Guidelines for Veterans -VA Proposed Law – “Agent Orange and Peripheral Neuropathy”

Does the VA recognize peripheral neuropathy as due to exposure to Agent Orange in Vietnam and Korea?

Yes.

Under the VA’s gold standard of the Ranch Hand Study and the Air Force Study, Peripheral Neuropathy is connected to exposure to the components of Agent Orange.

However, under the presumption list of disease that are presumed to be caused by exposure to Agent Orange, the VA only recognizes Acute and Sub-Acute Peripheral Neuropathy, which they define as symptoms that appear shortly after exposure and remit or cease in a few years. The question would be, why even list it.

However, the law permits the veteran to establish proof of a direct connection between exposure to Agent Orange, symptoms of a chronic neuropathy, diagnosis and medical history by establishment of reasonable doubt and the principle of high probability.

2010 update from the Institute of Medicine related to VA recognition of presumption for only Acute/Sub-Acute Peripheral Neuropathy

In the 2010 update, the Institute of Medicine committee recommends that the VA search its own records to look for possible associations between Vietnam service and specific health outcomes, specifically those that are relatively uncommon.

The only modification made in this update to disease entries in the categories of association is the notation that early-onset peripheral neuropathy (a condition which has been recognized since Update 1996 as having limited or suggestive evidence of an association with herbicide exposure but which must have developed within a year of exposure) is not necessarily transitory as the VA still claims for presumptive cause of neuropathy.

This undermines further the claim of the VA that AO causes only acute/sub-acute neuropathy. Similar to the VA denials of a relationship between AO and cancers since the Vietnam War and in the VA endless appeals to law suits brought by veterans in the 1990’s, the fact that AO does cause chronic forms of neuropathy years after exposure will become fact in the near future

This is why every Veteran with the symptoms of Neuropathy MUST file and APPEAL to keep the issue before the VA. The Veterans with cancers may have lost the individual battles of the 1990’s, but this is exactly why the IOM/VA was forced to have the research of 2007 done and so they won the war for so many others and for a few lucky ones, for themselves.

It is important to note that the IOM continues to recommend that laboratory research be conducted to characterize Agent Orange’s potential for inducing epigenetic modifications. Work needs to be undertaken to resolve questions regarding several health outcomes, most importantly COPD, tonsil cancer, melanoma, brain cancer, Alzheimer’s disease, and paternally transmitted effects to offspring.

Facts about Peripheral Neuropathy and exposure to the components of Agent Orange in Vietnam, Korea, the waters off Vietnam and other places it was processed, handled or used:

The Environmental Protection Agency decades ago confirmed the connection between Agent Orange / dioxin with Peripheral Neuropathy numerous times and in their literature they do not limit the neuropathy to only the acute form as does the VA. The EPA years ago noted that Agent Orange and the components of dioxin were serious toxins and carcinogen, but this was ignored for decades. Other medical literature warned of the possible dangers of dioxin years before its use in Vietnam, finding connections to serious illnesses, including the neuropathies, warning of the dire consequences. These warnings were ignored.

When veterans in the 1990’s sued the VA because they were dying of cancers (cancer and related treatments are a known cause of neuropathy), the VA fought multiple law suits by veterans, appealed any favorable verdict repeatedly, avoiding helping these veterans and their families who were dying of cancers since the Vietnam War. The high probability was ignored by everyone.

Now in December 2007 (again many decades later) a research study was published from the University of Pennsylvania, School of Veterinarian Medicine which confirmed that components of Agent Orange caused a heretofore unknown destructive effect on the basic cellular structure of the human body and was a serious toxin and a carcinogen of the worse kind.

Beyond the failure to respect the warnings and findings decades ago, many doctors and Neurologists still do not fully understand the clinical skills needed to diagnose and treat patients with Peripheral Neuropathy. There is much neuropathy research demanding to be done.

Training of neurologists in 2010 still does not include a significant consideration of Peripheral Neuropathy or provide the needed clinical education. This failure is due to multiple issues including poor attitudes, little awareness, dismissive thinking on neuropathy, resulting in limited clinical training and research and minimum serious long term research. One of the largest missed opportunities in research on toxic neuropathies is the fact of the chronic neuropathies in thousands of veterans, decades after exposure during the Vietnam and Korean Wars. Such research would have increased our understanding of toxic neuropathies beyond old thinking, because we assumed there was no relevance and closed our medical eyes to new possibilities!

Medicine is slowly coming to terms with the fact that Peripheral Neuropathy is a potentially serious condition and a disease of the Peripheral Nervous system, often leading to serious disability and is not JUST the symptom of something else. Every disease is a symptom of something else yet they are still a disease when a major body system is affected.

After four decades of a failure to diagnose my own polyneuropathy, following exposure to Agent Orange in Vietnam in 1968, I am puzzled by statements that toxic neuropathies are rare. Even in 2010 we still do not have a broadly accepted criteria or understanding for diagnosis of many neuropathies including my own and only old research on the neuropathies toxins cause! Most conditions that we cannot diagnose would be rare.

From my view point it is poor attitudes and out dated thinking that have allowed a failure to grasp one of the greatest opportunities ever in the toxic neuropathies. That opportunity was the dismissal of thousands upon thousands of veterans, who when exposed to Agent Orange/dioxin in Vietnam and Korea, became increasingly and progressively symptomatic with the chronic neuropathies decades after exposure! The response was that this was impossible because neuropathies resolve once the person is removed from exposure. Then there is the qualifier that this happens “usually” and it was this qualifier that should have raised questions in minds to ask better questions and challenge old thinking.

Too many old assumptions and aged thinking prevented medicine from taking these neuropathies seriously and asking new questions about old assumptions or outdated findings about toxic neuropathies. Who ever thought before 2007 that dioxin caused a hereto unknown destructive effect on the very cellular structure of the human body decades after exposure. (From the proceedings of the Institute of Medicine from research at the University Of Pennsylvania School Of Veterinarian Medicine in December 2007).

I was reassured in 1990 when in a taped lecture to neuropathy patients, a Board Certified Neurologist was asked about Agent Orange. He stated that dioxin was so safe he would be willing to live and sleep in it without fear. He then went on to state as an expert, “that if it does not affect the feet, it is not toxic neuropathy.” So while living in my body from “hell” from immune mediated polyneuropathies, I decided I had descended into hell itself, for after all this was the expert talking. It is time to really listen to patients, not silence them.

What does this mean to veterans of Vietnam, Korea or other areas exposed to this toxin, not to even mention the children and others who still live in toxic areas of Vietnam? Is it strange that these children of Vietnam decades later suffer from the same symptoms as me and other veterans exposed to Agent Orange? Understand that this is not political, for I am a center right conservative American citizen, opposed to any form of dictatorship whether on the extreme left or right and would gladly serve my country again in any fight for freedom. No, this is about what is right and what is wrong, taking responsibility when we are wrong and the values of honor and service that I learned as a military officer.

The foundation principle for dismissing toxins as rarely causing Peripheral Neuropathy is the long standing principle that once a person is removed from a toxin, the symptoms of Peripheral Neuropathy will usually cease and if the toxin is retained in the human body, the levels are not high enough to cause a chronic neuropathy.

Now I must say that the mother of any child actually understands this principle well, for in their experience with first aid, if a child who runs into poison ivy in the woods and you remove the child from the toxin, wash off the area and apply some creams, the symptoms remit. But what many do not recognize is the qualifier in such statements of “usually remit when the patient is removed from the toxin.” There are times when assumptions about toxic neuropathies often prevent good thinking and medical doctors need to read the book out of Harvard University on, How Doctors Think by Dr. Groopman MD.

It is known that toxins are stored in the teeth, bones and fat of the human body for years and that is why the cancers and the growing list of disease now recognized by the VA, appeared decades following exposure and why the VA now recognizes birth defects in children fathered by veterans exposed to Agent Orange, such as spina bifida. Perhaps this is a start to recognize why thousands of veterans from Korea and Vietnam plus other places, after exposure to Agent Orange, suffered without help or support for decades as we turned our eyes sending them home.

This is why any argument by the experts about dosages retained in the human body not being high enough is not even relevant. Any dosage of dioxin is dangerous to the human body and it is retained in the human body for decades, proven by the growing list of presumed conditions recognized by the VA, but denied only a few years ago to so many veterans of Vietnam and Korea plus.

One of the well known causes of Peripheral Neuropathy is type two diabetes, which the VA notes is caused by exposure to Agent Orange and so chronic peripheral neuropathy secondary to diabetes would be approved by the VA. Thus the standards of the VA, with claims that Agent Orange involves only acute forms of neuropathy and not chronic forms fail again the test of time and fact.

I know, you say this neuropathy is caused by diabetes and that is why it is chronic. Yet many veterans have been recognized and approved by the VA having service connected chronic neuropathy outside of diabetes due to exposure to Agent Orange. Is it possible that it is diabetes plus another form of autoimmune neuropathy or maybe even exposure to Agent Orange itself? Of course, assumptions sometimes are the worst enemy of good thinking and when one assumes the cause is diabetes, medical science rests and looks no further.

I remember the patient diagnosed with diabetic neuropathy and the doctor stopped looking. When the patient came to me for guidance and help, after listening to the patient it sure looked to this layman like they had something going on with the vascular system. Not being a doctor, but armed with the patient knowledge on Peripheral Neuropathy in the book by Dr. Norman Latov, MD (Neurologist - Weill Medical of Columbia University), I referred the patient to another doctor who diagnosed vasculitic neuropathy, treated it and perhaps saved the patient’s life.

When Peripheral Neuropathy was first listed by the VA in reference to Agent Orange, the VA criteria was very broad and Vietnam and Korean veterans flocked to the VA for help. The VA responded to this large surge of veterans seeking help by reducing the time criteria from exposure to symptoms and from symptom on set to remitting of symptoms. The VA did this multiple times sharing the fact of their uncertainty of what was involved with Peripheral Neuropathy. Then the VA stated that the condition recognized is limited to acute and sub-acute peripheral neuropathy. This medical opinion was based on NO research or fact of note combined with old and unscientific data or opinion. With these changes any claim regarding Peripheral Neuropathy based on presumed exposure to Agent Orange became a useless waste of time. To this day the VA continues to claim that any chronic neuropathy or polyneuropathy was not supported by the data from the Ranch Hand Study or Air Force Data, but then this is not relevant either.

The Provost of Research, Dean of the Graduate School of Kansas State and President of Kansas State University Research Foundation, Dr. R.W. Trewyn, PhD (in cellular and molecular biology) testified on March 15, 2000 before a congressional committee, that the Operation Ranch Hand Study, Army Chemical Corp personnel study in Vietnam and the Air Force Study were so scientifically flawed on every count, that they are basically useless to science and had no validity or reliability to prove anything. He noted that the VA should give every benefit of doubt to the veteran exposed to Agent Orange. Of course this never happened and this testimony by this expert on research and biology is buried under piles of paper along with the veterans who died without help or promised support. These flawed studies have been the gold standard for the VA decisions for years until the research in 2007.

It is not surprising then that today a number of veterans of Vietnam have been approved by the VA for benefits related to exposure to Agent Orange and chronic Peripheral Neuropathy. This was done, not on the basis of presumption or the VA definition, but on solid proof of the connection between exposure to Agent Orange, their medical history and diagnosis of neuropathy with all other causes ruled out.

Having shown that all other causes of their neuropathy or polyneuropathy were ruled out by testing, showing that the veteran served in Vietnam or Korea during war, were exposed to Agent Orange via clothing, equipment, food, water, or by breathing the air or smoke from the old dioxin barrels used to burn waste, they proved their case. This occurred on the legally recognized basis of reasonable doubt, with the conclusion reached based on the highest probability that the veteran’s diagnosed condition and disabilities were due to his exposure to Agent Orange. Thus Agent Orange was shown to be the highest probable cause of their Peripheral Neuropathy.

Veterans should consider using notarized affidavits from the treating Neuromuscular Neurologist, when the VA refuses to recognize facts in the veteran’s medical record. Affidavits from your qualified doctor can be used to counter opinions from unqualified VA doctors. Did you know that by VA law any doctor with an MD qualifies to render an opinion in your case and they may be from any field of medicine? Many of them are often retired, non-practicing and are not Board Certified or have current training. Affidavits from your qualified doctor can be effective when misstatements of fact are repeated in VA documents until the VA even believes them! The use of affidavits places the expertise of your treating Board Certified Neuromuscular Neurologists in the court with you.

In the real world, few Neuromuscular Neurologists will have the time to write these documents and it is doubtful you would be able to afford the time it takes to pay such a professional. Few Neuromuscular Neurologists will have the time to appear in court with you and it is doubtful you will have the funds to pay for such an appearance. So what do you do?

Using the facts in your medical record, write a DRAFT (get someone to help you) of the document for the doctor to consider and sign on their letterhead adding a notary seal. Remember, stick to the recorded facts and the doctor should not have a problem with the document. The doctor can confirm any medical conclusions regarding the facts with their medical expertise and updated sources of medical information about Neuropathy. What you are establishing is reasonable doubt while using the accepted principle of highest probability. If you show symptoms of a neuropathy or polyneuropathy after being exposed to Agent Orange, symptoms which progress over years, showing that medical tests have ruled out all other causes, then the highest probability is that your chronic neuropathy is due to your exposure to Agent Orange.

Please download the booklet (A Guide to Successful Legal Cases and Affidavits….) which will show you samples of such affidavits and the logic used in court hearings by the VA resulting in approval of the connection between Agent Orange exposure and a Chronic Peripheral Neuropathy.