Challenge to BVA on toxic chemical associations to stomach cancer

in our VIETNAM Veterans

 

Revised on 2 aug 2006

 

 

 

To Whom It May Concern:

 

This notice of disagreement and NEW evidentiary scientific and medical data submitted is for Veteran

 

___________________________________________________________.

 

Case Number:  _______________________________.

 

Toxic Chemical Issues and cumulative evidentiary data compiled by Charles Kelley – “Veterans Agent Orange Lay Expert.  Author “Vietnam’s Rain Agents Orange, White, and Blue (Weapons of Mass Destruction)”

 

OVERVIEW:

 

The Veterans claim was denied by the BVA because of service connection based on exposure to herbicides in RVN is not warranted for any conditions other than those for which VA has found a positive association exists between the condition and such exposure.

 

Board is “inconsistent” in statements of fact of the requirements for the Veteran to prove his service connection. 

 

In the first sentence of denial, the board mandates VA positive association on exposures to “herbicides" plural).  Then mandates the Veteran prove “dioxin” (singular) associations.

 

Veteran disagrees with the VA and Board that all such medical associations in claims in wartime service in a toxic chemicals (plural) environment must be addressed/associated to the one single by-product of the manufacturing process of (2, 4, 5 trichlorophenoxyacetic acid; 545.4 Kg/m3) {2,4, 5-T} producing the dioxin, TCDD with that being impure Dioxin (2, 3, 7, 8-tetrachlorodibenzo-p- Dioxin) {2,4,5-T}. 

 

Veteran states that the dioxin, TCDD is a “single toxicant” of a “single component” that made up the SINGLE Herbicide with the nomenclature of “Agent Orange.”  

 

Board and its members need to be cognizant and knowledgeable to the scientific facts there is no such thing as “a dioxin.” There are over 200 dioxins that are part of a family of “co-planer” toxicants, which includes dibenzofurans and polychlorinated biphenyls (PCB’s).

 

Facts are - that in science and toxicology the most carcinogenic of all the dioxins, dibenzofurans, and polychlorinated biphenyls (PCB’s) IS (2, 3, 7, 8-tetrachlorodibenzo-p- Dioxin) {2,4,5-T} found in Agent Orange. 

 

Science compares the carcinogenic severity of other dioxins, dibenzofurans, and polychlorinated biphenyls (PCB’s) to the dioxin, TCDD that “IS” quantified and qualified as the worst.  The key words are “carcinogenic severity of other carcinogens in this family of toxic chemicals.”  Therefore, it is logical the Veteran would not only be exposed to the single toxicant of one component but many toxicants of the many components that made up the “Herbicides” (plural).

 

Further stated by the Veteran the Herbicide with the nomenclature Agent White (2,4-D) also had other dioxin isomers as well as closely related furans, which was also used separately, and as a 50/50 mixture with Agent Orange.

 

Dr. Daniel Teitelbaum, MD., one of the world’s foremost toxicology experts in 1989 in a letter to Admiral Zumwalt during the 1989 Herbicide assessments stated: (1)

 

{In the context of evaluating Agent Orange but as documented after reviewing Dow Chemicals own documentation, his concern also was for Agent White (2,4-D):}

 

{Agent White was the code name for a mixture of an approximate ratio of 4:1 of 2, 4-D (2, 4-dichlorophenoxyacetic acid; 239.7 kg/m3) and Picloram (4-amino-3, 5, 6-trichloropicolinic acid; 64.7 kg/m3).} 

 

“What I do think...may bear on the Agent Orange issue, is the fact that in review of Dow’s 2,4-D documentation I found that there are significant concentrations of potentially carcinogenic materials present in 2,4-D which have never been made known to the EPA, FDA, or to any other agency.  Thus, in addition to the problem of the TCDD which, more likely than not, was present in the 2,4,5-T component of Agent Orange, the finding of other dioxins and closely related furans and xanthones in the 2,4-D formulation….”

 

Picloram was Dow proprietary and we now know that it contained not only nitrosamines but also hexachlorobenzene.  We now know that in 1985 the EPA mandated a reduction in not only nitrosamines but also hexachlorobenzene.  We now know that the product Picloram now has a maximum of 100 parts per million of hexachlorobenzene and no (zero) nitrosamines.  What we do not know is what this toxic formula strength was during our toxic chemical war.  “Veterans Lay Agent Orange Expert”

 

February 28, 1990 an additional study found that farmers exposed to various herbicides containing 2,4—D may experience elevated risks for certain cancers, particularly cancers of the stomach, connective tissue, skin, brain, prostate, and lymphatic and hematopoietic systems. (13)

 

It is further stated by the Veteran the Herbicide with the nomenclature Agent Blue cacodylic acid (dimethyl arsenic acid) symptoms include:(2)

 

Garlic type odor of breath and feces, and metallic taste in the mouth.

 

Adverse GI effects predominate with vomiting, abdominal pain and rice-water, or bloody diarrhea.

 

GI effects may also include inflammation, vesicle formation, and eventual sloughing of the mucosa in the mouth, pharynx, and esophagus.

 

Central nervous system effects that are common include: headache, dizziness, drowsiness, and confusion.

 

Symptoms may progress to include muscle weakness, spasms, hypothermia, lethargy, delirium, coma, and convulsions.

 

Renal injury manifests as proteinuria, hematuria, glycosuria, oliguria, and shows up in the urine.  In severe poisoning cases, acute tubular necrosis results.

 

Cardiovascular effects include shock, cyanosis, and cardiac arrhythmia.

 

Elevated liver enzymes and jaundice may manifest causing liver damage.

 

Injury to blood-forming tissues may cause anemia, leucopenia, and thrombocytopenia.

 

Chronic exposure may lead to:

 

Muscle weakness, fatigue, anorexia, weight loss.

 

Hyperpigmentation, hyperkeratosis.

 

Peripheral neuropathy, paresthesia, paresis, and ataxia.

 

Inability to coordinate voluntary muscular movements.

 

Subcutaneous edema in face, eyelids, and ankles.

 

Stomatitis, white striations across the nails (Mees lines) and sometimes loss of nails or hair.

 

Liver toxicity as indicated by hepatomegaly, jaundice, and cirrhosis.

 

Renal toxicity leading to oliguria, proteinuria, and hematuria.

 

EKG abnormalities and peripheral vascular disease.

 

Hematologic abnormalities.

 

Cancer.

 

Carcinogenicity has not been tested adequately, but it should be noted that other inorganic arsenic compounds have been found associated with liver, lung, skin, and “stomach cancers.”

 

Veteran states that given the documented facts of his toxic chemical environment war of at least three major military herbicides in the form of Agents Orange, White, and Blue and the other lesser known military herbicides of Agent Pink, Purple, and Green and with a minimum of eight other commercially named herbicides that were used; to mandate a claim to single byproduct of one toxic chemical is not only unscientific but would mandate harshness in the form of board/VA bias in that “no person in the world” can meet that standard mandated and it is “not required: in any other constitutional court in our nation.

 

The Veteran will be submitting SCIENTIFIC or MEDICAL evidence showing that his claimed condition is “at least as likely as not” medically associated with dioxin exposures and/or the other toxic chemicals involved that may have caused the conditions that created his adenocarcinoma stomach cancer.

 

The Veteran shall establish a well-grounded claim by submitting competent medical evidence showing that the currently diagnosed cancer is related to not only Agent Orange exposure but the other carcinogenic toxicants he was exposed to; see Brock v. Brown, 10 Vet.  App. 155 (1997), and that he was exposed to Agent Orange and the other toxins.  See McCartt v. West, 12 Vet.  App. 164 (1999).

 

The Veteran will establish that “it is as least as likely as not” his stomach cancer and the resulting disability from osteoporoses (already concluded and stated by his medical doctors), is well connected to his Wartime Service in Vietnam presumptive and/or known exposures to the toxic chemicals in Agent Orange or Agent White or Agent Blue and/or a combination of all three or any of the other known toxicants that were used.

 

 See Nehmer v. U.S. Veterans Admin., 712 F. Supp. 1404, 1408. (N.D. Cal. (1989). wherein the court found after reviewing the legislative history of the Act "that Congress intended service connection to be granted on the basis of "increased risk of incidence" or a "significant correlation" between dioxin and various diseases," rather than on the basis of a casual relationship.

 

Although, BVA should make no mistake, it is known that the dioxin, TCDD is also associated to forms of osteoporoses in our Vietnam Veterans in a much earlier age than the established norms.  This includes spinal column degeneration as well as “overall loss of bone mass.”

 

The 2003 Korean Agent Orange study found between Vietnam and Non-Vietnam veterans a p value of:  (3)

 

1        Spondylosis (spinal osteoarthritis) = 0.1311 with zero Non-Vietnam veterans being diagnosed.

 

2        Radiculopathy – (Mass lesions - benign or malignant - especially in patients with narrow canals, may compress both the root and spinal cord, adding a myelopathy to a root syndrome.) = 0.0002

 

3        Radiculopathy with HIVD (HIVD = herniated intervertebral disc) = 0.0001

 

4        Herniation of nucleus pulposus = 0.0028

 

Spondylosis = 0.1311 (Degeneration of the spine and neck bones) (None found in the comparison NON Vietnam Veteran group).

 

Myelopathy = 0.0851 Myelopathy (The process that leads to compression of the spinal cord, also called arthritis and cervical spondylosis).  (Cervical, thoracic, and/or lumbar regions of the spine affecting the intervertebral discs and facet joints).

 

Discussion:

 

Causes of stomach cancer called adenocarcinoma.

 

There is “no established known cause” in the medical world for the stomach cancer called adenocarcinoma. 

 

There are however, “trends” and “risk factors” in this medical issue, worldwide.

 

“Risk factors for gastric cancer are a family history of gastric cancer, Helicobacter pylori infection, blood type A, a personal history of pernicious anemia, a history of chronic atrophic gastritis, a condition of decreased gastric acid, and a prior history of adenomatous gastric polyp.”

 

It is well known and documented that Vietnam Veterans develop gastritis and digestive issues.  Some even shortly after coming home from Vietnam.  While there is no hereditary connection in the Vietnam Veteran, the symptoms were in many of our returning Vietnam Veterans, as well as our allies.

 

·         No heavy red meats.

·         No greasy or spicy foods.

·         A developed intolerance to milk products.

·         Chronic diarrhea, which was sometimes diagnosed as IBS.

·         Chronic upper digestive system distress, bloating and gas.

 

Veteran asserts, as many Vietnam Veterans, he also came home with these symptoms and has continued and this has contributed to his “risk factors” for the stomach cancer. 

 

Given the description of the “risk factors for gastric cancer” the Veteran’s “Lay Agent Orange Expert” asserts that “it is at least as likely as not” the symptoms developed by the Veteran in Vietnam or shortly after was caused by his exposures to the toxic chemicals (plural) and/or Wartime Service in RVN.

 

Pernicious anemia, another known indicator associated with stomach cancer, is a well known autoimmune disorder thought also to be part of the dioxin or toxic chemical exposures even though it would be a secondary effect of dioxin caused *lymphocytes blocking the cell receptors in the first few inches of the small intestines for B-12 absorption.

 

Pernicious anemia  - chronic illness caused by impaired absorption of vitamin B-12.

 

*According to Dr. Joseph Murray, MD, PhD of the University of Iowa College of Medicine one of or our nations foremost experts in these issues.  (4)

 

"These lymphocytes are the same lymphocytes found in the lymphoma cancers."

 

Lymphoma cancers are already presumptively associated by National Academy of Science as well as found presumptive by the Secretary of the Department of Veterans Affairs.

 

It would be medically and scientifically illogical to conclude or surmise that lymphocytes “dioxin created” in the Immune System cancers could not also produce the same lymphocyte in the B12 issues.

 

*According to Dr. Joseph Murray: (4)

 

"The longer, you have the benign lymphocytes the more chance you have a cell going cancerous."   Thereby resulting in one of the already presumptive lymphoma cancers.

 

In addition, this medical issue can be sub-clinical for years until the results of the damage such as stomach cancer begin to manifest and be diagnosed with invasive diagnostic tests.

 

The Veteran “does have a history” of Pernicious Anemia and a *history of digestive system issues that certainly according to the experts can be symptoms of the risk factors for stomach cancers and certainly could be associated with toxic chemical exposures.    

 

Veteran asserts that prior to his wartime service in the toxic chemical environment and/or Vietnam he did not have intolerance for: milk products, heavy red meats, greasy food, upper digestive gas and any sign of irritable bowel syndrome (IBS).

 

In statements of facts against the adenocarcinoma being risk for factors in the Veteran without some outside source.  

 

The Veteran does not have blood type A; the Veteran has no family history of such cancers, and no prior history of adenomatous gastric polyp which as stated above are risks for this type of cancer.  

 

In addition, this form of adenocarcinoma cancer of the stomach is “relatively uncommon” in the US, as pointed out below.

 

Adenocarcinoma of the stomach is a common cancer of the digestive tract worldwide, although it is relatively uncommon in the US. It occurs most frequently in men over 40 years old. The incidence of this form of gastric cancer is extremely high in Japan, Chile, and Iceland. The incidence of most types of gastric adenocarcinoma in the US has declined over the years. Experts think the decrease may be related to reduced intake of salted, cured, and smoked foods, and increased vitamin C consumption.

 

The fact that this adenocarcinoma of the stomach is relatively uncommon is just another indicator of heavy concentrations of toxic chemical exposures which of course are presumptive for the Vietnam Veteran as a causation.  The Veteran's wartime service in Vietnam in a toxic chemical environment should be included as presumptive to his adenocarcinoma and that “it is at least as likely as not” this service contributed to his adenocarcinoma stomach cancer.

 

Adenocarcinomas of the stomach originate from the glandular cells of the stomach lining.

  

For unknown reasons, adenocarcinoma of the stomach is becoming less common in the United States.  It is far more common in Japan, China, Chile, and Iceland; in these nations, screening programs are an important means of early detection.

 

Causes and Risk Factors

 

The cause of adenocarcinoma of the stomach is unknown.  It often begins at a site where the stomach lining is inflamed.  However, many experts now believe that inflammation is the result of adenocarcinoma rather than the cause of it.  Certain foods, especially smoked foods, are suspected as contributing to stomach cancer.

 

Some experts suggest that peptic ulcers in the stomach can lead to adenocarcinoma, but most people with ulcers and adenocarcinoma probably had an undetected cancer before the ulcers developed.

 

The bacterium Helicobacter pylori, which plays a role in producing ulcers, likely plays a role in the development of adenocarcinoma.

 

Adenocarcinoma of the stomach is particularly likely to develop if the polyps consist of glandular cells, if the polyps are larger than ¾ inch, or if several polyps exist.

 

Certain dietary factors are thought to play a role in the development of adenocarcinoma of the stomach.  These factors included a high intake of salt, a high intake of carbohydrates, a high intake of preservatives called nitrates (often present in smoked foods), and a low intake of fruit and green leafy vegetables.  However, none of these factors has been proven a cause.

 

The Board must bear in mind that nitrosamines were also in the main herbicides sprayed from the rust preventives that were used to prevent the highly toxic chemicals from rusting through the 55-gallon drums.  This of course only worked to a certain point in the life of the packaged drums as the longer the Hebrides remained in storage the more chance they began to leak.  This would conclude that while the half-life of the toxic chemicals was 7 to 10 years the rust inhibiters life was much less.  Fresh toxic chemicals would have very potent nitrosamines.  

 

Nitrosamines and Nitrates: 

 

Gastric cancer risk may be associated with exposure to nitrosamines, their precursors, or to nitrosation facilitators. Nitrosamines are formed by the union of nitrites with other amines; therefore, any factor that increases exposure to nitrites, nitrates or their precursors would increase the risk of gastric cancer. (5)

 

Data on Agent Orange by the EPA:

In summary the EPA concluded: (6)

 

“At levels below that where you see wasting, you can see effects on the lymphoid tissues and you actually have loss of the thymus and spleen and at slightly lower levels, and in the adult male you can have atrophy of the testis.  Effects on the liver--there are some differences in different species but, in general, you see enlargement of the liver, you see accumulation of fat in the liver.

 

“In some tissue, you have hyperplasia, which is a proliferation of cells.  The tissue actually gets bigger from having more cells, and this occurs in the lining of the gastro-intestinal tract, it occurs in the lining of the urinary tract, and it occurs in the bile duct, which comes from the liver.

 

As you can see from the above, the stomach lining is suspect in the development of adenocarcinoma and it is pointed out by our own EPA dioxin, TCDD expert that the dioxin, TCDD creates a proliferation of the stomach lining cells as well as other linings of other organs of which it would only take one excess cell to become malignant to create this form of cancer.  The odds certainly go up in this form of process since it is obvious by the statements of the EPA dioxin, TCDD expert that the process of "organ cell lining replacement" is corrupted by the direct exposures to the dioxin, TCDD which is presumptive in the Veterans wartime service in RVN.

 

This cancer development process is also well recognized in the plural linings of the lungs found already associated by the VA.

 

In the Ranch Hand scientific transcripts dated January 24, 2004, the statement was made that; digestive system cancers were significant.  Bearing in mind, the Ranch Handers were exposed by skin contact alone as a normal exposure situation; the most benign form of exposures. (7)

 

“A significant increase in the risk of cancer of the digestive system — smaller counts — prostate cancer in the high category.  In other words, high years of exposure is a relative risk of 8.7, p value 0.003.  We have done supplementary analyses to probe this data to make sure that the proportional hazards model is not leading us astray.  And we have demonstrated that that is the case; that the SAS proportional hazards procedure is in fact not leading us astray and that we are not — we are not simply displaying an artifact due to age.”

 

Here we find a Risk Ratio of 8.7 with P value of 0.003 in our own governments study that certainly meets the requirements of 38 C.F.R 1.17

 

“A valid positive study is one, which satisfies criteria in paragraph (d) (2) of this section and whose findings are statistically significant at a probability level of .05 or less with proper accounting for multiple comparisons and subgroup analyses.” 

 

Certainly the data submitted by the Veteran qualifies for inclusion into 38 C.F.R 1.17 paragraph (4) (e) and/or (d).

 

Specific digestive system cancers:

 

Stomach:

 

Dow Chemical Corporation Studies of Chlorophenol Production Workers. (8)

 

The 1989 Dow Chemical Corporation analysis of employees exposed to dioxins found elevated stomach cancer deaths.  When Dow directly compared "exposed" and "unexposed" workers, "exposed" workers were found to have statistically significant higher rates of stomach cancer.

 

National Institute for Occupational Safety and Health (NIOSH) Study of Maine Paper Mill Workers (8)

 

 The June 1991 NIOSH study of paper mill workers in Maine found elevated stomach cancer deaths, although this elevation was not significant.  The odds ratio for dying of stomach cancer, however, was found to increase in a statistically significant manner with increasing duration of employment at the paper mill, thus establishing a dose-response casual relationship between work at the paper mill and increased gastric cancer.

 

Significant Earlier Studies Showing Elevated Stomach Cancer (8)

 

Earlier studies have demonstrated statistically significant excesses of stomach cancer in populations exposed to dioxin. Three deaths from stomach cancer (0.6 expected) were found among workers exposed to a trichlorophenol process accident (p = 0.024 - 0.034).

 

An investigation of railway workers exposed to phenoxyacetic acid herbicides found an excess of stomach cancer deaths (odds ratio = 6.1; p< 0.05), for over 10 years latency from exposure.

 

Seveso, Italy 15 year mortality study shows stomach cancer incidence as high as RR = 1.3 and confidence interval (CI) .7-2.7.  (9)

 

American Journal of Epidemiology reports on Seveso, Italy (Dioxin, TCDD only) disaster 20-year study reports an increase in all cancers.  Stomach cancer was increased in the second decade.  In the 10–14-year period, digestive cancer mortality was elevated and stomach and liver cancer showed statistically significant increases.  (10)

 

It should be noted and recognized by the BVA the International Agency for Research on Cancer (IARC) classified the dioxin, TCDD a Group 1 human carcinogen based on the Ah receptor issues that occurs in both humans and animal studies. (11)

 

It should also be recognized by the BVA a study on dioxin, TCDD exposure response and risk assessment found dioxin TCDD might be the first all man-made cancer site human carcinogen.  Since there was little difference, found in “all cancer sites” versus “specific cancer sites.”  (12)

 

It should also be noted and recognized that doubling the background of the dioxin, TCDD increases the risk of cancer, any cancer, by 13% over life.  This risk analysis was only to five parts per trillion which would be the normalized population exposure levels. (12) 

 

In the Vietnam Veteran, this baseline would be significantly raised due to dioxin, TCDD exposures the Veteran was exposed with the Ranch Hand Rainbow Colors of Herbicides since these exposures was in “parts per million” not in parts per trillion.

 

The above referenced study, as most studies could not determine the response of the dioxin, TCDD as to linear, step linear, or logarithmic.  Therefore, the Veteran certainly cannot be mandated to produce some rational to the increase above the already found 13%. Certainly even in a linear response, the risk now becomes significantly higher because of his Rainbow Toxic Chemical exposures, presumptive or otherwise.

 

In a recently released study of genetic damage found in New Zealand Vietnam War Veterans the scientists also made references to the Seveso, Italy population study that found an excess of other digestive cancer induced deaths. (14)     

 

It is necessary both legally and logically with the state of the present scientific evidence that the Veterans adenocarcinoma of the stomach be found “associated to his toxic chemical wartime service in Vietnam” and that any resulting disabilities both physically and medically be also found associated to this service for the following reasons:

 

 

 

·         These symptoms were common symptoms in many returning Vietnam Veterans. 

 

 

 

 

Veteran has proven by logic and scientific evidence that his stomach cancer “is at least as likely as not” caused by his wartime service in a toxic chemicals (plural) environment in the Republic of Vietnam.

 

______________________________

 

Please see attached treating doctors statements that agree with the Veterans submitted rationale and new scientific and medical evidence.

 

Please see attached doctors own statements of fact.

 

 


REFERENCES:

 

(1) Department of Veterans Affairs Report “Classified Confidential Status 1, not for Publication and Release to the General Public.”  A report regarding adverse health affects from exposure to Agent Orange; Dated May 5 1990.

 

(2) See Recognition and Management of Pesticide Poisoning, 5th edition, U.S. EPA, Chapter 14.

 

 (3) Impact of Agent Orange Exposure among Korean Vietnam Veterans, published in Industrial Health 2003, 41, 149-157.

 

(4) Joseph Murray, MD PhD University of Iowa College of Medicine; Questions and Answers.

 

(5) Armijo R, Gonzales A, Orlellana M et al. Epidemiology of gastric cancer in Chile: II - nitrate exposures and stomach cancer frequency. Intl J Epidemiology 1981, 10, 57

 

(6) Re-Evaluation of Dioxin A Presentation by Dr. Linda Birnbaum, Director Environmental Toxicology Division U.S. Environmental Protection Agency (EPA) To the 102nd Meeting of the Great Lakes Water Quality Board, Chicago, Illinois July 15, 1993

 

(7) Department of Health and Human Services Food and Drug Administration National Center for Toxicological Research; Ranch Hand Advisory Committee Meeting, Rockville, MD January 21, 2004; Certified Verbatim Transcript.

 

(8) In the United Sates District Court for the Eastern District of New York case of Ivy versus – Diamond Shamrock Chemicals Company. Affidavit of Cate Jenkins, PH.D. 

 

(9) Short and Long Term Morbidity and Mortality in the Population Exposed to Dioxin after the Seveso Accident; published in Industrial Health 2003, 41 127 –138.

 

(10) Health Effects of Dioxin Exposures:  A 20 year mortality study published American Journal of Epidemiological Vol 153, No 11: 1031 –1044

 

(11) International Agency for Research on Cancer (IARC) (1997) Monographs on the evaluation of carcinogenic risks to humans, Vol 69, Polychlorinated dibenzo-para dioxins and polychlorinated dibenzofurans, IARC, Lyon.

 

(12) Dioxin: Exposure- Response Analysis and Risk Assessment published in Industrial Health 2003, 41; 175-180.

  

(13) Report of the Agent Orange Scientific Task Force of the American Legion, Vietnam Veterans of America, and the National Veterans Legal Services Project, reported by McAllister, "Viet Defoliant Linked to More Diseases, Washington Post, May 1, 1990 at AS, col. 4. The report also found that there are other disorders for which there is evidence suggesting an association with exposure to Agent Orange, but for which statistically significant evidence is not currently available. Those diseases include: leukemias, cancers of the kidney, testis, pancreas, stomach, prostate, colon hepatobiliary tract, and brain, psychosocial effects, immunological abnormalities, and gastrointestinal disorders.

 

(14) Genetic Damage in New Zealand Vietnam War Veterans, "participants report," Prepared by Louise Edwards; Institute of Molecular BioSciences, Massy University.