Aussie NAS/IOM Information

Biased and illogical Work of the NAS/IOM in ascertaining damages done to Vietnam Veterans

The first issue that should be addressed is the validity and constraints of the studies that are mandated to be reviewed by the NAS/IOM.

Where this conditional mandate comes from is unclear as to whether this is a VA, government, or a self-imposed study constraint.

The other issue is the Ranch Hand study, which is being used as a gold standard the NAS/IOM state that they review other studies but primarily use the Ranch Hand study.

Then state they know the dioxin can or should be able to produce certain effects but it is unclear how to apply it to the Vietnam Veteran. Is this because the association protocols used are too stringent that you would need a whole warehouse full of Vietnam Veterans to test to destruction to make the stringent protocol associations such as "cause and effect with a linear regression" to that one specific disorder per person? Not taking into account the many variables that may be associated to the exposures.

The NAS/IOM states it only uses peer reviewed studies. Peer reviewed studies are normally "crafted for publication" and not all the facts actually found are brought forth!

The Ranch Hand study, which again, is used and being held up as the gold standard is much much less than that and is used as a U.S. Government exonerating tool as described and charged by some of their own scientists by focusing only on the dioxin TCDD as opposed to the actual toxic chemical environment and reporting the found facts related to the real exposures.

“There are many Veterans, there are many members of Congress, there are many Americans who believe the Department of Defense and the Veterans Administration have been less than candid about the health effects that Agent Orange has had on them as well as on veterans' children. While the Government has acknowledged that some illnesses the Vietnam veterans developed are associated with Agent Orange exposure, and that these veterans can receive disability and death benefits. Many veterans believe that the health problems associated with Agent Orange are far more serious and widespread than the Government has acknowledged up to this point.

Twenty three years ago, the Air Force began a 25-year, $140 million research program to assess the relative health of 1,300 ranch hands, air and ground crew members who handled and sprayed Agent Orange and other herbicide defoliants in Vietnam. The Ranch Hand Study was designed to generate significant scientific data and analysis to be used by the Department of Veterans Affairs [VA], and others in making health care and compensation decisions regarding Vietnam Veterans.

Nevertheless, according the General Accounting Office (GAO), Ranch Hand has been slow to publish findings, unwilling to share data, inconsistent in conveying design limitations, and resistant to congressionally mandated participation by "independent parties."

Controversial from the outset, the Ranch Hand study has been consistently criticized for both scientific and administrative shortcomings. Many believe Ranch Hand has so far failed to fulfill its promise as the pivotal longitudinal study of herbicide toxicity. Some conclude it never will. Others believe this research was designed to fail or manipulated to avoid controversial findings.”

After reviewing the transcripts of the government oversight committee on Ranch Hand and the testimony of scientists themselves that were a lead part of the Ranch Hand; the head of medical research at Kansas State University (a two time member of the Ranch Hand study), and an advisor to the VA Secretary from Yale University. It was painfully obvious this study deserves this well-founded criticism.

There were direct charges of command influence being used, the changing of cleared for publication medical facts that were found, the changing of established protocols directed by using the name of the Surgeon General, scientific misconduct, linear dioxin dose responses to medical disorders that "were not understood" were and are not reported found, disorders found at a 50% increase "or more" are not reported because no dioxin linear dose response could be determined, etc, and an overall total lack of integrity. (1)

Additional charges were made that the study was only crafting for peer review and publication not actually publishing the found facts. (1)

Additional charges were made that whole chapters were being rewritten to de-emphasize the real findings.

The ultimate lack of integrity charge was that for 20 plus years the study had and continues such cover-ups to have never given the Veterans "a fair and unbiased assessment of their toxic chemical health status" in birth defects, other cancers, heart disease, vascular disease, neurological ailments, endocrine disturbances, and hematological difficulties. (1)

One of the most despicable events I ran across in my review of the Ranch Hand Transcripts was when one scientist, not wanting to duplicate his work asked; Would it not be better to wait to review the chapters until the Air Force gets done with all its changes? The leader of this group then stated we do not want to say, "changed." The scientists then said, "OK how about Airbrushed" as laughter broke out in the room. (6)

Veterans are going uncompensated in death and disability and this group is laughing at the fact the Air Force is going to change what they as scientists have found or suspect.

I would also add even B and T cell dysregulaton found that may even be the secondary root cause of all of our wide variety of issues of death and disablement is ignored. This includes down and up regulation in Interleukins 4 and 10, Interferon gamma, and some disturbance of the tumor necrosis factor alpha. (3)

Thus creating increased incidence and severity of infectious diseases as well as cancers. Conversely, inappropriate enhancement of immune function or the generation of misdirected immune function are considered to represent immunotoxicity effects of chemicals. On the other hand, since it proven there is up and down regulation, TCDD can create both at the same time with Type 1 and Type 2 responses.

Yet, even this obvious disease and disorder progression of any of the many autoimmune disorders created by a toxic chemical caused dysfunctional immune system is denied by the Secretary of the VA and his staff, as well as the NAS/IOM. Including the manifestation of smoldering cancers and cancer conditions.

Therefore, the gold standard the NAS/IOM says they primarily use in their assessments including a yearly presentation by the owners of this less than factual study is not exactly what one would call “cricket” for the Veterans of all of our allies.

In fact, in the transcripts of this so-called study, one conclusion was the reason why Ranch Handers were not developing the cancers expected is they were dying too early from dioxin caused cardiovascular issues. They knew this increase in mortality at least as far back as 1991. Certainly a comforting note for all Vietnam Veterans.

This was also found in the Seveso Italy dioxin only disaster with more mortality from this than the produced cancers and overwhelmingly found in the Korean AO Impact study concluded in 2003 that found ischemic heart disorders, vascular issues, valvular issues were associated to exposure levels. In fact, their scientist wondered in their study as to why the Ranch Hand had not found these issues. They had - they just did not tell anyone.

The Korean Impact study in my opinion is the only honest study done. Unlike our government studies that compare “like Veterans”, including only certain MOS’s which by default limits the type of exposures and ingestions and time of even skin contact.

The Korean study used doctors of certain medical areas with the exception of pulmonary disorders, which were not sampled. This was a totally blind study with all the statistics done by an outside house, not an integral part of the team as in the Ranch Hand. In addition, they had built in “quality assurance provisions” where at random the gathered data was sent out to other specialty doctors for their evaluation and confirmation.

MOS was not a value so it included “boots on the ground” not just the guys that sprayed the toxic chemicals from the air or on the ground and only exposed by one form of skin contact.

The OR’s and p-values found to what Veterans are actually experiencing were right on and directly opposed to what the NAS/IOM says.

The latest on Ranch Hand is as follows although the transcripts still report much more found in many areas and then debunked or just not reported.

The 2005 Ranch Hand Published report in Military Medicine, which with its past-criticized biased political history is certainly suspect to reporting all the found issues and finding anyway it can; to dilute the findings, which I also found in the transcripts, found as follows:

Bearing in mind, these men were primarily exposed by skin contact alone. That may have been a higher level of exposure per day but certainly not the worst form of exposure/ingestions as the boots on the ground. The Ranch Hand study was “White House relegated” to study one element of one toxic chemical and that being the dioxin, TCDD. Also, bearing in mind that this study only reports mortality. Not actually, “all found associated disabling disorders.”

Cited in the study is the VA’s own study that found increased risk of death attributable to digestive diseases.

Also cited in the study is the Australian study that found increased risk of death attributable to digestive diseases.

Since they, neither stated “all digestive diseases” or down selecting to a particular site or area, then one would have to assume “all digestive diseases.”

Yes, Vietnam Veterans have been reporting digestive system issues since at least 1968 but it fell on “deaf and dumb government and NAS/IOM ears.” Including it is now found that the small intestines are being damaged by the exact same lymphocyte found in the lymphoma cancers already associated and that lymphocyte is associated to what is called autoimmune neuropathy.

I am just going to list the Risk Ratio as the P-value is skewed because they are only looking for a single component rather than all possibilities of contamination.

This next one is just hilarious in the way it was reported - not funny in actuality.

Ill defined or unknown = RR – 1.5 - So if you served in Vietnam you have a RR of 1.5 over someone who did not serve in Nam or was not exposed. We just do not know what that something is and have no idea of the symptoms or systems affected. In a pigs eye!

Atherosclerotic heart disease = RR = 1.7- although on this one the p-value was 0.009

Cerebrovascular disease = RR = 2.3 -although on this one the p-value was 0.08

A cumulative total of RR = 1.7 with I might add a p-value of 0.001 which conclusively points to a connection to TCDD and a significant increase in mortality.

Yet, still the VA and the NAS/IOM will not associate these disorders to the toxic chemicals but only to a diabetes condition. That is a separate subject in and by itself as to what form of diabetes is actually found and the associated X-factor found.

Including that 37% of the cohort with confirmed diabetes Type II did not test properly for the A1C test. How many Veterans are running around with this form of diabetes and the A1C shows OK and the doctor says no problem because they were also not told of these issues in Vietnam Veterans and this form of what seems to be an increase in insulin resistance and timing of release regardless if you meet the ADA definition or not.

Once again, what was conveniently left out in the references was any reference to the last four dioxin EPA reassessments or to any of the actually honest Korean studies that also showed a definite connection to not only heart issues but related brain atrophy and brain infarction issues; also finding many peripheral vascular autoimmune disorders.

No other study has included “boots on the ground” including the VA study of Army Chemical Corps workers, which was also a sham of a study. They were supposed to use a non-toxic chemical comparison of Veterans similar to the Korean Study. Instead, for their comparison cohort group they used Army Chemical Corps workers that sprayed the stuff here in the states. Now I would have to assume they did the analysis they were spraying the exact same stuff, using the same equipment, and the same number of gallons of exposures. That is a big assumption I would conclude. What that study proved is just beyond my ability to comprehend.

Now one could say that they did the tissue analysis for residual dioxin and like the Ranch Hand conclude that anything less than 10 ppt was in the noise level but that is also an unproven assumption. Even doubling the background over a 60-year period increases the risk of cancer. (4) Including that the dioxin TCDD is considered the first all-site carcinogen and is not specific. (4)

In addition, if doubling the background causes an increase in cancer and the EPA has established that immunotoxicity and birth defects require a threshold 100 times less than that of cancer. Then one would logically conclude there would be more smoldering cancers and autoimmune disorders. Yet, the NAS/IOM says no to this logic.

How can a toxic chemical always cause a cancer condition manifesting cell changes and always continue the maturation to a cancer. Not even logical and would probably be a wonder of science in itself. Especially when most of the cancers are a result of B and T cell dysregulation and there are a ton of autoimmune disorders that are of the same type of dysregulation that for some reason, like the persons immune system, the maturation does not complete the cancer morphology. Much less, the fact if we had exposures then the EPA statement above should conclude there would be more autoimmune disorders, not cancers.

Unless the NAS/IOM and the VA are going to guarantee, a minimum total dose or a minimum dose rate for all Veterans serving and that would guarantee the development of only those cancers they have deemed associated. In addition, they would have to guarantee the method of ingestion as that also makes a difference by any scientific standard. All of this is of course nonsensical science.

The studies by the NAS/IOM seemed to have been reduced to a linear dose response to the dioxin TCDD only. This is hardly factual as there were at least three major military herbicides used along with 15 commercially named herbicides. Not including any synergy effect that may apply.

If one looks at 2,4-D and Picloram, we know now there were other dioxin isomers as well as closely related furan isomers. Remember for every gallon of AO there was at least one gallon of AW. With AW being sprayed by the millions of gallons by itself as well as AB which if you look at the issues it can mimic many the NAS/IOM are saying are only the dioxin TCDD.

We now know that "Agent White" with its DOW chemical proprietary formula had other forms of dioxins outside of the dioxin TCDD, closely related furans, as well as nitrosamines and hexachlorobenzene. And that this fact was never made known to the FDA, EPA, or to any other federal agency. (2)

We know that "Agent Blue" was a form of arsenic acid that is noted for its neurotoxicity properties including warnings of creating nerve damage such as peripheral neuropathy as well as many issues that overlap what the VA and NAS/IOM is saying is only the dioxin TCDD causations. (5)

As stated the requirements for the NAS/IOM seemed to be so constrained I doubt they could really associate anything. Including this fantasy linear dose response.

The EPA has concluded that for some disorder there does not seemed to be a linear response. This seems to be according the EPA especially in the area of thyroid atrophy.

The researchers in the Seveso, Italy dioxin disaster which had a central contamination point were surprised to find a linear dose did not hold true with regard to esophageal cancer and soft tissue sarcomas.

It was also found that two types of leukemia were found significant in the higher contaminated zones, which was CLL and AML with AML slightly more prevalent. However, when you go to the lesser-contaminated zone AML remained significant while CLL did not remain significant. This should conclude that AML would be more prevalent in the higher and lower dose rates. Yet, the NAS/IOM only approves CLL as even associated. Christ, many Vietnam Veterans have blood disorders that are precursors to and sub tier process damages to AML and this includes mortality!

Blood disorders are also prevalent in IgA, IgE, IgG1, and IgG2 all common and yet Vietnam Veterans cannot have these common associations based on "significant correlation" or "increased risk of incidence" by the NAS/IOM protocols. Then when you get down to the lower biological levels in the dysregulation of cytokines, macrophages, and monocytes that also direct immunity or the lack of immunity as chemical messengers the destruction becomes more and more relevant including the morphology of the development of the cancers themselves as well as the many autoimmune disorders that can be chronic or acute. Moreover, guess what? May not meet the standard ICD code that everyone with no logic is looking for that has been characterized for 150 years. Our toxic chemicals (plural) legacy is a once in 500-year legacy and for anyone to think that all the possibilities are going to meet some defined ICD code is out of their minds.

In fact, it might even be a mixture and what someone just might call a syndrome as it has in the past when the nations medical community had no clue as to the etiolgy of the development; only a set of shifting symptoms and levels of acuteness per individual. Never the less it is called something until it can be determined, which might be decades later as the studies continue.

In the 2000 Ranch Hand oversight review Dr. David Butler, Senior Program Officer, Veterans and Agent Orange Reports, Institute of Medicine, National Academy of Sciences when asked by the congressional folks how the process works and to what level of associations the NAS/IOM was determining the good doctor stammered and talked around the issue. The congressman finally asked him if he was refusing to answer the question. Then one of the Ranch Hand leaders came to the rescue along with the VA rep that was there. (1) What a team!

Now I have worked in failure analysis all my life and for this NAS/IOM good doctor not to know and be able to clearly elucidate the processes used in an unbiased scientific matrix that everyone at the NAS/IOM uses as to categories 1-4 and/or to associations and to what levels of proof or levels of association - I found very very disturbing! This is science not what you think it is, there must be a defined protocol, and decision matrix that is not "changed or altered" depending on what data is actually found and you want to find a way to exclude such conclusions because of politics and money.

Yet, the good NAS/IOM doctor seemed to not have a clue or at least he was not going to say what that process actually is, period.

I did glean from that conversation they had borrowed some protocols from the International Agency for Research on Cancer (IARC). However, it must be concluded that even though they used the same or at least similar protocols as the IARC the conclusions for Vietnam Veterans by the NAS/IOM do not match the findings of the IARC, which I will demonstrate later.

In 2005, I attended and presented at our totally bogus VA disability commission. Including I submitted over 500 pages of studies and science related to our legacy. I presented the day before the NAS/IOM presented. Believe it or not, Commissioner Grady actually took my data and read through it that night. The next day he began to ask questions of the NAS/IOM rep that was there, which I do not have his name at hand. He point blank asked the rep if they reviewed the Ranch Hand report. This guy had the gall to say he thought Dr. Stellman at Columbia had reviewed the report. As if they were not even using this report.

I also find this very disturbing that those that hold our fate are not forthcoming!

As I stated in my book Vietnam’s Rain Agents maybe congress does not feel the need to know exactly how we are being judged with unbiased (cast in concrete protocols that are not changed as in the Ranch Hand), decision matrices, and to what level of associations are being judged. I think all Vietnam Veterans, their widows, and their damaged offspring have every-civil right to know those exact facts!

I would also feel more comfortable, as even some of the Ranch Hand folks suggested, to some agency not associated to our collaborative government and contracted by that same government being involved such as the International Agency for Research on Cancer (IARC).

How can any of us trust what has gone on for four decades as a game. A game that has allowed 10’s maybe even 100’s of thousands of our mates and comrades to die with no warning when our respective governments knew better. Since 1991, the NAS/IOM has been an integral part of that knowing better.

The next section below I will take just one disorder the NAS/IOM is denying and demonstrate the overwhelming evidence that they are wrong or biased, which ever the case maybe.

(1) March of 2000, House of Representatives, Subcommittee on National Security, Veterans Affairs, and International Relations, Committee on Government Reform, Washington, DC, ;Oversight review of the Ranch Hand Study.

(2) 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.

(3) Immunotoxicological Effects of Agent Orange Exposure to the Vietnam War Korean Veterans, published in Industrial Health 2003, 41, 158-166.

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

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

(6) October 14-15, 1999 Ranch Hand Advisory Committee Meeting, transcripts from

Evidence of facts and studies that show a direct link to Peripheral Neuropathy and Central Nervous System Damages from exposures to Agent Orange, Agent Blue, and Agent White toxic chemical exposures.

When President Clinton approved this nerve disorder as being associated the nomenclature used was; “ACUTE NEUROPATHY.”

The DVA/White House to control the Veterans’ compensation expenditures put a time limit on this prolific nerve disorder with a time limit of resolution and/or cure of this nerve disorder.

The first proposal was for a 10-year time limit and a two-year resolution. Many scientists and doctors protested even this VA action to Secretary Derwinski. What it ended up was a one-year time limit and a two-year resolution announced in 1996. Which makes about as much sense as concluding the following: “That within 678 and one-half days the Veteran must manifest in order to draw disability compensations.”

It does not take a mathematical genius to crunch the numbers and calculate that even when this nerve disorder was announced, “As Associated,” no Veteran at that time could qualify or would ever qualify. Nice propaganda move on the part of the VA, its’ Secretary, the White House, and the NAS/IOM.

The VA then classified this nerve disorder; “transient acute and sub acute peripheral neuropathy,” which no Vietnam Veteran has submitted for compensations.

In the VA propaganda magazine “Agent Orange in Review” which should be “Dioxin TCDD in Review” since no (zero) “U.S. Government Study” has done any studies on the herbicide Agent Orange, the issue was falsely printed as Peripheral Neuropathy. Only after protests by Veterans, such as myself, that this was a VA mischaracterization to the public did they finally change the listing to some form of truth.

Including complaints from Veterans, such as myself, of Veterans’ Magazines reprinting the bogus VA claims. In which, editors printed retractions after realizing the truth.

By associating this medical disorder and two other disorders to a time limit, the VA has distanced themselves from the real causes of the three time limit disorders.

In fact, by determining a time limit and pronouncing that a cure is available or at least the nerve damage will resolve itself over time; the DVA and the National Academy of Science Institute of Medicine (NAS/IOM)**, the hired guns of the government replacing the despicable Veterans Affairs Chemical and Environmental Hazards Committee that operated from 1979 to 1991, certainly must have concluded the following:

Therefore, one must conclude that the VA and the NAS/IOM have discovered this morphology and have kept this medical secret to themselves.

The VA and NAS/IOM have concluded a cure or resolution for this nerve disorder does exist. Yet, in seeing three board certified neurologists; one of whom was the head of neurology at Emory University indicates this nerve damage is chronic, debilitating, and not curable. It is self-manifesting from the secondary effects of the toxic chemicals. Not an antigenic response and more in the form of an autoimmune disorder, which is one of the cruelest of all diseases and disorders.

Some have suggested that to have this nerve disorder this badly it had to be caused by either heavy metals or toxic chemicals and not a diabetic connection. Once again it seems the VA and the NAS/IOM know how to cure this nerve disorder when the rest of the nations board certified doctors/neurologists seemed to be nothing but board certified quacks.

The Congress has gone along with this DOD/VA –NAS/IOM collaboration that everything is associated to one single toxic chemical component (the dioxin TCDD) of three major Herbicides used; which is shear and total scientific nonsense.

We now know that "Agent White" with its DOW chemical proprietary formula had other forms of dioxins outside of the dioxin TCDD, closely related furans, as well as nitrosamines. And that this fact was never made known to the FDA, EPA, or to any other federal agency. (2)

We now know that Agent White contained Hexachlorobenzene, a noted liver damage toxic chemical.

“Nitrosamines are a type of carcinogenic chemicals that are known to cause cancers and other medical problems.

Exposure to high concentrations of nitrosamines is associated with increased mortality from cancers of the esophagus, oral cavity, and pharynx. When used in pesticides or herbicides it may cause DNA damage and cell death.”

Congress must realize the synergy effect of all these toxic chemicals used in one area can increase the potency and generated outcomes by a factor of 1600 times when using only two toxic chemicals over what a single toxic chemical can produce. (12)

The bottom line for Vietnam Veterans is that no one will ever know what caused what to some level of “cause and effect” that the DOD, the VA, the NAS/IOM, and our White House is demanding to a single toxic chemical element for death and disability compensations.

Attachment 2 documents just how ridiculous this stand by the VA –NAS/IOM really is with respect to actual science, medical facts, statistics, and above all common sense with regard to this most prolific Vietnam Veterans nerve disorder. With wide ranging symptoms from constant discomfort and much pain to mimicking a muscular dystrophy issue with wasting and weakness of the limbs requiring a wheel chair or leg braces.

**NAS/IOM is the government-contracted agency that associates Veterans Medical Issues. The same government contracted agency that for 10 years led the finger pointing that stress in a 100-hour war where the enemy was retreating and being slaughtered caused all the death, disability, and birth defects in our returning Gulf War Veterans. Veterans now know better after 10’s of thousands became disabled and/or died and other INDEPENDENT studies show stress had nothing to do with this death and disablement.

Many Veterans that have dealt with the NAS/IOM and their total bias are now concluding they work at the behest of the White House/DVA connection only. Given requests to IOM to define the "evidences" of presumptive service and service connection, but in no way does anyone specify what that is or what level of proof is required; at least that anyone will admit.

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

What many government scientists do not take into account and totally disregard is Vietnam Veterans are a once in 500 years “environmental disaster victims.” Considering that no prior toxic chemical accidents or even farmers, railroad workers, forestry workers, etc., who used these toxic chemicals had total control over the dose or application rate. Veterans had no such control and were not only subjected to higher levels of TCDD formulas but dose or application rates at six to 25 times higher than what was recommended by the less than forthcoming chemical companies. Including, that Veterans were exposed to not only TCDD as in a separate herbicide but the herbicide used in and around Vietnam Veterans was a combination of herbicides. With additional forms of directed specific plant types of herbicides used, such as Agent Blue, also in their bodies at the very same time.

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 or total dose for Vietnam Veterans is much higher than even in the Love Canal disaster.

It is mind-boggling and heartless that while the government/DOD/VA lied to our nations warriors in 1982 that there was no TCDD impact. The whole town of Times Beach, Missouri was bought up and civilians told to leave and not come back.(1) Told to leave and not come back for TCDD exposures in the infamous Christmas message only at an exposure rate of an “exponentially number amount less” than the Vietnam Veterans were exposed. Yet, for the Nations Veterans the government/DOD/VA portrayed this TCDD exposure totally benign. Not telling the Veterans, they more than likely would develop many medical issues from this DOD/government mistake.

Big difference between the way the government treats its civilians versus the way the government treats its used up government assets since these used up government assets, the Veterans, are powerless; thanks to the congress to stop this government collaboration and conspiracy.

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.

“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)

“The evidence from the 1990 Ranch Hand study (Thomas, et al., 1990) is particularly compelling

“The VA proposed exclusion of peripheral neuropathies that only become evident 10 or more years after service in Vietnam, on the assumption that such a neuropathy could not be associated with Agent Orange exposure, due to the long interval from exposure. (2)

“This assumption contradicts the findings of the OTA, which found that neurological damage is not always detectable clinically, or noticeable by, the sufferer after exposure to a neurotoxic substance such as dioxin. As time progresses or old age approaches, the rate of natural neuronal cell death accelerates, and the results of earlier neurological damage may first become evident, or unmasked (OTA, 1990). The availability of alternate neuronal pathways is reduced, which were formerly responsible for compensating for earlier toxic damage. The OTA specifically noted the importance of research showing the possibility that neurotoxic substances were important in Alzheimer's disease, the degenerative brain disease of old age.” (2)

These found Ranch Hand medical dioxin correlation facts “were not published” in their released publications. One would wonder why?

One openly criticized fact is the cohort selection of the Ranch Hand study. The Ranch Hand study used those MOS’s associated with loading, spraying, and overall handling of the toxic chemicals. Yet, they were compared to other Vietnam Veterans that were supposedly never exposed. How this was ascertained at the inception of the study is unknown since the methodology for measuring dioxin was not recognized until 1987, while the first physicals were given in 1982. In using the dioxin method approved in 1987, the Ranch Hand made the decision to cut off at 10 parts per trillion (ppt). Even though the studies at Emory University show a correlation to an increase in cancer, any cancer, when going from 5 ppt to 10 ppt. (6)

Including the scientists could not correlate that this increase remained linear across the scale or did at some level become logarithmic or possibly a step linear progression.

Why this study did not use a cohort “not associated with Vietnam” in its correlation and statistical comparisons is a real question involving integrity of the study. Like comparing a sick two-story building with the 1^st and 2^nd floors only and then say, “see we found no statistical increases between the two floors in any disorders.” (Everyone in the building is sick and dying.)

Unlike our own government studies that refuse to statistically compare Vietnam Veterans and non-Vietnam Veterans, this study did compare “unlike Veterans” as well as had no default selection as to MOS, which limits the methods of exposure.

1973 and 1974 - “Similar findings were reported by Jerasneh, et al (1973, 1974) in a factory in Czechoslovakia which in 1965-68 produced 76 cases of chloracne, 2 deaths from bronchogenic cancers. Some workers had porphyria cutanea tarda, urophryimuria, abnormal liver tests, severe neurasthenia, depression syndrome, and peripheral neuropathy.” (9)

1975 - “An accident in West Virginia affected 228 people. Symptoms included chloracne, melanosis, muscular aches and pains, fatigue, nervousness, and intolerance to cold. (9)

In humans the IARC found that: a 23 year old farming student, who committed suicide, had 6 grams of 2,4-D in his body, acute congestion of all organs, severe degeneration of ganglion cells in his central nervous system, and three cases of peripheral neuropathy in humans sprayed with 2,4-D with initial symptoms of nausea, vomiting, diarrhea, swelling and aching of feet, legs with latency. (9)

In individual cases showed paresthesia in the extremities, pain in the legs, numbness and aching of fingers and toes, swelling in hand joints, and flaccid parapheresis. Similar case reports in agriculture workers sprayed by 2,4-D, or workers associated with 2,4-D developed symptoms of somnolence, anorexia, gastralgia, increased salivation, a sweet taste in the mouth, a sensation of drunkenness, heaviness of the legs and hyperacusea, rapid fatigue, headache, loss of appetite, pains in the region of liver and stomach, weakness, vertigo, hypotension, bradycardia, dyspeptic symptoms, gastritis, liver dysfunction, changes in metabolic processes. (9)

1977 - “The IARC International Agency for Research on Cancer reported in 1977 with respect to 2,4,5-T’s effects on humans that: workers exposed at a factory in the USSR had skin lesions, acne, liver impairment, and neurasthenic syndrome.” (9)

1985 - “The Hawaii Department of Health released an evaluation of the health of 418 Hawaii veterans of the Vietnam Era. The veterans for this study group were selected at random from both Vietnam and non-Vietnam veterans currently living in Oahu, Hawaii, and matched according to health status prior to military service. Veterans were sent questionnaires, followed up by letters and telephone calls, resulting in an 81% response rate.

These Vietnam Veterans show the same typical symptoms that many Vietnam veterans demonstrate in what seems to be some sort of “toxic chemical syndrome, which includes a chronic and debilitating neuropathy condition bordering on some from of MS.

1987 - the Department of Neurological Sciences at the St. Lukes Medical Center in Chicago published findings on the neurological damage to 47 railroad workers. These workers were responsible for cleaning up a 1979 spill of Monsanto's dioxin contaminated "OCP-Crude," a mixture of mono- to trichlorinated phenols. Two of the 47 workers committed suicide. Forty-three of the remaining 45 were diagnosed as having peripheral neuropathies. (The excess rate of suicides in this group is more than obvious.) (2)

1990 – The VA study of Army Chemical Corps units found excess deaths from nervous system disease. As well as the excess deaths from Hodgkin's disease, leukemia, and brain cancer. Deaths from nervous system diseases included two deaths (0.7 expected, SMR = 4.16) from amyotrophic lateral sclerosis and one from multiple sclerosis. These three deaths represented a fourfold increase in mortality from diseases of nervous system, although this excess was not statistically significant. The authors discussed the fact that although these diseases were of unknown origin, “recent epidemiological studies suggest a possible association between motor neuron disease and occupational exposure to organic solvents.”(2)

It must be pointed out that the Australians reported in their survey of over 44,000 Australian Vietnam Veterans that they expected to find two motor neuron disorders instead they found 128; with respect to MS they expected to find 19 instead they found 84.(10)

This was over a decade ago so what the increase in continued development is at present is not known. *Motor Neuron disorder is the European term for our amyotrophic lateral sclerosis (ALS).

Again, it must be pointed out that while the VA study did have cohorts that served in Vietnam as well as outside Vietnam the cohorts were the same in toxic chemical exposures. The comparison group was also Army Chemical Corps workers that sprayed the toxic chemicals in the United States. When asked why they did not use a toxic chemical clean comparison group as was recommended, the answer was. The NAS/IOM “did not mandate” such a comparison group. (11)

Commonly, railroad workers exposed were found to have intermittent distal paresthesia (abnormal sensations in the extremities, such as burning, prickling, "pins and needles," etc.), often with distal sensory loss of a mild degree, decreased reflexes, and electrical evidence of slowed conduction in one or more nerve. Thirty-five also manifested postural and terminal intention tremor that resembled benign essential tremor. The tremors were still progressing in some workers at the time the study ended.

Twenty-four had irregular involuntary contractions of the muscles, writer's cramp and/or other action of the hands, not seen initially, becoming prominent only several years after exposure. In all 24 of these individuals, the dystonic movements were associated with prolonged or continued muscle activity that invariably involved holding some object and moving that object in some way, e.g., writing, turning a screw driver, hammering, etc. (2)

It should be noted that the Ranch Hand transcripts also noted a found issue with Ranch Handers of difficulty in repetitive motions. Including in the first draft a reported finding of Ranch Handers experiencing “degenerating neurological disorders.” This was deleted from the published report because of statements that the “Exposure Index” was wrong. This is another criticism of the Ranch Hand report and that is the use of this Exposure Index that can be changed or manipulated. If that is the case then the study could just as well have said that the Ranch Handers were experiencing degenerating neurological disorders from eating too many C rations.

Prior to the development of the tremors, however, the railroad workers experienced a sense of fatigue and muscle aching. In physical examinations during 1981, a total of 22 of the 45 had indications of some cognitive impairment, commonly involving attention and concentration, based on subtests of the Wechsler Memory Scales, and on slowed reaction times.

In an examination in November 1981, all 45 had scores on the Beck Depression Inventory indicating some degree of depression.

1989 - Dow Chemical Corporation performed an analysis in 1989 of two groups of employees who had been employed sometime between 1937 to 1980, who had been exposed to dioxins, finding elevated soft tissue sarcomas, prostate, and stomach cancer. In addition, Dow found elevated deaths from vascular lesions of the central nervous system, although these excess were not statistically significant.

Seveso, Italy Residents in the 15-year mortality dioxin accident study found a “three-fold increase” in peripheral neuropathy.

Missouri Residents Exposed to Dioxin-Contaminated Soils, CDC Study.

In 1971, dioxin-contaminated oily wastes from 2,4,5-trichlorophenol and hexachlorophene production were mixed with waste oil and sprayed for dust control on roads in residential and recreational areas in eastern Missouri near St. Louis. In 1986, the CDC published a study documenting the health effects in residents exposed to the dioxin-contaminated soils around the Quail Run Mobile Home Park in Gray Summit, Missouri. The study subjects had lived in the area for at least six or more between 1971 to 1983, for an average of 2.8 years. A range of statistically significant adverse clinical tests and reported symptoms were found in the 154 exposed persons several years after exposure when compared to controls, including neurological and immunological abnormalities, abnormal liver enzymes, excretion of uroporphyrin suggestive of porphyria cutanea tarda, and dermatologic disorders.

Statistically significant differences were found between the exposed persons and the controls for 2 of the 14 self-reported neurological symptoms, including numbness or "pins and needles" (28.6% vs 18.1%; p < 0.05), and persistent severe headaches (26.0% vs 14.2%; p< 0.05). The statistical significance of these findings was found to persist when the CDC made adjustments for psychological stress (knowing you lived in a dioxin contaminated area), age, sex, and socioeconomic status. The exposed group also reported a greater prevalence of tremors (9.1% vs 3.9%; p = 0.07) and chronic memory loss (8.4% vs 3.2%; p = 0.06), although these differences were only of borderline statistical significance.

It should be noted also that the Ranch Hand study found a direct linear dose response to short-term memory loss, which also correlated to the number of days of exposure.

In 1990, the CDC published a follow-up study of the 41 Quail Run residents. Four of the exposed persons, upon medical examinations, were found to have abnormal pain sensation (pin prick) in the lower extremities. Five were found to have abnormal reflexes. These abnormalities were found almost two decades after exposure.

Central nervous system damage by dioxin (and other organic compounds such as solvents, discussed in a following section) occurs before any clinical diagnosis of peripheral nerve damage is possible. The effects of dioxin on the central nervous system include poor coordination and neuropsychiatric effects (depression, anxiety, loss of libido, suicide, decreased mental functioning, poor coordination, accidents, etc.). These central nervous system effects may be measured clinically by a range of memory, intelligence, coordination, and mental skill tests that require certain types of mental functioning.

Central nervous system effects will occur at lower exposures to dioxin that will result in any peripheral nerve damage that can be demonstrated clinically (such as by nerve condition test). The most severe consequences of central nervous system damage by dioxin is an excess of suicides, resulting from an underlying depression state, as well as fatal accidents arising from coordination dysfunction. The high rate of psychosocial problems experienced by Vietnam veterans thus appears to be related in part to dioxin exposure, and not solely to some unique stress from service in Vietnam.

Harvard Study of Vietnam Veterans with Organic Psychological Disorders.

In 1988, the Department of Psychiatry, Harvard Medical School published a study of the psychological disorders of Vietnam veterans heavily exposed to Agent Orange. The presence of chloracne (a skin condition resembling acne, persisting several decades after exposure) was used to indicate past heavy exposures to Agent Orange. A total of 1957 Vietnam veterans in the Boston area were contacted. Of these, 42 veterans reported a condition possibly indicative of chloracne. Six were confirmed to have current mild cases of chloracne.

Twenty-five control subjects, also Vietnam veterans, were selected at random. These controls were confirmed as not having chloracne, scars possibly indicative of chloracne, or recollection of any condition resembling chloracne. In order to account for the effect of combat stress, all of the control subjects were chosen to equal or exceed the combat experience of the exposed subjects. Reports of combat experience in all study participants were verified independently.

Common tests for central nervous system function include the following: Dotting tests require the placement, as rapidly as possible, of dots on either side of two parallel lines. Trail making tests require the subject to join numbered objects with a pencil mark. Visual Search tests require visual searching of a pattern for similarities. Digit Symbol tests require the subject to substitute symbols for the numbers 1-9 as rapidly as possible. The Grooved Pegboard test require the placement of 25 keys into shaped holes, etc.

A neuropsychological battery of tests sensitive to the effects of brain dysfunction was administered to the chloracne and control groups, as well as standardized interview to determine whether they experienced the symptoms of posttraumatic stress disorder (PTSD) in the last 6 months. The testers and interviewers were blind to the chloracne diagnosis of the veterans.

The exposed group scored significantly lower (indicating greater deficits) than the control group on six of the nine neuropsychological tests for brain dysfunction, and highly significantly lower on four of these tests (p < 0.01.)

The exposed subjects had significantly higher scores than did control subjects on the measures for PTSD. All of the exposed subjects met the diagnostic criteria for PTSD and the three associated features (depression, anxiety, and aggression). In contrast, in the control subjects, the PTSD rate was only 20%, and the rate for the three
associated features was only 8%.

The author of the study concluded that the statistical evidence for organic psychological deficits in the exposed subjects is very strong, based on the neuropsychological battery of tests, as well as on the difference in the rate of PTSD and the associated features of depression, anxiety, and aggression. There were enough significant correlations between the PTSD and neuropsychological measures to make it unlikely that this degree of association could occur by chance.

Significant exposure to Agent Orange, as measured by the presence of chloracne, appeared to increase the prevalence of PTSD. The probability of finding six PTSD cases in six veterans in the exposed group, based on the prevalence of PTSD in the controls (5 out of 25), was only 0.000064 (p= 0.000064). The level of combat experience was found not to be a likely explanation of the differences in PTSD scores, since two of the exposed subjects experienced only light combat, while all of the controls experienced heavy combat. Furthermore, the type of anxiety described by the exposed Vietnam veterans, on a subjective basis, differed substantially from the less exposed Vietnam veterans.

The 1990 study by the Department of Veterans Affairs (VA) on Vietnam veterans who had served in the Army Chemical Corps found an excessive hospitalization rate for mental disorders. These mental disorder diagnosis were accompanied by other findings of excess brain cancer, nervous system disease, and neurologically- based excess accidental

Out of approximately 1000 men serving in the Chemical Corps, 894 were located for the study. During the study period from 1978 to 1988, 136 out of the 894 Chemical Corps veterans were treated as inpatients in the VA medical system. Mental disorders were the most common primary diagnosis among the 136 patients. The VA provided no statistical analysis of these findings.

The February 1990 Air Force Ranch Hand follow-up morbidity report found a greater frequency of central nervous system deficits in some test categories for Ranch Hand veterans compared to controls. When Ranch Hand veterans or controls that had known past exposures to insecticides were excluded from the analysis (so that any neurological findings could be attributed solely to Agent Orange), Ranch Hand veterans exhibited a significantly elevated relative risk for a measure of cranial nerve function. Analysis disclosed marginally more balance/Romberg sign (standing without swaying when eyes closed and feet together) and coordination abnormalities for Ranch Hand veterans.

The Air Force study released in March 1991 correlated the physical health findings from the 1990 Ranch Hand study with “serum dioxin levels.” Dioxin levels were found to be significantly associated with poor coordination and deficits in a central nervous system index.

The CDC also has established increased occurrences of depression and anxiety in Vietnam veterans. In the 1988 Psychosocial Characteristics part of the Vietnam Experience Study (VES), the CDC found that among Vietnam veterans, certain psychological problems were significantly more prevalent, including depression (4.5% vs. 2.3%; odds ratio = 2.0; 95% C.I. = 1.3 - 1.8) and generalized anxiety (4.9% vs. 3.2%; odds ratio = 2.0; 95% C.I. = 1.1 - 2.1). About 15% of Vietnam Veterans experienced combat-related posttraumatic stress disorder at some time during their military service. Depression and anxiety were not restricted to the group of veterans having posttraumatic stress disorder.

In 1988, the American Legion-Columbia University Vietnam Veteran Study examined the health and reproductive outcome of Vietnam veterans in relation to past exposures to Agent Orange. The study was conducted by Dr. Jeanne Stellman, Professor of Public Health at Columbia, and Dr. Steven Stellman, the Assistant Vice President for Epidemiology at the American Cancer Society. An Agent Orange exposure estimation methodology was developed based on the Department of Defence spray mission data and troop movement files development by the U.S. Army and Joint Services and Environmental Support Group.

Agent Orange exposure status was scored for 2087 men who served in Southeast Asia, categorized as low (0 -0.097) for 947 men, medium (0.098 - 0.308) for 583 men, and high (0.308 -9.9) for 557 men. The Vietnam veterans responding to the questionnaire did not know their exposure status ranking. A group of 102 Vietnam veterans who had handled Agent Orange directly were placed in a separate category.

A health "symptom complex" scale was developed that could indicate neurological effects from Agent Orange exposure, which included reports of either feeling faint, fatigue, or aches. Compared to veterans of the same era who did not serve in Vietnam, a statistically significant greater number Vietnam veterans overall were found to report these symptoms (p < 0.001). For veterans who were herbicide handlers, when compared to other Vietnam veterans, there were also significantly higher reports of these symptoms (p < 0.001 - 0.05).

Monsanto 2,4,5-T Production Workers.

In an independent 1984 study of workers at Monsanto's Nitro, West Virginia 2,4,5-T manufacturing plant, workers who had exhibited chloracne (a criteria for exposure) had statistically significant (p < 0.025) higher prevalence of reported symptoms of muscle pain, insomnia, as well as reported sexual dysfunction and decreased libido. A study published in the same year by Monsanto Corporation also found statistically significant increased incidences for three neurological/psychological syndromes. For nervousness/anxiety/depression, the rate ratio for all exposed workers compared to "unexposed" workers at the same plant was 1.3, which increased to 2.9 for the subgroup of exposed workers over the age of 50. For decreased libido, the rate was higher among exposed workers (rate ratio = 2.28). For impotence, the rate was higher among exposed compared to unexposed workers (rate ratio = 2.35).

The 1986 CDC study documenting the health effects in residents exposed to the dioxin-contaminated soils around the Quail Run Mobile Home Park in Gray Summit, Missouri found psycho neurological and neuropsychiatric abnormalities. A statistically significant difference between the exposed and non-exposed group was found for the vocabulary subset of the Wechsler Adult Intelligence Scale. The exposed group was found to have statistically significant higher (more abnormal) scores on the tension/anxiety and anger/hostility scales. In addition, the scores of the exposed group were higher for the depression/dejection and fatigue/inertia scales, although these differences were not statistically significant. The exposed group also consistently took longer to complete and made more errors in the Trail Making tests.

Earlier Studies Establishing Neuropsychiatric Abnormalities from Exposures to Dioxin

Earlier studies have also established a casual link between occupational exposures to dioxin and psychological abnormalities. In a 1981 study of dioxin-exposed residents in Seveso, Italy, there was a nearly threefold higher incidence of peripheral neuropathy in those subjects exhibiting signs of dioxin exposure, such as chloracne or abnormal serum hepatic enzymes. In one study of workers at a U.S. 2,4-D and 2,4,5-T manufacturing plant, workers with the most severe chloracne scored significantly higher on the manic scale of the Minnesota Multiphasic Personality Inventory (MMPI) than those workers who had less severe acne (p< 0.05).

A study of three laboratory scientists who had transient minimal exposure to dioxin found them to have personality changes and other neurological disturbances, as well as chloracne in two of the scientists.

A study published in 1981 showed markedly higher rates of both nerve damage and psychiatric problems in Czechoslovakian 2,4,5-T production workers. This study is important in showing the central nervous system involvement, manifesting as neuropsychiatric disorders, when peripheral nervous system damage was diagnosed. Sixty four percent of the 55 workers were found to have psychiatric changes, severe neurotic symptoms, and signs with disorders of the vegetative nervous system. Eleven percent exhibited neurasthenia syndromes with depressive components. Fourteen percent exhibited pseudo neurasthenia syndromes where there was arteriosclerosis of the central nervous system.

Although, the authors of the study for comparison provided no controls or standard incidences of these abnormalities for the general population, the relative rates were obviously and strikingly elevated. In 1968 and 1969, 80 out of 400 2,4,5-T production workers became ill, and 55 were admitted into the Department of Occupational Diseases University in Prague. Out of the 55 workers, 23 percent were found to have neurological effects at the time of the onset of illness, with 31 percent currently. These neuropathies predominantly consisted of peripheral neuron lesions in the lower extremities (peripheral neuropathy), verified by electromyography. Seven percent had encephalopathy (atherosclerosis of the cerebral arteries) at the time of onset of illness, with 9 percent suffering from this disorder after 10 years. In some patients, symptoms became more severe during the 3 to 4 year period after the initial illness, and illness persisted in all of the patients at the time of the publication of the study.

Studies on several populations exposed to dioxin and phenoxyacetic acid herbicides have demonstrated statistically significant increased risks of suicide. The fact that elevated suicide rates were found in forestry workers as well as in chemical production workers, argues against the excess suicides among Vietnam veterans being attributable solely to
psychological disorders unrelated to dioxin exposures (such as combat related posttraumatic stress disorder).

Furthermore, a significant fraction of the excessive rates of accidental deaths among Vietnam veterans and dioxin-exposed chemical production workers, are probably due to suicide. This is because a corner's report does not indicate suicide for a death certificate unless the victim clearly indicated intent to commit suicide, or the evidence clearly indicates suicide. Suicides may be intentionally disguised as fatal accidents, drug overdose, and single driver accidents.

A 1988 study by the Massachusetts Department of Public Health found elevated estimated suicide deaths in Vietnam veterans compared to either non-Vietnam veterans (standardized mortality odds ratio (MOR) =1.46; 95% C.I. = 0.89 - 2.37) or non-veteran male controls (MOR) = 1.73; 95% C.I. = 1.22 - 2.44).

In 1985, the New York State Department of Health, in conjunction with the VA and NCI, published a study of causes of death among New York State (excluding New York City) Vietnam veterans between 1965-1967 and 1970-1980. Both non-veterans and non-Vietnam veterans were used as controls. Statistically significant excess suicides were observed for Vietnam veterans compared to non-veterans (adjusted Mortality Odds Ratio [MOR] = 1.62, C.I. = 1.44 - 1.82). Excess suicides were also observed when Vietnam veterans were compared to veterans who did not serve in Vietnam (MOR = 1.24, C.I. = 0.88 - 1.75), although this excess failed to reach statistical significance.

In 1987, the CDC published findings of the causes of death in 9324 U.S. Army veterans who served in Vietnam, compared to 8989 non-Vietnam veterans. Excess mortality in Vietnam veterans occurred mainly in the first five years after discharge from active duty (rate ratio = 1.45; 95% C.I. = 1.08 - 1.96). The CDC found that Vietnam veterans (as a whole group, without controlling for the most heavily exposed) had increased risks for dying from suicide within five years post discharge (rate ratio = 1.72; 95% C.I. = 0.72 - 3.88). In addition, it was found that Vietnam service had a greater effect on mortality for those who were discharged before 1970, compared to those discharged during 1970 or later (p = 0.05). The elevated death rate for discharge before 1970 corresponds to the fact that Agent Orange spraying reached a peak in 1969, tapering off in 1970, and eventually was stopped completely in 1971.

The 1986 Wisconsin Department of Health study found significantly elevated deaths from
suicide among Wisconsin Vietnam veteran compared to non-veterans (civilians) (SMR = 1.18; p < 0.05). Elevated rates were also found when Vietnam veterans were compared to other veterans who had not served in Vietnam (SMR = 1.14), although in this comparison the difference failed to reach statistical significance.

The Australian Veterans Health Services published a mortality study comparing 19,205 Australian Vietnam veterans with 25,677 non-Vietnam veterans who served only in Australia. For the period from 1983 to 1985, death rates from suicide were significantly elevated (odds ratio = 1.5; 95% C.I. = 1.0 - 2.4).

215. In 1991, the Ontario electrical utility company published a mortality study of 1222 men employed by the company between 1950 through 1982 for at least 6 months, who were exposed to phenoxyacetic acid herbicides. Herbicides were used to clear the right-of-way for power lines. Most forestry workers were exposed to herbicides on a weekly basis throughout the year, and no protective clothing was worn in the 1950s and 1960s. The most commonly used herbicides were 2,4-D and 2,4,5-T (2,4,5-T up until March 1979).