Agent Orange Agent Orange 20112011

Science Politics Policy and PracticeScience Politics Policy and Practice

OverviewOverview

What isare dioxin(s)What isare dioxin(s)

VHA response to Vietnam WarVHA response to Vietnam War

Presumptive conditionsPresumptive conditions

Exposures of special groupsExposures of special groups

The futureThe future

ResourcesResources

QuestionsQuestions

Herbicide (Agent) Orange Herbicide (Agent) Orange (1)(1)

11 mixture of 24-dichlorophenoxy acetic 11 mixture of 24-dichlorophenoxy acetic acid (24-D 50) and 245-acid (24-D 50) and 245-trichlorphenoxyacetic acid (245-T 50) trichlorphenoxyacetic acid (245-T 50)

245-T was used extensively as an 245-T was used extensively as an herbicide in forestry and agriculture herbicide in forestry and agriculture domestically and abroad starting in the domestically and abroad starting in the 1940s1940s

Shipped to Vietnam in 55-gallon steel drums Shipped to Vietnam in 55-gallon steel drums with an orange stripe around the middlewith an orange stripe around the middle

~1219x10~1219x1066 gallons used in Vietnam = AO gallons used in Vietnam = AO

Herbicide (Agent) Orange Herbicide (Agent) Orange (2)(2)

24-D24-D

245-T245-T

Other Herbicides Used in Other Herbicides Used in VietnamVietnam

PicloramPicloram

Cacodilic AcidCacodilic Acid

DibenzofuransDibenzofurans

Heavily Sprayed Areas - Heavily Sprayed Areas - MapMap

Inland forests near the demarcation zoneInland forests near the demarcation zone

Inland forests at the junction of the borders Inland forests at the junction of the borders of Cambodia Laos and South Vietnamof Cambodia Laos and South Vietnam

Inland forests north and northwest of SaigonInland forests north and northwest of Saigon

Mangrove forests on the southernmost Mangrove forests on the southernmost peninsula of Vietnampeninsula of Vietnam

Mangrove forests along major shipping Mangrove forests along major shipping channels southeast of Saigonchannels southeast of Saigon

DioxinsDioxins

A group of chlorinated dibenzo-A group of chlorinated dibenzo-pp-dioxins -dioxins (CDDs) with 75 isomeric forms of 2378-(CDDs) with 75 isomeric forms of 2378-tetrachlorobenzo-tetrachlorobenzo-pp-dioxin (TCDD)-dioxin (TCDD)

A condensation reaction occurred during A condensation reaction occurred during production of 245-trichlorophenol production of 245-trichlorophenol resulting in the creation of TCDD a resulting in the creation of TCDD a contaminantcontaminant

(TCDD)(TCDD)cc varied by lot 1-50 ppm varied by lot 1-50 ppm

HandoutHandout

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

OverviewOverview

What isare dioxin(s)What isare dioxin(s)

VHA response to Vietnam WarVHA response to Vietnam War

Presumptive conditionsPresumptive conditions

Exposures of special groupsExposures of special groups

The futureThe future

ResourcesResources

QuestionsQuestions

Herbicide (Agent) Orange Herbicide (Agent) Orange (1)(1)

11 mixture of 24-dichlorophenoxy acetic 11 mixture of 24-dichlorophenoxy acetic acid (24-D 50) and 245-acid (24-D 50) and 245-trichlorphenoxyacetic acid (245-T 50) trichlorphenoxyacetic acid (245-T 50)

245-T was used extensively as an 245-T was used extensively as an herbicide in forestry and agriculture herbicide in forestry and agriculture domestically and abroad starting in the domestically and abroad starting in the 1940s1940s

Shipped to Vietnam in 55-gallon steel drums Shipped to Vietnam in 55-gallon steel drums with an orange stripe around the middlewith an orange stripe around the middle

~1219x10~1219x1066 gallons used in Vietnam = AO gallons used in Vietnam = AO

Herbicide (Agent) Orange Herbicide (Agent) Orange (2)(2)

24-D24-D

245-T245-T

Other Herbicides Used in Other Herbicides Used in VietnamVietnam

PicloramPicloram

Cacodilic AcidCacodilic Acid

DibenzofuransDibenzofurans

Heavily Sprayed Areas - Heavily Sprayed Areas - MapMap

Inland forests near the demarcation zoneInland forests near the demarcation zone

Inland forests at the junction of the borders Inland forests at the junction of the borders of Cambodia Laos and South Vietnamof Cambodia Laos and South Vietnam

Inland forests north and northwest of SaigonInland forests north and northwest of Saigon

Mangrove forests on the southernmost Mangrove forests on the southernmost peninsula of Vietnampeninsula of Vietnam

Mangrove forests along major shipping Mangrove forests along major shipping channels southeast of Saigonchannels southeast of Saigon

DioxinsDioxins

A group of chlorinated dibenzo-A group of chlorinated dibenzo-pp-dioxins -dioxins (CDDs) with 75 isomeric forms of 2378-(CDDs) with 75 isomeric forms of 2378-tetrachlorobenzo-tetrachlorobenzo-pp-dioxin (TCDD)-dioxin (TCDD)

A condensation reaction occurred during A condensation reaction occurred during production of 245-trichlorophenol production of 245-trichlorophenol resulting in the creation of TCDD a resulting in the creation of TCDD a contaminantcontaminant

(TCDD)(TCDD)cc varied by lot 1-50 ppm varied by lot 1-50 ppm

HandoutHandout

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Herbicide (Agent) Orange Herbicide (Agent) Orange (1)(1)

11 mixture of 24-dichlorophenoxy acetic 11 mixture of 24-dichlorophenoxy acetic acid (24-D 50) and 245-acid (24-D 50) and 245-trichlorphenoxyacetic acid (245-T 50) trichlorphenoxyacetic acid (245-T 50)

245-T was used extensively as an 245-T was used extensively as an herbicide in forestry and agriculture herbicide in forestry and agriculture domestically and abroad starting in the domestically and abroad starting in the 1940s1940s

Shipped to Vietnam in 55-gallon steel drums Shipped to Vietnam in 55-gallon steel drums with an orange stripe around the middlewith an orange stripe around the middle

~1219x10~1219x1066 gallons used in Vietnam = AO gallons used in Vietnam = AO

Herbicide (Agent) Orange Herbicide (Agent) Orange (2)(2)

24-D24-D

245-T245-T

Other Herbicides Used in Other Herbicides Used in VietnamVietnam

PicloramPicloram

Cacodilic AcidCacodilic Acid

DibenzofuransDibenzofurans

Heavily Sprayed Areas - Heavily Sprayed Areas - MapMap

Inland forests near the demarcation zoneInland forests near the demarcation zone

Inland forests at the junction of the borders Inland forests at the junction of the borders of Cambodia Laos and South Vietnamof Cambodia Laos and South Vietnam

Inland forests north and northwest of SaigonInland forests north and northwest of Saigon

Mangrove forests on the southernmost Mangrove forests on the southernmost peninsula of Vietnampeninsula of Vietnam

Mangrove forests along major shipping Mangrove forests along major shipping channels southeast of Saigonchannels southeast of Saigon

DioxinsDioxins

A group of chlorinated dibenzo-A group of chlorinated dibenzo-pp-dioxins -dioxins (CDDs) with 75 isomeric forms of 2378-(CDDs) with 75 isomeric forms of 2378-tetrachlorobenzo-tetrachlorobenzo-pp-dioxin (TCDD)-dioxin (TCDD)

A condensation reaction occurred during A condensation reaction occurred during production of 245-trichlorophenol production of 245-trichlorophenol resulting in the creation of TCDD a resulting in the creation of TCDD a contaminantcontaminant

(TCDD)(TCDD)cc varied by lot 1-50 ppm varied by lot 1-50 ppm

HandoutHandout

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Herbicide (Agent) Orange Herbicide (Agent) Orange (2)(2)

24-D24-D

245-T245-T

Other Herbicides Used in Other Herbicides Used in VietnamVietnam

PicloramPicloram

Cacodilic AcidCacodilic Acid

DibenzofuransDibenzofurans

Heavily Sprayed Areas - Heavily Sprayed Areas - MapMap

Inland forests near the demarcation zoneInland forests near the demarcation zone

Inland forests at the junction of the borders Inland forests at the junction of the borders of Cambodia Laos and South Vietnamof Cambodia Laos and South Vietnam

Inland forests north and northwest of SaigonInland forests north and northwest of Saigon

Mangrove forests on the southernmost Mangrove forests on the southernmost peninsula of Vietnampeninsula of Vietnam

Mangrove forests along major shipping Mangrove forests along major shipping channels southeast of Saigonchannels southeast of Saigon

DioxinsDioxins

A group of chlorinated dibenzo-A group of chlorinated dibenzo-pp-dioxins -dioxins (CDDs) with 75 isomeric forms of 2378-(CDDs) with 75 isomeric forms of 2378-tetrachlorobenzo-tetrachlorobenzo-pp-dioxin (TCDD)-dioxin (TCDD)

A condensation reaction occurred during A condensation reaction occurred during production of 245-trichlorophenol production of 245-trichlorophenol resulting in the creation of TCDD a resulting in the creation of TCDD a contaminantcontaminant

(TCDD)(TCDD)cc varied by lot 1-50 ppm varied by lot 1-50 ppm

HandoutHandout

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Other Herbicides Used in Other Herbicides Used in VietnamVietnam

PicloramPicloram

Cacodilic AcidCacodilic Acid

DibenzofuransDibenzofurans

Heavily Sprayed Areas - Heavily Sprayed Areas - MapMap

Inland forests near the demarcation zoneInland forests near the demarcation zone

Inland forests at the junction of the borders Inland forests at the junction of the borders of Cambodia Laos and South Vietnamof Cambodia Laos and South Vietnam

Inland forests north and northwest of SaigonInland forests north and northwest of Saigon

Mangrove forests on the southernmost Mangrove forests on the southernmost peninsula of Vietnampeninsula of Vietnam

Mangrove forests along major shipping Mangrove forests along major shipping channels southeast of Saigonchannels southeast of Saigon

DioxinsDioxins

A group of chlorinated dibenzo-A group of chlorinated dibenzo-pp-dioxins -dioxins (CDDs) with 75 isomeric forms of 2378-(CDDs) with 75 isomeric forms of 2378-tetrachlorobenzo-tetrachlorobenzo-pp-dioxin (TCDD)-dioxin (TCDD)

A condensation reaction occurred during A condensation reaction occurred during production of 245-trichlorophenol production of 245-trichlorophenol resulting in the creation of TCDD a resulting in the creation of TCDD a contaminantcontaminant

(TCDD)(TCDD)cc varied by lot 1-50 ppm varied by lot 1-50 ppm

HandoutHandout

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Heavily Sprayed Areas - Heavily Sprayed Areas - MapMap

Inland forests near the demarcation zoneInland forests near the demarcation zone

Inland forests at the junction of the borders Inland forests at the junction of the borders of Cambodia Laos and South Vietnamof Cambodia Laos and South Vietnam

Inland forests north and northwest of SaigonInland forests north and northwest of Saigon

Mangrove forests on the southernmost Mangrove forests on the southernmost peninsula of Vietnampeninsula of Vietnam

Mangrove forests along major shipping Mangrove forests along major shipping channels southeast of Saigonchannels southeast of Saigon

DioxinsDioxins

A group of chlorinated dibenzo-A group of chlorinated dibenzo-pp-dioxins -dioxins (CDDs) with 75 isomeric forms of 2378-(CDDs) with 75 isomeric forms of 2378-tetrachlorobenzo-tetrachlorobenzo-pp-dioxin (TCDD)-dioxin (TCDD)

A condensation reaction occurred during A condensation reaction occurred during production of 245-trichlorophenol production of 245-trichlorophenol resulting in the creation of TCDD a resulting in the creation of TCDD a contaminantcontaminant

(TCDD)(TCDD)cc varied by lot 1-50 ppm varied by lot 1-50 ppm

HandoutHandout

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

DioxinsDioxins

A group of chlorinated dibenzo-A group of chlorinated dibenzo-pp-dioxins -dioxins (CDDs) with 75 isomeric forms of 2378-(CDDs) with 75 isomeric forms of 2378-tetrachlorobenzo-tetrachlorobenzo-pp-dioxin (TCDD)-dioxin (TCDD)

A condensation reaction occurred during A condensation reaction occurred during production of 245-trichlorophenol production of 245-trichlorophenol resulting in the creation of TCDD a resulting in the creation of TCDD a contaminantcontaminant

(TCDD)(TCDD)cc varied by lot 1-50 ppm varied by lot 1-50 ppm

HandoutHandout

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Dioxins - Dioxins - PharmacologyPharmacology

Entry ndash skin respiratory and GI tractsEntry ndash skin respiratory and GI tracts

Extremely lipophilic ndash fat liverExtremely lipophilic ndash fat liver

T12 ndash 7 to 10 yearsT12 ndash 7 to 10 years

Ah (Ah (aaromatic romatic hhydrocarbon) receptor ydrocarbon) receptor activation in mouse and humansactivation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) - Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme inducible enzyme

Excretion - bile or urineExcretion - bile or urine

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Dioxins - ToxicologyDioxins - Toxicology

Varies by speciesVaries by species

Involves many systems ndash skin endocrine Involves many systems ndash skin endocrine reproductive (female) liver CNS ()reproductive (female) liver CNS ()

Human toxicity determined variouslyHuman toxicity determined variously Chloracne - clinicaldoseresponse toxicityChloracne - clinicaldoseresponse toxicity

Lymphoma ndash domestic agricultureLymphoma ndash domestic agriculture

Reproductive ndash Seveso Italy Reproductive ndash Seveso Italy et alet al

Diabetes - EpidemiologyDiabetes - Epidemiology

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

PoliticsPolitics

Congress ordered the end of Herbicide Congress ordered the end of Herbicide Orange spraying when two studies showed Orange spraying when two studies showed birth defects and other endocrine-related birth defects and other endocrine-related pathology in rats pathology in rats

For the purposes of policy re presumptive For the purposes of policy re presumptive conditions the Department of Veterans conditions the Department of Veterans Affairs does not require the same order of Affairs does not require the same order of ldquoproofrdquo of toxicity as do scientistsldquoproofrdquo of toxicity as do scientists

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Federal Response to Federal Response to VietnamVietnam

1970s - Agent Orange examination and 1970s - Agent Orange examination and Agent Orange ReviewAgent Orange Review

1980s ndash EpidemiologyCase lawLegislation1980s ndash EpidemiologyCase lawLegislation VHA EES CDCVHA EES CDC

1991 ndash Agent Orange Act1991 ndash Agent Orange Act

1960s ndash 2011 ndash Scientific Study1960s ndash 2011 ndash Scientific Study 1980s ndash Air Force Ranch Hand1980s ndash Air Force Ranch Hand

1990s 1990s et seq et seq ndash NASIOM biennial ndash NASIOM biennial AO AO ReportReport

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Presumptive Presumptive ConditionsConditions (1) (1)

Acute and Subacute Peripheral NeuropathyA nervous system condition that causes numbness tingling and motor weakness Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began

AL AmyloidosisA rare disease caused when an abnormal protein amyloid enters tissues or organs

Chloracne (or Similar Acneform Disease)A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers Under VAs rating regulations chloracne (or other acneform disease similar to chloracne) must be at least 10 disabling within 1 year of exposure to herbicides

Presumptive Conditions Presumptive Conditions (2)(2)

Chronic B-cell LeukemiasA type of cancer which affects white blood cells

Diabetes Mellitus (Type 2)A disease characterized by high blood sugar levels resulting from the bodyrsquos inability to respond properly to the hormone insulin

Hodgkinrsquos DiseaseA malignant lymphoma (cancer) characterized by progressive enlargement of the lymph nodes liver and spleen and by progressive anemia

Presumptive Conditions Presumptive Conditions (3)(3)

Ischemic Heart DiseaseA disease characterized by a reduced supply of blood to the heart that leads to chest pain

Multiple MyelomaA cancer of plasma cells a type of white blood cell in bone marrow

Non-Hodgkinrsquos LymphomaA group of cancers that affect the lymph glands and other lymphatic tissue

Presumptive Conditoins Presumptive Conditoins (4)(4)

Porphyria Cutanea TardaA disorder characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas Under VAs rating regulations it must be at least 10 disabling within 1 year of exposure to herbicides

Prostate CancerCancer of the prostate one of the most common cancers among men

Presumptive Conditions Presumptive Conditions (5)(5)

Respiratory CancersCancers of the lung larynx trachea and bronchus

Soft Tissue Sarcoma (other than Osteosarcoma Chondrosarcoma Kaposirsquos sarcoma or Mesothelioma)A group of different types of cancers in body tissues such as muscle fat blood and lymph vessels and connective tissues

Other Military Other Military ExposuresExposures

KoreaKorea

WaterwaysWaterways InlandInland

CostalCostal

On-shoreOn-shore

Blue waterBlue water

Requires specific informationRequires specific information

Women Veterans and Women Veterans and OffspringOffspring

Am J Ind Med 2000 Oct38(4)447-54Am J Ind Med 2000 Oct38(4)447-54

Pregnancy outcomes among US women Vietnam Pregnancy outcomes among US women Vietnam veteransveterans

Kang HK Mahan CM Lee KY Magee CA Mather SH Mather SH Matanoski GMatanoski G

A comparison of self-reported pregnancy outcomes for A comparison of self-reported pregnancy outcomes for 4140 women Vietnam veterans with those of 4140 4140 women Vietnam veterans with those of 4140 contemporary women veterans who were not deployed to contemporary women veterans who were not deployed to Vietnam Vietnam

There was no statistically significant association between There was no statistically significant association between military service in Vietnam and index pregnancies resulting military service in Vietnam and index pregnancies resulting in miscarriage or stillbirth low birth weight pre-term in miscarriage or stillbirth low birth weight pre-term delivery or infant death The risk of having children with delivery or infant death The risk of having children with moderate-to-severe birth defects was significantly moderate-to-severe birth defects was significantly elevated among Vietnam veterans (adjusted OR = 146 elevated among Vietnam veterans (adjusted OR = 146 95 CI = 106-202)95 CI = 106-202)

Women Veterans and Women Veterans and OffspringOffspring

Am J Ind Med 2000 Oct38(4)447-54Am J Ind Med 2000 Oct38(4)447-54

Pregnancy outcomes among US women Vietnam Pregnancy outcomes among US women Vietnam veteransveterans

Kang HK Mahan CM Lee KY Magee CA Mather SH Mather SH Matanoski GMatanoski G

A comparison of self-reported pregnancy outcomes for A comparison of self-reported pregnancy outcomes for 4140 women Vietnam veterans with those of 4140 4140 women Vietnam veterans with those of 4140 contemporary women veterans who were not deployed to contemporary women veterans who were not deployed to Vietnam Vietnam

There was no statistically significant association between There was no statistically significant association between military service in Vietnam and index pregnancies resulting military service in Vietnam and index pregnancies resulting in miscarriage or stillbirth low birth weight pre-term in miscarriage or stillbirth low birth weight pre-term delivery or infant death The risk of having children with delivery or infant death The risk of having children with moderate-to-severe birth defects was significantly moderate-to-severe birth defects was significantly elevated among Vietnam veterans (adjusted OR = 146 elevated among Vietnam veterans (adjusted OR = 146 95 CI = 106-202)95 CI = 106-202)

Covered Birth Covered Birth Defects (1)Defects (1)

AchondroplasiaAchondroplasia

Cleft lip and cleft palateCleft lip and cleft palate

Congenital heart diseaseCongenital heart disease

Congenital talipes equinovarus (clubfoot)Congenital talipes equinovarus (clubfoot)

Esophageal and intestinal atresiaEsophageal and intestinal atresia

Hallerman-Streiff syndromeHallerman-Streiff syndrome

Covered Birth Covered Birth Defects (2)Defects (2)

Hip dysplasiaHip dysplasia

Hirschprungs disease (congenital Hirschprungs disease (congenital megacolon)megacolon)

Hydrocephalus due to aqueductal stenosisHydrocephalus due to aqueductal stenosis

HypospadiasHypospadias

Imperforate anusImperforate anus

Neural tube defectsNeural tube defects

Covered Birth Covered Birth Defects (3)Defects (3)

Poland syndromePoland syndrome

Pyloric stenosisPyloric stenosis

Syndactyly (fused digits)Syndactyly (fused digits)

Tracheoesophageal fistulaTracheoesophageal fistula

Undescended testicleUndescended testicle

Williams syndromeWilliams syndrome

Death from Agent OrangeDeath from Agent Orange

Surviving spouses dependent children Surviving spouses dependent children and dependent parents of Veterans who and dependent parents of Veterans who were exposed to Agent Orange and died were exposed to Agent Orange and died as the result of diseases related to Agent as the result of diseases related to Agent Orange exposure may be eligible Orange exposure may be eligible for for survivors benefitssurvivors benefits

httphttpwwwpublichealthvagovwwwpublichealthvagovexposuresagentorangesurvivors-exposuresagentorangesurvivors-benefitsasp benefitsasp

NASIOM Veterans and NASIOM Veterans and Agent Orange ndash 2010Agent Orange ndash 2010

Veterans and Agent Orange Update 2010Veterans and Agent Orange Update 2010

Released September 29 2011Released September 29 2011

Veterans Review of the Health Effects in Veterans Review of the Health Effects in Vietnam Veterans of Exposure to Vietnam Veterans of Exposure to Herbicides (Eighth) Biennial UpdateHerbicides (Eighth) Biennial Update

ResourcesResources

VHA Agent Orange Home PageVHA Agent Orange Home Page

httpwwwpublichealthvagovexposureshttpwwwpublichealthvagovexposuresagentorangeagentorange

Vietnam Veterans of America Home PageVietnam Veterans of America Home Page

httpVVAorghttpVVAorg

• Agent Orange 2011
• Overview
• Herbicide (Agent) Orange (1)
• Herbicide (Agent) Orange (2)
• Other Herbicides Used in Vietnam
• Heavily Sprayed Areas - Map
• Dioxins
• Dioxins - Pharmacology
• Dioxins - Toxicology
• Politics
• Federal Response to Vietnam
• Presumptive Conditions (1)
• Presumptive Conditions (2)
• Presumptive Conditions (3)
• Presumptive Conditoins (4)
• Presumptive Conditions (5)
• Other Military Exposures
• Women Veterans and Offspring
• Covered Birth Defects (1)
• Covered Birth Defects (2)
• Covered Birth Defects (3)
• Death from Agent Orange
• NASIOM Veterans and Agent Orange ndash 2010
• Resources
• Slide 25

Covered Birth Covered Birth Defects (2)Defects (2)

Hip dysplasiaHip dysplasia

Hirschprungs disease (congenital Hirschprungs disease (congenital megacolon)megacolon)

Hydrocephalus due to aqueductal stenosisHydrocephalus due to aqueductal stenosis

HypospadiasHypospadias

Imperforate anusImperforate anus

Neural tube defectsNeural tube defects

Covered Birth Covered Birth Defects (3)Defects (3)

Poland syndromePoland syndrome

Pyloric stenosisPyloric stenosis

Syndactyly (fused digits)Syndactyly (fused digits)

Tracheoesophageal fistulaTracheoesophageal fistula

Undescended testicleUndescended testicle

Williams syndromeWilliams syndrome

Death from Agent OrangeDeath from Agent Orange

Surviving spouses dependent children Surviving spouses dependent children and dependent parents of Veterans who and dependent parents of Veterans who were exposed to Agent Orange and died were exposed to Agent Orange and died as the result of diseases related to Agent as the result of diseases related to Agent Orange exposure may be eligible Orange exposure may be eligible for for survivors benefitssurvivors benefits

httphttpwwwpublichealthvagovwwwpublichealthvagovexposuresagentorangesurvivors-exposuresagentorangesurvivors-benefitsasp benefitsasp

NASIOM Veterans and NASIOM Veterans and Agent Orange ndash 2010Agent Orange ndash 2010

Veterans and Agent Orange Update 2010Veterans and Agent Orange Update 2010

Released September 29 2011Released September 29 2011

Veterans Review of the Health Effects in Veterans Review of the Health Effects in Vietnam Veterans of Exposure to Vietnam Veterans of Exposure to Herbicides (Eighth) Biennial UpdateHerbicides (Eighth) Biennial Update

ResourcesResources

VHA Agent Orange Home PageVHA Agent Orange Home Page

httpwwwpublichealthvagovexposureshttpwwwpublichealthvagovexposuresagentorangeagentorange

Vietnam Veterans of America Home PageVietnam Veterans of America Home Page

httpVVAorghttpVVAorg

• Agent Orange 2011
• Overview
• Herbicide (Agent) Orange (1)
• Herbicide (Agent) Orange (2)
• Other Herbicides Used in Vietnam
• Heavily Sprayed Areas - Map
• Dioxins
• Dioxins - Pharmacology
• Dioxins - Toxicology
• Politics
• Federal Response to Vietnam
• Presumptive Conditions (1)
• Presumptive Conditions (2)
• Presumptive Conditions (3)
• Presumptive Conditoins (4)
• Presumptive Conditions (5)
• Other Military Exposures
• Women Veterans and Offspring
• Covered Birth Defects (1)
• Covered Birth Defects (2)
• Covered Birth Defects (3)
• Death from Agent Orange
• NASIOM Veterans and Agent Orange ndash 2010
• Resources
• Slide 25

Covered Birth Covered Birth Defects (3)Defects (3)

Poland syndromePoland syndrome

Pyloric stenosisPyloric stenosis

Syndactyly (fused digits)Syndactyly (fused digits)

Tracheoesophageal fistulaTracheoesophageal fistula

Undescended testicleUndescended testicle

Williams syndromeWilliams syndrome

Death from Agent OrangeDeath from Agent Orange

Surviving spouses dependent children Surviving spouses dependent children and dependent parents of Veterans who and dependent parents of Veterans who were exposed to Agent Orange and died were exposed to Agent Orange and died as the result of diseases related to Agent as the result of diseases related to Agent Orange exposure may be eligible Orange exposure may be eligible for for survivors benefitssurvivors benefits

httphttpwwwpublichealthvagovwwwpublichealthvagovexposuresagentorangesurvivors-exposuresagentorangesurvivors-benefitsasp benefitsasp

NASIOM Veterans and NASIOM Veterans and Agent Orange ndash 2010Agent Orange ndash 2010

Veterans and Agent Orange Update 2010Veterans and Agent Orange Update 2010

Released September 29 2011Released September 29 2011

Veterans Review of the Health Effects in Veterans Review of the Health Effects in Vietnam Veterans of Exposure to Vietnam Veterans of Exposure to Herbicides (Eighth) Biennial UpdateHerbicides (Eighth) Biennial Update

ResourcesResources

VHA Agent Orange Home PageVHA Agent Orange Home Page

httpwwwpublichealthvagovexposureshttpwwwpublichealthvagovexposuresagentorangeagentorange

Vietnam Veterans of America Home PageVietnam Veterans of America Home Page

httpVVAorghttpVVAorg

• Agent Orange 2011
• Overview
• Herbicide (Agent) Orange (1)
• Herbicide (Agent) Orange (2)
• Other Herbicides Used in Vietnam
• Heavily Sprayed Areas - Map
• Dioxins
• Dioxins - Pharmacology
• Dioxins - Toxicology
• Politics
• Federal Response to Vietnam
• Presumptive Conditions (1)
• Presumptive Conditions (2)
• Presumptive Conditions (3)
• Presumptive Conditoins (4)
• Presumptive Conditions (5)
• Other Military Exposures
• Women Veterans and Offspring
• Covered Birth Defects (1)
• Covered Birth Defects (2)
• Covered Birth Defects (3)
• Death from Agent Orange
• NASIOM Veterans and Agent Orange ndash 2010
• Resources
• Slide 25

Death from Agent OrangeDeath from Agent Orange

Surviving spouses dependent children Surviving spouses dependent children and dependent parents of Veterans who and dependent parents of Veterans who were exposed to Agent Orange and died were exposed to Agent Orange and died as the result of diseases related to Agent as the result of diseases related to Agent Orange exposure may be eligible Orange exposure may be eligible for for survivors benefitssurvivors benefits

httphttpwwwpublichealthvagovwwwpublichealthvagovexposuresagentorangesurvivors-exposuresagentorangesurvivors-benefitsasp benefitsasp

NASIOM Veterans and NASIOM Veterans and Agent Orange ndash 2010Agent Orange ndash 2010

Veterans and Agent Orange Update 2010Veterans and Agent Orange Update 2010

Released September 29 2011Released September 29 2011

Veterans Review of the Health Effects in Veterans Review of the Health Effects in Vietnam Veterans of Exposure to Vietnam Veterans of Exposure to Herbicides (Eighth) Biennial UpdateHerbicides (Eighth) Biennial Update

ResourcesResources

VHA Agent Orange Home PageVHA Agent Orange Home Page

httpwwwpublichealthvagovexposureshttpwwwpublichealthvagovexposuresagentorangeagentorange

Vietnam Veterans of America Home PageVietnam Veterans of America Home Page

httpVVAorghttpVVAorg

• Agent Orange 2011
• Overview
• Herbicide (Agent) Orange (1)
• Herbicide (Agent) Orange (2)
• Other Herbicides Used in Vietnam
• Heavily Sprayed Areas - Map
• Dioxins
• Dioxins - Pharmacology
• Dioxins - Toxicology
• Politics
• Federal Response to Vietnam
• Presumptive Conditions (1)
• Presumptive Conditions (2)
• Presumptive Conditions (3)
• Presumptive Conditoins (4)
• Presumptive Conditions (5)
• Other Military Exposures
• Women Veterans and Offspring
• Covered Birth Defects (1)
• Covered Birth Defects (2)
• Covered Birth Defects (3)
• Death from Agent Orange
• NASIOM Veterans and Agent Orange ndash 2010
• Resources
• Slide 25

NASIOM Veterans and NASIOM Veterans and Agent Orange ndash 2010Agent Orange ndash 2010

Veterans and Agent Orange Update 2010Veterans and Agent Orange Update 2010

Released September 29 2011Released September 29 2011

Veterans Review of the Health Effects in Veterans Review of the Health Effects in Vietnam Veterans of Exposure to Vietnam Veterans of Exposure to Herbicides (Eighth) Biennial UpdateHerbicides (Eighth) Biennial Update

ResourcesResources

VHA Agent Orange Home PageVHA Agent Orange Home Page

httpwwwpublichealthvagovexposureshttpwwwpublichealthvagovexposuresagentorangeagentorange

Vietnam Veterans of America Home PageVietnam Veterans of America Home Page

httpVVAorghttpVVAorg

• Agent Orange 2011
• Overview
• Herbicide (Agent) Orange (1)
• Herbicide (Agent) Orange (2)
• Other Herbicides Used in Vietnam
• Heavily Sprayed Areas - Map
• Dioxins
• Dioxins - Pharmacology
• Dioxins - Toxicology
• Politics
• Federal Response to Vietnam
• Presumptive Conditions (1)
• Presumptive Conditions (2)
• Presumptive Conditions (3)
• Presumptive Conditoins (4)
• Presumptive Conditions (5)
• Other Military Exposures
• Women Veterans and Offspring
• Covered Birth Defects (1)
• Covered Birth Defects (2)
• Covered Birth Defects (3)
• Death from Agent Orange
• NASIOM Veterans and Agent Orange ndash 2010
• Resources
• Slide 25

ResourcesResources

VHA Agent Orange Home PageVHA Agent Orange Home Page

httpwwwpublichealthvagovexposureshttpwwwpublichealthvagovexposuresagentorangeagentorange

Vietnam Veterans of America Home PageVietnam Veterans of America Home Page

httpVVAorghttpVVAorg

• Agent Orange 2011
• Overview
• Herbicide (Agent) Orange (1)
• Herbicide (Agent) Orange (2)
• Other Herbicides Used in Vietnam
• Heavily Sprayed Areas - Map
• Dioxins
• Dioxins - Pharmacology
• Dioxins - Toxicology
• Politics
• Federal Response to Vietnam
• Presumptive Conditions (1)
• Presumptive Conditions (2)
• Presumptive Conditions (3)
• Presumptive Conditoins (4)
• Presumptive Conditions (5)
• Other Military Exposures
• Women Veterans and Offspring
• Covered Birth Defects (1)
• Covered Birth Defects (2)
• Covered Birth Defects (3)
• Death from Agent Orange
• NASIOM Veterans and Agent Orange ndash 2010
• Resources
• Slide 25

• Agent Orange 2011
• Overview
• Herbicide (Agent) Orange (1)
• Herbicide (Agent) Orange (2)
• Other Herbicides Used in Vietnam
• Heavily Sprayed Areas - Map
• Dioxins
• Dioxins - Pharmacology
• Dioxins - Toxicology
• Politics
• Federal Response to Vietnam
• Presumptive Conditions (1)
• Presumptive Conditions (2)
• Presumptive Conditions (3)
• Presumptive Conditoins (4)
• Presumptive Conditions (5)
• Other Military Exposures
• Women Veterans and Offspring
• Covered Birth Defects (1)
• Covered Birth Defects (2)
• Covered Birth Defects (3)
• Death from Agent Orange
• NASIOM Veterans and Agent Orange ndash 2010
• Resources
• Slide 25