2/94th Battalion Update Number 11
Item to discuss
Cardiovascular Issue VA Submittals
Some have asked, after Update 8, what do we do in the spectrum of cardiovascular issues with regard to the VA, since I think it is obvious there is a connection by the evidence?
I cannot tell you what is the best thing to do. I know what I would do, and I have restated this at the reunions. If you think it is related - then submit for it. You have nothing to lose but some time. Do not get aggravated like I do, as you know going in they are denying it based on nothing but politics and money; and not science.
Just smile when the VA says we have the total power to say “no,” regardless of your evidence. The answer to that is simply yes, but the whole world knows you (the VA) are lying; you are just too stupid to know it! NO, NO, NO, do not do it that way! Ha Ha
I am to the point I would spit on the VA secretary and dare him to do something about it with all the pain and suffering they have let go on. Compensations is just one issue. This lack of letting the world know the real information and preventions that could have taken place, at some point in time, becomes criminal.
As you will see, even the Ranch Hand found these cardiovascular issues to a p = 0.009.
I have created a sample submittal below of what I would submit and the documentation I would use.
You certainly can use the some of the information and come up with a submittal of your own.
Now in my visit yesterday at the VA Glenda went with me for the first time. Even she was mad afterwards.
Now let me tell you what went on - off the record!
The caseworker wanted to know where we lived as she said it would be better if I got away from this Atlanta VA hospital and got one away from the Regional VA across the street.
She also suggested that I consult outside medical sources for opinions rather than rely on the Atlanta VA hospital doctors. Which is fine except most doctors do not want to get involved with the VA because the VA will use up their resources asking more and more questions to show the doctor, "do not mess with us."
Anyway as I said it was off the record and the worker said she would deny it ever happened.
I would suggest if you have a doctor that will stand up for you, then show him the evidence below and see if you can include his conclusions as an attachment also.
I did find something else in researching this for the fellows that wrote in. That was a discussion on neuropathy and diabetes that I had missed before.
The discussion was if this diabetes and neuropathy is related then why are we not seeing the kidney issues that would be common with this, as in the real world. Just another nail in the coffin of this myth the VA is associating all this nerve damage to diabetes. Even though a confirmed linear dose response was found specifically to neuropathy. This VA connection is very misleading and should be looked at with caution.
Especially since the Koreans found no statistical value as it related to commonality of both in their veterans. While individually it was overwhelming.
I did get some info from Greg and updated our 2006 reunion link. http://www.2ndbattalion94thartillery.com/Chas/Reunion2006.htm
For those of you that are trying to change your e-mail on the sign-in on the I Corps site under the 2/94th. I have no access to that. Please address e-mail changes to Will at email@example.com
Using the option afforded me under the VA rules of any veteran’s claim against the U.S. government; I am submitting my own documented and referenced named studies as evidence to contradict the obvious bias of the Veterans Administration and the Secretary of the VA.
Since our government has been less than forth coming in toxin caused diseases and disorders associated directly with coronary artery disease, ischemic heart disease, hypertension, and valvular heart issues, the following study information is submitted regarding these diseases and their association to either or all:
Military Service in the Republic of Vietnam.
Military Service in the Republic of Vietnam and constant exposures to three main toxic herbicides with the nomenclatures of Agents Orange, White, and Blue.
Military Service in the Republic of Vietnam and constant exposures to the herbicide with the nomenclature of Agent Orange (50/50 mixture of 2,4-D and 2,4,5-T).
These studies consist of direct information that relates to the “significant increase,” or “the increased risk of incidence” of the above disorders as it directly relates to Vietnam Veterans; and does not address the root cause or the morphology of the medical disorders. “Significant increase” or “increased risk of incidence” is all that is required for a positive claim including the congressional mandate that demands this federal agency give any veteran “the benefit of the doubt” when addressing toxin issues. This also was reiterated in the Dioxin Act of 1984 passed by the United States Congress.
These valid studies point out irrefutable evidence to a mathematical statistical p-value of <0.05. This value is used by the entire scientific world as proof for providing mathematical evidence that the issues are not subject to chance and are directly related to the study variant.
The Ranch Hand Report, which is being used as the world’s gold standard for dioxin damage is less than forthcoming and controlled by the Air Force, including changing medical conclusions that the evidence found.
The Ranch Hand scientific transcripts themselves point out the following as it relates to specifically dioxin and dioxin exposures.
Increased dioxin levels in Hematology. (Hematology, The study of the blood and blood-producing organs.) (1)
Relationship to triglyceride levels in the blood and dioxin level was found. (1)
· Chapter 14 - Cardiovascular. This chapter was reviewed by Drs. Trewyn and Tabacova, and was presented by Dr. Michalek. He reported that many findings “are negative” in this chapter. (2)
· Dr. Michalek told the committee that one strong association is the enlisted ground crew, which had the heaviest exposures, experienced significant increases in cardiovascular mortality. (2)
· Dr. Trewyn told the group that the cardiovascular assessment focuses inordinately on dioxin rather than herbicides. In addition, he said, there seemed to be a lot of jumping back and forth in the summary and the conclusion between what's significant and what's non-significant…. and did not help him understand the data that's in the chapter. (2)
· Dr. Trewyn asked why the data from the 1994 Air Force mortality update was not included; and thought that it would help, because one can then discuss the relevance of those numbers of the people who have died, and it would help round out the information in the chapter.
· Dr. Harrison inquired further about deaths from heart disease in the study group. Dr. Michalek stated that many of the cardiovascular deaths occurred before the study started. (2)
· Dr. Michalek … “It's only when you look in the subgroups by cause that you see the big increase, or the significant increase in heart disease deaths in the enlisted ground.” (2)
· Dr. Delongchamp theorized that at higher doses, people were getting heart disease and dying; and at lower doses, they were getting cancer. (2)
· Chapter 19 – Conclusions: Dr. Michalek presented a slide listing findings throughout the report: a significant number of Ranch Handers with increased dioxin; continued relation between body fat and dioxin and serum lipids and dioxin; and increased liver enzymes; platelets increased consistently across study cycles, including this one; consistent relations with diabetes, and a new finding in cardiovascular on the ECGs, evidence of prior heart attack, and a new finding in neurology of confirmed polyneuropathy. (2)
· Dr. Harrison inquired further about deaths from heart disease in the study group. Dr. Michalek stated that many of the cardiovascular deaths occurred before the study started. (2)
· Dr. Delongchamp said that the way the report has analyzed its data is with methods that look at prevalence, and they don't really deal with competing risks very well or anything like this, which is what this whole mortality issue raises. He said that if you wanted to evaluate neoplasia and cardiovascular disease, you would want to look at deaths, and that data is not in the report. (2)
Demographic data (3)
Increased risk of death from cardiovascular disease among enlisted ground crew (first noted in 1991).
III. Study observations to date – Air Force Report (Dr. Joel Michalek) (3)
A significant adverse relation between reported health and dioxin body burden, and an increased risk of reporting fair-to-poor health in the high dioxin-exposed category.
An overall 25 percent increase in cardiovascular disease in the Ranch Hand group. (3)
Dr. Michalek … And here you see one of the reasons why we have an increased risk--borderline significant increase in all-cause mortality, is being driven by circulatory deaths in the Ranch Hand cohort; relative risk 1.3, also borderline significant. Moreover, there's a reason for that, which you'll see in subsequent slides. (4)
· In addition, on asterisk on the 66 means that in the previous publication we have 39 deaths from circulatory diseases, whereas now we have 66 in the Ranch Hand cohort. (4)
· DR. STILLS: Joel, what sort of circulatory diseases do you mean here? (4)
· DR. MICHALEK: Primarily heart disease. In addition, I have another slide breaking that out by specific type of heart disease. (4)
· DR. HARRISON: Joel, in your discussion of this, do you relate that at all to the increased risk of diabetes? (4)
· DR. MICHALEK: We don't have diabetes as a cause of death on death certificates. (4)
· DR. HARRISON: Diabetes doesn't cause death. Diabetes causes circulatory disease. (4)
· DR. MICHALEK: … And now we start to see what's really driving this increased mortality in the Ranch Hand cohort. It's coming from the enlisted ground crew. In addition, you'll see soon that what's happening in the enlisted ground crew is that those--the overall mortality in that cohort is being driven by circulatory-disease deaths. (4)
· However, we do have also a significant increase--although small numbers--in Ranch Hand administrative officers. There are Ranch Hand officers who did not fly airplanes but--and certainly did not handle herbicides, but are experiencing increased mortality. (4)
· However, when we look at circulatory disease mortality, now we see the reasons for these increases are driven by 40 enlisted ground individuals who have died of diseases of the circulatory system; 6.8 percent, against 3.7 percent enlisted group comparisons, which is a relative risk of 1.7, and that “reaches a significance.” (4)
· In our previous article, we had 24 enlisted ground that had died from diseases of the circulatory system, and expected 16, a relative risk of 1.5. Therefore, what's happened is that the “result becomes stronger” since we published our last paper. (4)
· Among those enlisted ground personnel who died from disease of the circulatory system, the majority of those deaths were cause by “atherosclerotic heart disease.” There you see 28 of the 40 were caused by “atherosclerotic heart disease” among Ranch Hand, or 4.8 percent versus 2.6 percent in the comparison cohort; p-value of 009. (4)
(See Attachment 1 for medical definitions of “atherosclerotic heart disease.”)
· DR. MICHALEK: …and the bottom line is what you just heard: that there's a “significant increase in risk of death from circulatory diseases” among enlisted Ranch Hand ground crew. (4)
· The first reviewer was concerned that these results are already published, and why are we trying to publish this again? Well, the results are worse; I mean, they're adverse. They're getting worse than they were two years ago! (4)
· The second part of that is that the protocol prescribes a series of mortality analyses coming out of the study. In previous years, we would write an Air Force Technical report summarizing mortality, and that would get a blue cover and put on our shelf. It doesn't receive as much attention as a published article does. It's not peer reviewed. (4)
· DR. MICHALEK: We have--syndrome X involves heart disease, hypertension, and diabetes. (4)
· DR. MICHALEK: …40 percent of the cohort has a diagnosed history of hypertension.
· DR. MICHALEK: And so after you adjust for age, you see a significant increase in the risk of hypertension in the highest quintile of skin exposure in the Ranch Hand enlisted, which is consistent with the idea that there really is a relation between dioxin exposure, or herbicide exposure, and hypertension. (4)
These transcripts obviously show a found relationship to ischemic heart disease as well as cardiovascular issues as it relates to only skin exposures of dioxin Defined by these scientists as “atherosclerotic heart disease.” (See Attachment 1)
Unfortunately, for the veterans of the nation, their doctors, and other doctors researching this issue, as it will become obvious in the Korean report, this information has not been forthcoming to anyone.
In addition to the obvious lack of information and indeed, “information void created,” Dr Albanese testified before congress in 2000 that for 20 years this study has never reported the truth to veterans concerning heart disease, vascular disease, neurological ailments, endocrine disturbances, and hematological difficulties. (5)
Dr. Albanese was one of the original principal investigators in the United States Air Force health study, the Ranch Hand study. Is one of the authors of the original protocols that seem to have become moving targets along with using “command influence” to change data found related to Veterans and toxin exposures. (5)
The following referenced Korean Agent Orange impact study (6) released in 2003 verifies the found and “unreported” ischemic heart, vascular, and hypertension issues found the Ranch Hand study.
This Korean study did not use MOS to down select and limit only those veterans exposed by one form of exposures. It is the only study that comes close to documenting what the men in the field developed from exposure to dioxin, or military service in the Republic of Vietnam.
This study was a total blind study, had quality assurance provisions, adjusted for confounders, and the statistics were done outside the study personal, unlike our own government studies.
From that study: (6)
“Abstract: In order to determine whether Agent Orange exposure was associated with increased frequency of medical problems we conducted a cross-sectional epidemiologic study of Korean Veterans during 1995 - 1996. Exposure to Agent Orange was assessed by structural in-depth interview on the participants' history of service in Vietnam. Health outcomes were assessed by a standardized comprehensive clinical investigation by a group of clinical specialists. The differences in the prevalence of various medical diagnoses were assessed by Cochran-Mantel-Haenszel chi-square tests comparing the exposure levels of Vietnam veterans, adjusting for age. Multiple logistic regression was performed to estimate the effect of "service in Vietnam" adjusting for age, smoking, alcohol, body mass index, education, and marital status.
“Vietnam veterans had an increased frequency of eczema (odds ratio [OR] = 6.54), radiculopathy (OR= 3.98), diabetes (OR = 2.69), peripheral neuropathy (OR= 2.39), and hypertension (OR = 2.29), compared to non-Vietnam veterans adjusting for potential confounders.
“In addition, higher levels of exposure among Vietnam veterans were associated with increased frequency of ischemic heart disease (p = <0.01), valvular heart disease (p<0.01), and retinopathy (p = <0.01). We concluded that exposure to Agent Orange is associated with various health impacts in Korean Vietnam veterans.”
The study indicates for “p-values of difference” between Vietnam Veterans and non-Vietnam Veterans for cardiovascular medical issues the following:
Hypertension - p = 0.0143
Vasculopathy – p = 0.0002 (See Attachment 2)
Vascular Necrosis – p = 0.1270
*Peripheral Vasculopathy – p = 0.0628 (See Attachment 2)
Ischemic Heart Disease – p = 0.0045
Valvular Heart Disease – p = 0.0019
*Includes Berger’s disease, Raynaud’s syndrome, and other vasculopathy.
In addition to the found p-values, the stated conclusions of the study was as follows:
“We observed excess frequencies of several medical problems such as diabetes mellitus, eczema, hypertension, peripheral neuropathy, and radiculopathy, among Vietnam veterans. The increased frequencies of these frequencies remained significant even after adjusting for age, smoking, alcohol, body mass index, education, and marital status.
“Also increased were vasculopathy and brain infarction.
“In addition, ischemic heart disease, valvular heart disease, and retinopathy were "significantly associated with levels of exposure to Agent Orange," among Vietnam Veterans.
“These findings coherently suggest that Vietnam Veterans have a higher frequency of vasculopathy in association with Agent Orange exposure.”
The Korean doctors did not understand, why the Ranch Hand report did not find these issues of cardiovascular involvement. Clearly, in the previous section covered above in this Ranch Hand study, these issues were indeed found and then not reported.
Clearly, a found p-value of 0.009 to “atherosclerotic heart disease” was found in the Ranch hand report and should have been reported to the world. Instead, it was “not reported” for politics and money in lieu of scientific truth.
In addition to these above cited studies, the Australians (13 years ago) found at least a 200% increase in ischemic heart disease when comparing their Vietnam Veterans to the normal population of Australia.
Clearly, these studies show a direct connection to my medical issues resulting from either
Military Service in the Republic of Vietnam and/or; Military Service in the Republic of Vietnam and constant exposures to three main toxic herbicides with the nomenclatures of Agents Orange, White, and Blue and/or; Military Service in the Republic of Vietnam and constant exposures to the herbicide with the nomenclature of Agent Orange (50/50 mixture of 2,4-D and 2,4,5-T).
It is requested based on the above information and conclusions that you find my medical issues and disabilities “service connected,” and that I be awarded compensations commensurate with the disabilities I now have and can demonstrate.
(1) RANCH HAND ADVISORY COMMITTEE MEETING
October 26-27, 1998
Holiday Inn Riverwalk, Tarantella Room #4
San Antonio, Texas
(2) MINUTES RANCH HAND ADVISORY COMMITTEE MEETING
October 14-15, 1999
Parklawn Building, Conference Room K
(3) RANCH HAND ADVISORY COMMITTEE MEETING
October 19-20, 2000
Hilton Palacio Del Rio
San Antonio, Texas
(4) SSDEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION
CENTER FOR TOXICOLOGICAL RESEARCH
RANCH HAND ADVISORY COMMITTEE
Thursday, March 13, 2003
San Diego Marriot La Jolla
4240 La Jolla Village Drive
La Jolla, California
(5) Congressional Oversight Committee transcripts - review of the Ranch Hand report March 2000.
(6) Impact of Agent Orange Exposure among Korean Vietnam Veterans; accepted May 28, 2003.
General Description of Coronary Artery Disease and Names
Attachment 1 –Coronary heart disease (CHD), also called coronary artery disease (CAD) and "atherosclerotic heart disease," is the end-result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). While the symptoms and signs of coronary heart disease are noted in the advanced state of disease, most individuals with coronary heart disease would have evidence of disease decades before the first symptoms arise.
After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. Current views are that an inflammatory process of the lining of the arteries, though poorly understood in specifics, promotes the disease progression.
“Atherosclerotic heart disease” can be thought of as a “wide spectrum of disease of the heart.” At one end of the spectrum is the asymptomatic individual with atheromatous streaks within the walls of the coronary arteries (the arteries of the heart). These streaks represent the early stage of atherosclerotic heart disease and do not obstruct the flow of blood. A coronary angiogram performed during this stage of disease may not show any evidence of coronary artery disease, because the lumen of the coronary artery has not decreased in caliber.
Over a period of many years, these streaks increase in thickness. While the atheromatous plaques initially expand into the walls of the arteries, eventually they will expand into the lumen of the vessel. As the plaques expand into the lumen of the vessel, they can affect the flow of blood through the arteries. While it was originally believed that the growth of atheromatous plaques was a slow, gradual process, some recent evidence suggests that the gradual buildup of plaque may be complemented by small plaque ruptures which cause the sudden increase in the plaque burden due to accumulation of thrombus material.
Atheromatous plaques that cause obstruction of less than 70 percent of the diameter of the vessel rarely cause symptoms of obstructive coronary artery disease. As the plaques grow in thickness and obstruct more than 70 percent of the diameter of the vessel, the individual develops symptoms of obstructive coronary artery disease. At this stage of the disease process, the patient can be said to have ischemic heart disease.
The symptoms of ischemic heart disease are often first noted during times of increased workload of the heart. For instance, the first symptoms include exertional angina or decreased exercise tolerance.
As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary heart disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.
A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of oxygen supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.
It is interesting to note that an individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary heart disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack). It is unclear at present which plaques in an individual are more likely to rupture in the future and cause a heart attack.
General description of Vasculopathy and Peripheral Vasculopathy
Vasculopathy (problems with the blood vessels)
Hyalinization - (a substance formed on the vessel walls, that occurs when the vessel is degenerating)
Perivascular inflammation - (inflammation around the blood vessels)
Endothelial proliferation - (a thickening of the walls of the vessels)
Thrombosis - (clotting)
Vasculitis - (inflammation of the blood vessels)
Peripheral vascular disease is characterized by progressive atherosclerotic deterioration of peripheral arteries and coronary and "cerebral vascular" complications.