Challenge to the Secretary of VETERANS AFFAIRS, CONGRESSIONAL leaders, the CONGRESSIONAL leaders on the senate and

house veterans affairs committees,

and BVA on toxic chemical associations to

PERSISTENT PERIPHERAL NEUROPATHY

in our VIETNAM Veterans 

 

Draft in work 16 July 2006

 

To: Senators, Congresspersons, Government decision makers, and Congressional Staff Members

 

Mr. Jeff Phillips

Communications Director

House Veterans Affairs Committee

U.S. House of Representatives

335 Cannon House Office Building

Washington, DC  20515

 

Mr. Jeff Schade

Communications Director

Senate Veterans Affairs Committee

412 Russell
Senate Office Building
Washington D.C. 20510

 

Mr. Len Sistek

U.S. House of Representatives

Committee on Veterans Affairs

Oversight and Investigations

Room 333

Cannon House Office Building

Washington, DC  20515

 

Mr. Chris McNamee

U.S. House of Representatives

Committee on Veterans Affairs

Professional Staff Member

Subcommittee on Disability Assistance

337 Cannon HOB

Washington, DC 20515

 

Mr. William McLemore

Deputy Assistant Secretary

Intergovernmental and International Affairs

Department of Veterans Affairs

810 Vermont Avenue N.W. Suite 915

Washington, DC 20420

 

Mr. Jim Nicholson

Secretary - Department of Veterans Affairs

810 Vermont Avenue, NW, Room 1000
Washington, D.C. 20420

 

Mr. David Abbot

Staff Member

Compensation & Pension Service

VA Central Office

810 Vermont Avenue,

Washington, D.C. 20420

 

Ms. Renee L. Szybala

Director

Compensation & Pension Service

VA Central Office

810 Vermont Avenue,

Washington, D.C. 20420

 

Ms. Michelle Catlin, PhD

National Academy of Sciences
500 Fifth Street, NW

Washington, DC 20001

 

FROM:

Please respond to: 

Charles Kelley

2078 Eastwood Drive,

Snellville, GA 30078

SP5Kelley2nd94th@aol.com

Cell: 404-641-6477

 

Subject:  Denial of the United States Government on the Associations to Peripheral Neuropathy (PN) from exposures to such toxic chemicals known to cause while in Military Service in the Republic of South Vietnam. 

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)”}

 

 

Contents

Veteran’s Statements

OVERVIEW

History

The government slippery slope

EVIDENCE

summary

conclusions 

 

Veteran’s Statements:

 

  1. The Veteran shall establish SCIENTIFIC, statistical, and MEDICAL evidence showing that his/her diagnosed condition of “chronic and persistent polyneuropathy” is “at least as likely as not” medically associated with dioxin, TCDD exposures and/or the other toxic chemicals involved that may have caused the conditions that “at least as likely as NOT” created his/her “chronic and persistent polyneuropathy.”

 

  1. The Veteran shall establish a well-grounded claim by submitting competent medical evidence showing that the currently diagnosed “chronic and persistent polyneuropathy” is related to not only Agent Orange Herbicide exposure but many of the other toxic chemicals he was exposed; see Brock v. Brown, 10 Vet.  App. 155 (1997), and that he was exposed to Agent Orange and the other toxic chemicals.  See McCartt v. West, 12 Vet.  App. 164 (1999).

 

  1. The Veteran shall establish that “it is as least as likely as not” his “chronic and persistent polyneuropathy” diagnosis is well connected to his Wartime Service in Vietnam and presumptive and/or known exposures to the toxic chemicals (plural) in the herbicides Agent Orange or Agent White or Agent Blue and/or a combination of all three or any of the other known toxic chemicals that were used during the Vietnam War by the UNITED STATES GOVERNMENT.

 

  1. Veteran shall establish the Department of Veterans Affairs along with the government contracted NAS/IOM’s statements and findings that only “transient acute and subacute peripheral neuropathy” is associated to wartime service in a toxic chemical environment is erroneous and based on early faulty scientific conclusions and assumptions.

 

  1. Veteran shall establish that “a dioxin” is never is found alone and therefore government studies used as “gold standards” that mandated for sampling of a single dioxin isomer of is little value when considering the possible outcomes in medical causations the Veteran may suffer disability or death from mixed dioxin compound isomers or dioxin like isomers in the form of furans and/or polychlorinated biphenyls (PCB’s).

 

  1. Veteran shall establish that because of this government mandate, many disorders found as significant and associated to exposures are not being brought forward giving the Veteran a fair assessment of his health as a result of the government wrong doing and mistakes.    

 

Isomer Definition: A chemical species with the same number and types of atoms as another chemical species, but possessing different properties.

 

OVERVIEW:

 

The Veterans claim was denied by the DEPARTMENT OF VETERANS AFFAIRS 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. 

 

Veteran further states the evidence and facts that will be demonstrated and documented qualifies this disorder for inclusion for automatically associated presumptive disorders.

 

The Board and the Secretary of the Department of Veterans Affairs is “inconsistent” in statements of fact of the requirements for the Veteran to prove his service connection including that many studies have shown association of neuropathies that meet the VA’s own requirements of such studies.  (See 38 C.F.R 1.17  “Evaluation of studies relating to health effects of dioxin and radiation exposures.”)

 

The VA/board mandates positive association on exposures to “herbicides" plural).  Then mandates the Veteran prove “dioxin” (singular) associations.

 

Veteran disagrees with the VA and/or 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) and are rarely found alone, if at all, with just a single dioxin isomer.

 

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).

 

Veteran is in disagreement with the present acute and subacute transient peripheral neuropathy conclusions by the Department of Veterans Affairs as well as the NAS/IOM contracted by the same government agency the Veteran is now seeking disability compensation from on the issue of Peripheral Neuropathy.

 

Present Department of Veterans Affairs and government contracted Institute of Medicine (IOM) position on Peripheral Neuropathy is government biased and scientifically flawed.

 

History: 

 

It is imperative that those Congresspersons/Senators/Government decision makers know and understand the history of this nerve disorder, its associations to toxic chemicals, and the wide variety of opinions and biases against the nations Veterans when VA using the power it has in 38 C.F.R paragraph 1.17.  This 38 C.F.R. allows the Secretary to provide “guidelines for establishment of service connection” then minimize the effects and costs of this disorder and make many baseless, presumptuous, and erroneous decisions.

 

On May 23, 1991, the Veterans' Advisory Committee on Environmental Hazards (VACEH) considered the relationship between exposure to dioxin and the development of this condition.  The Committee concluded that there is a "significant statistical association" between “peripheral neuropathy” and exposure to dioxin.  The Committee qualified this opinion, stating that the association could be said to exist in the absence of exposure to chemical substances known to cause this disorder.  Committee members indicated that other risk factors that must be considered are age and whether the individual suffers from other known causes of peripheral neuropathy such as diabetes, alcoholism, or Guillain-Barre syndrome.  The Committee also advised that the disorder must become manifest within “ten years” of the last known dioxin exposure.

 

Taking the VACEH’s last statement first, which is again “erroneous” scientifically and in statements of fact.

 

Ironically in 1991, this committee stated a number of exclusionary disorders such as diabetes, alcoholism, or Guillain-Barr syndrome.  We now have diabetes associated to the exposures as an automatic inclusive government compensated disability disorder.  The state of the scientific evidence (See Evidence Section Immune system) now has concluded that it is at least as likely as not the Guillain-Barr syndrome or similar immune system damages should also be included as a form of peripheral nervous system damages as an autoimmune disorder.

 

Guillain-Barr syndrome - Guillain-Barre syndrome may be an autoimmune disorder in which the body produces antibodies that damage the myelin sheath that surrounds peripheral nerves.  The myelin sheath is a fatty substance that surrounds axons

 

It is impossible to know when the last dioxin exposures occurred in the Vietnam Veteran no matter where he/she resided after the war.  It is well known that most of the world’s population including the United States is exposed to some level of dioxins and/or dioxin like isomers.  Especially industrialized nations that continue to pollute the environment.

 

The questions have always been; what types of harm do these ingestions cause, what form of ingestions are at risk, what rate of ingestions are at risk, or what cumulative body threshold over time is required to cause some form of damage to organs and/or body operating systems.

 

The Environmental Protection Agency (EPA) in its reassessments of dioxins clearly stated that dioxin ingestions must be thought of as “cumulative lead ingestions.”  Having many subclinical long-term effects before the damage is discovered or manifestations began.

 

Therefore, the government/VA stance on any “time limit” to manifestations of any disorder is totally without merit or scientific precedence regarding an unknown toxic chemical or a group of unknown toxic chemicals that can have a cumulative effect not only in body accumulation but damages that occur because of constant duration of exposures.

 

Congresspersons/Senators/Government decision makers must know or become aware that these dioxins and dioxin like furans remain in the body attached to more lipid cells (fat) and only degrade in toxicity at a rate of seven to ten years of half-life.  It should also be noted that our central nervous system cells are about 70% - 80% lipids (fat) and the rest is protein.   

 

In dioxins reassessment reports, EPA identified 18 major U.S. Dioxin Sources.  It might be well for the Congresspersons/Senators/Government decision makers to make note that one of the identified sources of major dioxin contamination was the toxic chemical 2,4, -D.  Those that are familiar with the Vietnam Veterans Toxic Chemical Legacy may recall that 2,4-D was not only used as a separate herbicide with the nomenclature Agent White but also used as a 50/50 mixture within the herbicide with the nomenclature Agent Orange.

 

Clearly pointing out that the most widely used dioxins containing herbicide chemical was Agent White and not Agent Orange.  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), used from 1965 to 1971.

 

The toxic chemical 2,4-D is also noted for attachment to more lipid cells as a repository.

 

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 is a conveniently Dow proprietary chemical formula that contained not only nitrosamines but also a form of benzene toxic chemical known as hexachlorobenzene.  Which would almost guarantee this formula would have other dioxins and dioxin like isomers.

 

For example:

 

Any of the hexachlorodibenzofuran isomers

Any of the hexachlorodibenzo-p-dioxin isomers

Any of the tetrachlorodibenzofuran isomers

Any of the tetrachlorodibenzofuran –p-dioxin

Any of the pentachlorodibenzofuran isomers

Any of the pentachlorodibenzo – p-dioxin isomers

 

It should be noted here, as you have seen on TV the lawyer commercials, the benzene family of toxic chemicals are also noted for causing blood disorders, including leukemia’s.

 

One can readily see that the government mandated to a “cause and effect” of the one dioxin isomer, TCDD to one medical disorder or a group of medical disorders from mixed dioxin compound isomers or dioxin like isomers in the form of furans and/or polychlorinated biphenyls (PCB’s) is outside the realm and ability of science as we know it at this present time and has mandated “undue hardship on the Veterans of this nation” that served in the government created toxic chemicals (plural) environment.

 

VA and U.S. Government, studies have solely concentrated on the worst dioxin that being 2, 3, 7, 8-tetrachlorodibenzo-p- Dioxin found in 2, 4, 5-T or Agent Orange.  Clearly, there are other dioxins, xanthones, and closely related dioxin like furan isomers that have never been looked at, identified, nor even a VA/government concern for over 40 years.

 

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

 

Acute exposure may lead to:

 

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.”

 

While not in the dioxins family Agent Blue cacodylic acid (dimethyl arsenic acid) certainly has toxic chemical properties according to our own US EPA.  (XX)

 

In 1969 when the US State Department got involved in analyzing and minimizing the effects that were being seen in our Vietnam Veterans.  The US State Department clearly indicated in a report by ______ that Agent Orange was of very little concern.  However, Agent Blue with its arsenic acid base “was a real concern.”

 

These toxic chemical effects and possible outcomes cannot be just government ignored because Agent Blue was not as widely used as Agent White or Agent Orange.    

        

Congresspersons/Senators/Government decision makers must recognize this clear difference between Vietnam Veterans and other increased risks of working with these isomers, and the normal genotype population.  The Vietnam Veteran in general is not going to meet the normal genotype population in background exposure levels.  Not only in dioxin isomers but also exposures to other toxic chemicals at the exact same time.

 

A study published in Industrial Health on Dioxin; Exposure-Response Analysis and Risk Assessment the following statements were made.  (X)

 

Abstract:

 

…In 1997, dioxin was found to be a human carcinogen by the International Agency for Research on Cancer (IARC), based on four other studies of industrial workers exposed to high levels.  Recently there has been interest in estimating human cancer risk at “low-level environmental exposures.”  Here we review quantitative exposure – response analysis and risk assessment for low level environmental levels…  In the US the background risk of cancer death by 75 is 12%, so doubling the background levels of dioxin exposure risk to somewhere between 12.1 and 13.0%.  Our results agree broadly with results from a German cohort, which is the only other cohort for which a quantitative risk assessment has been conducted.

 

This study also found that “all cancer sites” were elevated not just the ones the government/VA has reluctantly stated are associated.  Additional statements were made that dioxins may be the first manmade “all site” cancer-producing carcinogen.  In addition, those cohort individuals that were exposed to pentachlorophenol (PCP) were excluded from this study.

 

Pentachlorophenol is also a major product of the metabolism of hexachlorobenzene in mammals.

 

Chronic toxicity: Much research on PCP has been performed with poorly characterized technical material, and the chronic toxicity observed may depend in large measure on the proportion of chlorodibenzo-p-dioxins present in the mixture [69].  In a 90-day feeding trial in rats, 30 mg/kg/day produced depressed red blood cell and hemoglobin levels as well as liver degeneration, and even lower doses resulted in irregular blood chemistry and enzyme levels, along with increased liver and kidney weights [69,71].  Pure PCP, and technical PCP without dioxin contamination, produced only slight enlargement of livers and kidneys [69].  Purified PCP also did not produce toxic effects such as liver damage and immune system alterations, which had previously been reported for the technical product [69,71].  In humans, the most common exposure to PCP is inhalation in the workplace.  Abdominal pain, nausea, fever, and respiratory irritation, as well as eye, skin, and throat irritation, may result from such exposure [70], while very high levels may cause obstruction of the circulatory system in the lungs and cause heart failure [70].  Survivors of toxic exposures may suffer permanent visual and central nervous system damage [70].  Persons regularly exposed to PCP tend to tolerate higher levels of PCP vapors than persons having little contact with these vapors [70,71].

 

While cancer is not the subject of the Veterans denial, cancer risk does play a part in the rebuttal of denial.  It is clinically impossible to have a cancer causing toxicant that can only produce cancer and not autoimmune derivates of a cancer.  This will be shown in the dysregulation of B and T cells in the immune system found associated and the variances found in the cytokines of the immune system.  (See Evidence Section)  Many subclinical autoimmune disorders are associated with peripheral neuropathies.

 

Veteran will also demonstrate the association to many such immune disorders that will cause many forms of neuropathy.  Including Veterans evidence will show that EPA and NAS now agree – “The NAS committee agreed with EPA's conclusion that dioxins are probably toxic to the human immune system,….”

 

This study also found that while smoking and asbestos cause cancer at many sites “but not all.”  The fact that the Ah receptor occurs in all parts of the body may be the reason for TCDD not being limited to only a few cancer sites but “all cancer sites.”  In addition, SMR for all cancers = 1.46; digestive system cancers = 1.41 (which are still denied by the government/VA); respiratory cancers = 1.67.  Not a lot of variance; yet, Veterans are still denied at present.

 

This study also took the minimum TEQ of 10 not 20, which would have been worst case.

 

Congresspersons/Senators/Government decision makers must learn from this study that when graphed as to which fit the parts per trillion in years scenario.  The logarithmic and piece-wise linear graph fit the analysis.  This is the important part for those not familiar; a threshold model did not fit the analysis suggesting there was “no threshold of exposure level below, which there were no (zero) cancer risks.”

 

Once again, this study as in the Ranch Hand study was mainly for those exposed by dermal exposures, which is the most benign of all the exposures.  Skin does not absorb the toxicants very well; yet, the lungs and gastrointestinal system readily absorb dioxins.  In other words, this study as well as the Ranch Hand study would be the best-case analysis not the worst-case analysis. 

 

The Environmental Protection Agency (EPA) as recently as 2005 stated general exposure levels in its dioxin reassessments, which began in 1992.  While the mid-90’s levels of exposures is about half of what it was in the 1980’s it is still at 25 parts per trillion Toxic Equivalent (TEQ) lipid.  The Vietnam Veteran was at his/her most vulnerable for additional cumulative damages in the 1980’s at approximately 55 parts per trillion Toxic Equivalent (TEQ) lipids.  So even on long-term damages, there can be no time limit from initial massive multiple toxic chemical exposures resulting from the Veterans wartime service in the parts per trillion range or the parts per million ranges.  Chronic exposures resulting in constant/continuous exposures must be considered; not some “initial estimated dose” of one toxic chemical isomer of many toxic chemical isomers involved experienced during only the time spent in Vietnam. 

 

Vietnam Veterans are outside this generic qualification of background exposures.  As anyone can see it might be the additional 20 or 30 years of dioxins accumulation that is the causation dose or reaches the cumulative body threshold.  However, if not for Service in Vietnam in a toxic chemicals (plural) environment that increased his or her increased baseline at an early age then the mortality and disability manifestations caused by the dioxin, TCDD may not have taken place or had any effect on early mortality or early disability the Veteran now develops.      

 

It was known that Peripheral Neuropathies and Chronic Fatigue Syndrome (the old medical term of Neurasthenic syndrome) were associated to toxic chemical pesticide and herbicide exposures as far back as the late 1940’s.  (See Evidence Section)

 

Neurasthenic syndrome - Some medical historians consider neurasthenia to be the diagnostic predecessor of Chronic Fatigue Syndrome.  Chronic Fatigue Syndrome (CFS) – Is just what the name implies.  A few good days of rest and you still do not recover.  No energy, listless, weakness, waking up and felling fatigued, or shortly after doing any work extreme fatigue.  May show up in the afternoon with almost feeling like you have flu symptoms with a low-grade fever type of fatigue.  At first, some scientists thought this was caused by a nervous disorder therefore the former name neurasthenic syndrome.  Then it was found that the Epstein-Barr virus (EBV) was associated.  High levels of EBV antibodies (disease-fighting proteins) were found in those patients suffering from CFS.  Later diagnosis of CFS of some patients without this high level of disease-fighting proteins indicated there were other causes.  Other causes may be iron-poor blood (anemia), low blood sugar (hypoglycemia), environmental allergy, a body wide yeast infection (candidiasis).  I have seen some theories that those individuals with neuropathy and that type of condition, that CFS is caused by the damaged nerve endings.

 

Today, CFS also is known as myalgic encephalomyelitis, post viral fatigue syndrome, and chronic fatigue and immune dysfunction syndrome.)  Chronic fatigue and immune dysfunction syndrome pointing out this CFS, once again could be attributed to an autoimmune systemic issue caused by toxicant damages the Veterans were and are experiencing.  Immune system dysfunction that can lead to both disorders has clearly been found in dioxin studies.

 

In addition, recently a new medical finding located in dorsal root ganglionitis (inflammation in the spinal cord) - recently discovered in a two-week autopsy, with the cause of death listed as Chronic Fatigue Syndrome.  This becomes a “clear physical manifestation” of the disorder in the Central Nervous System.

 

This new finding seems to confirm what many scientists have been saying for decades now regarding toxic chemical Peripheral Nervous System (PNS) issues and that is before any PNS issues manifest a Central Nervous System (CNS) subclinical event/causation has taken place and precedes any PNS manifestations.

 

While there seems to be, a running battle between psychiatrists and medical doctors as to the cause of this disorder.  It seems there is a biological issue associated to our toxic chemical exposures in our damaged immune systems that create this nerve damage or inflammation as well as the chronic fatigue issues found in 1984 by our own governments studies of those that sprayed the toxic chemicals.

 

The “Government Bias” has always been that toxic chemical etiolgy must be found directly to an antigenic response by the body to the toxicant that caused the peripheral neuropathy.  This is also a flawed assumption.  Flawed by the assumptions that exposure to multiple toxic chemicals event would force the body to a direct response to the dioxin, TCDD, or any other toxicant.  With a half-life in the body of a decade or longer thereby demanding the exposures to the various toxic chemicals must be considered as simultaneous or parallel multiple exposures as opposed to a serial single toxicant exposure. This clearly demonstrates that any time limit put on a Veteran for diagnoses is a false conclusion by the government/VA in any disorder. 

 

Dioxin exposures create many systemic body damages such as in the immune system that will not meet some mandated International Classification of Diseases (ICD) but rather an undefined toxic chemicals (plural) syndrome of organ and/or body system damages in neurological, endocrine, hematological, immunological, gastrological, cardiovascular, urology, or any combination of each.  Each one separately can be the cause of chronic and persistent neuropathies of many types and varieties and even combination of different neuropathies (autonomic, sensory, motor).

 

The Veterans' Advisory Committee on Environmental Hazards did not qualify the association to “acute or subacute transient peripheral neuropathy” but clearly stated "significant statistical association" between peripheral neuropathy and exposure to dioxin did exist as early as 1991 clearly meeting the requirements in 38 C.F.R. 1.17.

 

While the Veterans' Advisory Committee on Environmental Hazards did put a time limit of 10 years on the manifestation of the nerve damages, it did not indicate any time of resolution of the disorder.  Primarily because of the conditions in which the nerve damage is being caused by is more than likely not going to be curable such as in autoimmune peripheral neuropathy or even some of the smoldering cancer conditions or undiagnosed toxic chemical caused cancers.  Thus, this also eliminated the slow progression of the real disorders and long-term development from being compensated or service connected.

 

This particular disorder has an even more obvious government/VA bias and undue hardship on the Veteran in that our government put a time limit on not only the manifestation but also the damage to the nerve myelin matter would repair itself within two years after removal from the toxic chemicals or resolve itself.

 

While that may be true for the Department of Defense testing program on Vietnam Veterans in the use of Dapsone for the harsh type of malaria that was found in Vietnam.  It is not true of dioxin associated Peripheral Neuropathies.  Dapsone is noted for causing peripheral neuropathy and hematological disorders directly as in a direct antigenic response to the chemicals in Dapsone (a leprosy treatment medication).  This is especially true in hematological issues, which is the most common adverse effect and is seen in patients with or without G6PD deficiency.  {Glucose 6-phosphate dehydrogenase (G6PD) deficiency is an enzyme deficiency of the red blood cells.  G6PD deficiency leads to an abnormal rupture (breakage) of the red blood cells called hemolytic anemia (abnormally low red blood cell count)}.  Almost all patients demonstrate the inter-related changes of a loss of 1-2 g of hemoglobin, an increase in the reticulocytes (2-12%), a shortened red cell life span and a rise in methemoglobin.  G6PD deficient patients have greater responses.

 

Once a medical diagnosis is reached that, the patient is having these difficulties with red blood cells or Peripheral Neuropathy and muscle weakness the recommend medical treatment is to remove the patient from the Dapsone.  Normally Recovery on withdrawal is “usually substantially complete.”  The mechanism of recovery is reported by axonal regeneration.

 

In addition to the warnings and adverse effects reported above, additional adverse reactions include: nausea, vomiting, abdominal pains, pancreatitis, vertigo, blurred vision, tinnitus, insomnia, fever, headache, psychosis, photo toxicity, pulmonary eosinophilia, tachycardia, albuminuria, the nephrotic syndrome, hypoalbuminemia without proteinuria, renal papillary necrosis, male infertility, drug-induced Lupus erythematosus, and an infectious mononucleosis-like syndrome.  In general, with the exception of the complications of severe anoxia from over dosage (retinal and optic nerve damage, etc.) these adverse reactions have regressed off drug.

 

This is an example of how the one year or ten year rule would fit the diagnosed VA scenario and even the scenario that in most cases the medical issues caused by the direct taking of the Dapsone (a direct antigenic response) should resolve in most patients, once removed. 

 

This scenario does not fit the secondary Ah receptor toxic chemical damages done by the dioxin, TCDD or many toxicants of similar dioxin like isomer properties the Veteran was exposed.

 

Our own Environmental Protection Agency has clearly stated as well as other studies that dioxins in and by themselves do not cause an antigenic body response such as a poisonous plant, spider, snake, or even some types of tick bite.  Once again, the taking of Dapsone may produce an antigenic response.  In these examples once the toxicant is eliminated by the body, which varies in time and methodology the body damage is then over, and the body as you have read will repair itself to some level.

 

Common and medical scientific sense mandates that there can be no antigenic response for the dioxins since the dioxins are in the body 40 years after the exposures.  This would also mandate that since there is no antigenic response there could be no time limit of resolution.  This would also mandate that only a C & P for the damages or the doctor’s opinion with diagnostics that the damages being done are getting better or resolving.  That is not up to VA or the IOM for the individual veteran. 

 

This would have to conclude that somehow our government/VA/NAS-IOM has magically defined the following:

 

 

Therefore, some one somewhere has determined that direct contact with the dioxin, TCDD at some level will create some level of “direct peripheral nerve damage only” that does not involve a central nervous system involvement or any cell DNA or mitochondria cell DNA modifications and they know how it does it and what the ingestion rate must be and/or the total body threshold is; regardless of method of ingestions.

 

Congresspersons/Senators/Government decision makers, Veteran finds the VA decisions on peripheral neuropathy disorder to be only transient and resolution of disorder baseless, presumptuous, and erroneous and not scientific as it applies to the toxicants in question. 

 

 

On July 1, 1991, Secretary of Veterans Affairs Derwinski announced that VA will propose rules granting service-connected disability status to certain veterans with peripheral neuropathy.  Proposed rule implementing the Secretary's decision was published for public comment in the Federal Register in January 1992.  (See 57 Fed. Reg. 2236, January 21, 1992).  It was anticipated that the final rule would be published in 1993.  However, in July 1993, when the National Academy of Sciences (NAS) released its comprehensive report, entitled Veterans and Agent Orange - Health Effects of Herbicides Used in Vietnam, peripheral neuropathy was not included in the category "sufficient evidence of an association" or even "limited/suggestive evidence of an association."  Rather, the NAS reviewers concluded that there is "inadequate or insufficient evidence to determine whether an association exists between exposure to herbicides (2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram) and disorders of the peripheral nervous system."  The NAS report added, "Although many case reports suggest that an acute or subacute peripheral neuropathy can develop with exposure to TCDD and related chemicals, reports with comparison groups do not offer clear evidence that TCDD exposure is associated with chronic peripheral neuropathy.  The most rigorously conducted studies argue against a relationship between TCDD or herbicides and chronic neuropathy."

 

Acute is used to mean immediate effect; as opposed to chronic that means an effect not appearing immediately.

 

VA asked the NAS, in its follow-up report, to consider the relationship between exposure to herbicides and the subsequent development of the acute and subacute effects of peripheral neuropathy (as compared to the chronic effects, which were focused on in the initial report).

 

In January 1994, VA published a notice in the Federal Register that Secretary Brown has determined that a presumption of service connection based on exposure to herbicides used in Vietnam is not warranted for a long list of conditions identified in the NAS report.  Peripheral neuropathy was included in this list.  (See 59 Fed. Reg. 341, January 4, 1994).

 

What did the NAS 1996 update conclude about peripheral neuropathy?

 

When the NAS reviewers separately reviewed chronic persistent peripheral neuropathy and acute and subacute transient peripheral neuropathy, they found that there was still inadequate or insufficient evidence to determine whether an association exists between exposure to herbicides and chronic persistent peripheral neuropathy.  On the other hand, they reported that there is some evidence to suggest, “neuropathy of acute or subacute onset may be associated with herbicide exposure.”  They included acute and subacute transient peripheral neuropathy among those conditions they placed in their second category “limited/suggestive evidence of an association.”  (Chronic persistent peripheral neuropathy remained in category three, “inadequate/insufficient evidence to determine whether an association exists.”)

 

What was VA’s response to the NAS 1996 finding about acute and subacute transient peripheral neuropathy?

 

After careful review of the report, Secretary Brown decided that VA should add acute and subacute peripheral neuropathy (when manifested within one year of exposure) to the list of conditions recognized for presumption of service connection for Vietnam veterans based on exposure to herbicides.  President Clinton announced this, along with other, decisions, at the White House, on May 28, 1996.  The proposed rule was published for public comment in the Federal Register in August 1996.  (See 61 Fed. Reg. 41368, August 8, 1996).  The final rule was published in the Federal Register in November 1996.  (See 61 Fed. Reg. 57587, November 7, 1996).

 

What did subsequent NAS updates conclude about peripheral neuropathy?

 

With regard to chronic persistent peripheral neuropathy, the 1998 report stated, “No new information has appeared in the intervening two years that alters this (the 1996) conclusion.”

 

With regard to acute and subacute transient peripheral neuropathy, the 1998 update reported, “The committee is aware of no new publications that bear on this issue.  If TCDD were associated with the development of transient acute and subacute peripheral neuropathy, the disorder would become evident shortly after exposure.  The committee knows of no evidence that new cases developing long after service in Vietnam are associated with herbicide exposure.” 

 

In update 2000:  For chronic persistent peripheral neuropathy, there is only inadequate or insufficient evidence to determine whether an association exists between exposure to dioxin or the herbicides studied in this report.  NAS found that there was limited/suggestive evidence of an association between exposure to the herbicides considered in this report and acute or subacute transient peripheral neuropathy.  The evidence regarding association was drawn from occupation and other studies in which subjects were exposed to a variety of herbicides and herbicides components.  Information available to NAS continued to support this conclusion.

 

The government/va slippery slope:

 

Congresspersons/Senators/Government decision must remember that the Veterans' Advisory Committee on Environmental Hazards (VACEH) clearly stated above there was significant statistical evidence that found an association to Peripheral Neuropathy and the dioxin, TCDD in 1991.

 

Congresspersons/Senators/Government decision makers must be aware of during this same time frame in 1989 of our “Vietnam Veterans Toxic Chemical Legacy” a district court found after reviewing the legislative history of the 1984 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.  - See Nehmer v. U.S. Veterans Admin., 712 F. Supp. 1404, 1408. (N.D. Cal. (1989).

 

The act known as the Veterans’ Dioxin and Radiation Exposure Compensation Standards Act, Pub. L. 98—542, Oct. 24, 1984 was - one could consider nothing but a “public relations act” half hearted congressional attempt at doing something for the nations government damaged Veterans.

 

In recognition of the uncertain state of scientific evidence and the inability to make an absolute causal connection between exposure to herbicides containing dioxin and affliction with various rare cancer diseases, Congress mandated that the VA Administrator resolve any doubt in favor of the veteran seeking compensation

 

VA not only confounded the perceived intent of the Congress, but also directly contradicted its- own established practice of granting compensable service-connection status for diseases on the lesser showing of a statistical association, promulgating instead the more stringent requirement that compensation depends on establishing a cause and effect relationship.

 

The district court invalidated the VA’s Dioxin regulation, which denied service connection for all diseases other than chloracne; ordered the VA to amend its rules; and further ordered that the Advisory Committee (VACEH) reassess its recommendations in light of the court’s order.32

 

In promulgating such rules, the Dioxin Standards Act required the VA to appoint a Veterans’ Advisory Committee on Environmental Hazards (the "Advisory Committee") -- composed of experts in dioxin, experts in epidemiology, and interested members of the public -- to review the scientific literature on dioxin and submit periodic recommendations and evaluations to the Administrator. 27 Such experts were directed to evaluate the scientific evidence pursuant to regulations promulgated by the VA, and thereafter to submit recommendations and evaluations to the Administrator of the VA on whether "sound scientific or medical evidence" indicated a connection to exposure to Agent Orange and the manifestation of various diseases.28

 

VA did not challenge the courts ruling but instead October 2, 1989, the VA amended 38 C.F.R. Part 1, which among other things set forth various factors for the Secretary and the Advisory Committee to consider in determining whether it is "at least as likely as not" that a scientific study shows a "significant statistical association" between a particular exposure to herbicides containing dioxin and a specific adverse health effect.33

This Veteran as well as all the Nations Veterans contend that this stated policy has never been the operating philosophy of VA for Vietnam Veterans but instead VA has chosen to operate as a government yearly budget control based on the concluding White House Philosophy of the Reagan /Bush White House that clearly defined; it did not want the financial responsibility for the toxic chemical nightmare inflicted on our Veterans as well as the environmental disasters in the Republic of Vietnam created by other administrations.

 

This led to a memo put out by the White House Bureau of Budget to all federal agencies of government in essence not to find a correlation between Agent Orange and health affects.  Stating that it would be most unfortunate for two reasons:

 

A) The cost of supporting the Veterans.

B) The court liability to which corporations would be exposed.

 

This would also “just as likely as not” conclude the Government was interested in protecting the chemical company industry as well as protecting their own lobby money and not supporting our government damaged Veterans and their families.

 

Clearly Congresspersons/Senators/Government decision makers can see that in 1991 the actual committee of experts mandated by congress stated their expert opinion under the new rules mandated by the court their indeed was statistical association – then five years later in 1996 as VA stalled and stalled the newly congressional appointed National Academy of Science that conveniently had replaced the VACEH then makes the statement: 

 

“Rather, the NAS reviewers concluded that there is "inadequate or insufficient evidence to determine whether an association exists between exposure to herbicides (2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram) and disorders of the peripheral nervous system.”

 

Since during this exact time frame Ranch Hand was finding adverse association to specifically polyneuropathy in its medical transcripts as well as other Nations Vietnam Veterans studies were showing, that peripheral neuropathy is the most prolific disorder associated to the dioxin, TCDD.  (VV) These NAS conclusions seem biased and spurious at best.

 

This was not the year after Vietnam but three decades after Vietnam, therefore Veterans question the integrity, and the effort put forth by the government contracted NAS.

 

Veterans also question if NAS and VACEH were using the same court mandated level of associations required to associate such disorders.

 

To add insult to injury of our Nations Veterans and pour salt into our open government caused wounds.  On May 28, 1996 President William Jefferson Clinton stated in a speech on Veterans Announcements:

 

REMARKS BY THE PRESIDENT
IN VETERANS ANNOUNCEMENT
Room 450
Old Executive Office Building

1:22 P.M. EDT

May 28, 1996

 

“THE PRESIDENT: Mr. Vice President, thank you very much, for your very moving remarks and your support of this endeavor.  Secretary Brown, thank you for your service to our country in so many ways, and especially for your work at the Veterans Administration, along with Deputy Secretary Hershel Gober and the others who are here.  Senator Robb, Congressman Evans, and to members of Congress who are not here, including Senator Daschle who worked so hard on this issue; to the Vietnam veterans who are here and all others who are concerned about this matter:

 

This is an important day for the United States to take further steps to ease the suffering our nation unintentionally caused its own sons and daughters by exposing them to Agent Orange in Vietnam.  For over two decades Vietnam veterans made the case that exposure to Agent Orange was injuring and killing them long before they left the field of battle, even damaging their children.

 

For years, the government did not listen.  With steps taken since 1993, and the important step we are taking today, we are showing that America can listen and act.  I'm announcing that Vietnam veterans with prostate cancer and the neurological disorder, peripheral neuropathy, are entitled to disability payments based upon their exposure to Agent Orange.  Our administration will also propose legislation to meet the needs of veterans' children afflicted with the birth defect, spina bifida -- the first time the offspring of American soldiers will receive benefits for combat-related health problems.

 

From the outset, we have pressed hard for answers about the effects of Agent Orange and other chemicals used to kill vegetation during the war in Vietnam.  Once we had those answers, we've looked for practical ways to ease the pain of Americans who have already sacrifice so much for their country.”

 

Congresspersons/Senators/Government decision makers this was a nice way to buy votes.  It was on the other hand a bunch of “presidential lies” to our Nations Veterans while congress stood by for the accolades.

 

President Clinton made a bid deal out of it and by the time VA finished with its less than truthful constraints not one, mind you not one Veteran would ever qualify for any service association to what President Clinton described as a “neurological disorder” which indeed it is.

 

Of course, this was all orchestrated.  WHY?  Because the neurological disorder is associated to immune system damages and those in the White House and VA wanted to stay away from anything that might indicate any association to damaging the immune system even though “it is just as likely as not” the cancers are being created by a damaged immune system.  (See Evidence Section)

 

In other words, we messed up, without thinking and announced this disorder, and lets not do this one because it will lead to more disorders associated with a compromised immune system from exposures to the toxic chemicals (plural).

 

Many would say all of this is just coincidental.  Veterans would say this too coincidental and too convenient. 

 

The United States Government and its federal agencies not only had White House direction but also certainly had and continue to have dollar motive for collaboration.

 

While the Veterans have, had three different committees formed that act as judge and executioner during our 40-year legacy.  It seems our congress is “less than forthcoming” in allowing those Veterans and their families know exactly “how they are being judged,” to “what level they are being judged,” and what “oversight congress is providing” to make sure their purported and publicly stated wishes are carried out by the Presidents and the Secretary of the Department of Veterans Affairs and any associated government possible collaborations in reports and studies as well as direct White House interference in such studies and activities directed against our nations Veterans and their families.  

 

EVIDENCE:

 

Veteran will submit evidence that clearly shows the neurological condition, chronic polyneuropathy, is associated to exposures to dioxins as well as the associated Chronic Fatigue Syndrome (formerly diagnosed as Neurasthenic Syndrome) as a stand alone disorder and should be “automatically associated” for all Vietnam Veterans with that diagnosis that served in geographical Vietnam as well as those Veterans that were exposed around the world to the same “government created toxic chemical formulas and doses.”

 

The Chronic Fatigue Issues that go with this nerve disorder also found in exposure victims even in our own government studies that “is just as likely as not” associated to Central Nervous System damage associated with Chronic Fatigue Immune Dysfunction Syndrome, or sometimes called Myalgic Encephalopathy. 

  

A recent new finding seems to confirm what many scientists have been saying for decades now regarding PNS issues and that is before any PNS issues manifest a CNS subclinical event/causation has taken place and precedes any PNS manifestations.

 

This seems to be located in dorsal root ganglionitis (inflammation in the spinal cord) - recently discovered in a two-week autopsy, with the cause of death listed as Chronic Fatigue Syndrome.  This becomes a “clear physical manifestation” of the neurological disorder.

 

“Evidence reveals that Dow Chemical, a manufacturer of Agent Orange was aware as early as 1964 that TCDD was a byproduct of the manufacturing process.  According to Dow’s then medical director, Dr. Benjamin Holder, extreme exposure to dioxins could result in "general organ toxicity" as well as "psychopathological" and "other systemic" problems.”  (19)

 

{Psychopathological - The manifestation of mental or behavioral disorders.

 

Many toxicologists believe that not only do these toxic chemical herbicides (plural) cause peripheral neuropathy (PN) but also central nervous system (CNS) issues.

 

It should also be noted that in 1969 the United States “State Department” got involved in the controversy of the use of herbicides.  Their scientific conclusion was that Agent Orange posed little threat to humans but that Agent Blue was of major concern with its form of arsenic acid.  (12) (13)

 

This description of our toxic chemical exposures matches no other toxic chemical hazard other than the possibility of the Love Canal, New York environmental disaster, which contained many of the same forms of toxic chemicals (plural) that Vietnam Veterans were exposed.  However, once again the dose rate for Vietnam Veterans is much higher than even in the Love Canal disaster. 

 

Toxicologists state the CNS damage in the form of nervous system lesions or other issues precludes a PN involvement.  (2) The EPA, in their 1992-1996 dioxin reassessments categorically stated that the brain may be particularly vulnerable to accumulating dioxin into its fat content.  Nervous system tissue itself, with its high lipid content, can also act as a repository for dioxin.  Dioxin accumulates in the body fat and once in the body, even at very minuscule amounts, interferes with cell development.  (3)

 

It is also note worthy that the main toxic chemical in Agent White 2,4-D, is also noted for this seeking of a more lipid environment as a repository.

 

Dioxin exposure causes damage to the peripheral and central nervous systems.  The association between dioxin and damage to the nervous system is reflected in a finding by the Veterans' Advisory Committee on Environmental Hazards, which recommended that the VA compensate Vietnam veterans for peripheral neuropathies as “service related.”

 

Already discussed in the formal presentation are the VA’s constraints that were put on this “obvious toxic chemical caused disorder” to the point that no (zero) Veteran would qualify.

 

Effects on the central nervous system occur before gross pathological damage can be demonstrated in the peripheral nerves.  The neuropsychiatric and neuropsychological symptoms of central nervous include depression, anxiety, reduced cognitive function, poor coordination, etc. (2) 

 
One severe consequence of central nervous system damage by dioxin is higher rates of suicide (shown in dioxin-exposed Vietnam veterans, chemical production workers, and forestry workers).  Another severe consequence is excess deaths from accidents (also significantly elevated in dioxin-exposed chemical production workers and Vietnam veterans).  These accidents could be caused by neurological malfunction, or also represent disguised suicide to a certain extent.  (2) 

 

Other effects on the central nervous system found in exposed Vietnam veterans and chemical production workers include depression, anxiety, loss of libido, and other neuropsychiatric and neuropsychological effects.  Effects on the central nervous system also have been demonstrated in a dose-related manner in Vietnam veterans and chemical production workers, providing firm epidemiological evidence that dioxin caused these effects.  (2)

 
In addition, the same range of neuropsychiatric and neuropsychological effects seen in dioxin-exposed populations have been demonstrated for exposure to other neurotoxic substances, such as solvents.  This demonstrates a similar biological mechanism between the neuropsychiatric and neuropsychological effects caused by dioxin and other substances.  (2)


Peripheral Nerve and Cerebrovascular Abnormalities

The following studies document clinically diagnosed neurological and cerebrovascular effects among several populations exposed to dioxin.  (2)

 
These gross abnormalities of the peripheral and central nervous system serve to indicate extreme endpoints of the effects of dioxin.  More subtle effects on the central nervous system occur before clinically demonstrable peripheral nerve damage.


Peripheral Nerve and Cerebrovascular Abnormalities

 

Government studies: 

 

·         “Data showed a significant increase in the index of polyneuropathy.  Another run through the data showed it correlated significantly with dioxin.”  (4)

 

·         “A significant and adverse relationship between peripheral neuropathy and dioxin body burden was found.”  (5)

 

“The most severe neuropsychological consequence of dioxin exposure is excessive suicides, which has been demonstrated among exposed Vietnam Veterans, chemical production workers in the U.S. and European countries, forestry workers, and railroad workers.  Another severe consequence is the excessive death rate from accidents found among the dioxin-exposed chemical production workers and Vietnam Veterans, representing either motor neuron malfunction or suicide in disguise.

 

“In 1977, the Working Group of the International Agency for Research on Cancer (IARC) found that neurological and behavioral changes were among the most frequently reported effects in studies of exposures to 2,4,5-T (IARC, 1977a). 

 

IARC identified 6 out of 7 different populations occupationally exposed to chlorinated phenolic compounds where neuropsychological symptoms such as neurasthenic or depressive syndromes were established (IARC, 1977b).  IARC noted that PNS damage was also found in the same 6 dioxin-exposed populations, including polyneuropathies, lower extremity weakness, and sensorial impairments (sight, hearing, smell, taste). 

 

In 1986, the IARC clearly restated it’s finding that dioxin had been found to be associated with peripheral neuropathies and personality changes (IARC, 1986).  (2)