the House Committee on Veterans Affairs, the Department of Defense confirmed about 5,000 drums of herbicide Agent Purple were transported to Guam and stored in an undisclosed area in 1952 in anticipation of use on the Korean peninsula but claimed they were never used and were returned to the United States. 
“The department has no record of the use, storage or testing of herbicides Orange, Blue or White on Guam,” Phillips W. Grone, then-deputy undersecretary of the Department of Defense, said in a Sept. 23, 2003 letter to Evans.
These denials, however, were contradicted by the decisions made by the Department of Veterans Affairs in separate cases between 2005 and 2013, acknowledging that herbicides, particularly Agent Orange, were used on Guam from 1968 to 1970.
According to scientists, Agent Orange is a mixture of trichlorophenoxyacetic acid and dichlorophenoxyacetic acid and has been linked to numerous health effects, primarily caused by contamination with tetrachlorodibenzodioxin or TCDD.
“TCDD has been classified as carcinogenic to humans by the International Agency for Research on Cancer and as a probable human carcinogen by the U.S. Environmental Protection Agency (EPA),” the study says. “There is also evidence suggesting that AO exposure is associated with ischemic heart disease, Parkinson's disease, and respiratory cancers.”
The authors of the study noted that infant and fetal exposure to Agent Orange can occur “through paternal and maternal mechanisms, with recent evidence showing breast milk as an important AO vector.
“Moreover, children of fathers who served in southeast Asia during the Vietnam War and participated in Operation Ranch Hand, the U.S. Department of Defense's defoliation program during the war, had significantly greater risk of infant death compared to children of fathers who served in Southeast Asia but did not participate in the operation,” the study said.