New Information on Hypertension Associated to Herbicides

On June 10, 2008, Secretary Peake announced that, based on the National Academies of Sciences (NAS) Institute of Medicine report, there was no evidence to support the presumption of service connection for hypertension due to herbicide (Agent Orange) exposure. In Fast Letter (FL) 08-14, Interim Guidance on Claims Involving Hypertension Based on Herbicide Exposure, released on May 21, 2008, we instructed the field to control these claims using a future end product (EP) 695 maturing on September 1, 2008. This FL is now rescinded.

Effective immediately, please commence processing all claims or appeals involving service connection or dependency and indemnity compensation for hypertension based on herbicide exposure. If a rating EP does not exist, establish a rating EP using the date of the announcement as the effective date (June 10, 2008), or if a subsequent claim is received thereafter, use the date of receipt as the date of claim.

Fast Letter (FL) 08-15, Overview of Changes Made By Public Law 110-181, the National Defense Authorization Act for Fiscal Year 2008

Fast Letter (FL) 08-15, Overview of Changes Made By Public Law 110-181, the National Defense Authorization Act for Fiscal Year 2008, was posted May 21, 2008. This FL provided guidance regarding statutory changes that impact delivery of VA disability benefits. This FL also contains information involving disability severance pay, Combat-Related Special Compensation (CRSC), Concurrent Retirement and Disability Pay (CRDP), and certain educational and health care benefits.

Once again the IOM/VA connection has collaborated to deny what seems to be an obvious connection to increased hypertension and outcomes of such a medical anomaly in strokes, brain atrophy, and heart disease. With Secretary Peake being “the judge” and then using “the jury” at the IOM to pronounce sentence. Yet, there is no legal aspect to this government tyranny that the victim (Veteran/Widow/Orphan) has privy to nor can redress at the constitutional level of justice, or is this even a form of justice or just decrees by a government that knows it made a huge colossal mistake.

Here is what I found based on review of studies, science articles, medical books, testing and pathology, etc. Now there are references to other issues found associated that many of you are interested in but I am only focusing on hypertension since it is the latest FUBAR by the VA/IOM.

In a published study in the American Journal of Industrial Medicines, Dr. Kang who is the Director, Environmental Epidemiological Service, Department of Veterans Affairs; his study shows the following:

Methods A health survey of these 1,499 Vietnam veterans and a group of 1,428 non-Vietnam veterans assigned to chemical operations jobs was conducted using a computer assisted telephone interview system. Exposure to herbicides was assessed by analyzing serum specimens from a sample of 897 veterans for dioxin. Logistic regression analyses were used to estimate the risk of selected medical outcomes associated with herbicide exposure.

Results Odds ratios for diabetes, heart disease, hypertension, and chronic respiratory disease were elevated, but not significantly (p>0.05) for those who served in Vietnam. However, they were significantly elevated among those Vietnam veterans who sprayed Herbicides: diabetes, OR=1.50 (95% CI=1.15-1.95); heart disease, OR=1.52 (1.18-1.94); hypertension, OR=1.32 (1.08-1.61), and chronic respiratory condition, OR=1.62 (1.28-2.05).

Hepatitis was associated with Vietnam service, but not with herbicide application.

There was no statistically significant effect due to Vietnam service in general for each of these four conditions when adjustments were made for the other covariates. However, each of these four conditions was significantly associated with a history of spraying herbicide: diabetes OR=1.50(95% CI=1.15-1.95); heart disease

OR=1.52 (95% CI=1.18-1.94); hypertension OR=1.32(95% CI=1.08-1.61); and chronic respiratory disease OR=1.62(95% CI=1.28-2.05

(p>0.05) You will notice here that Dr. Kang did not give the real data of significance factor but only that it was greater than the statistical scientific standard of 0.05. Nice touch! It could have been p>0.051 and we as victims would never know what the hell this scientists did to get to that number and how many induced errors that may have been used. The other issue is timing in the persistent body destruction of dioxin. Most of those that sprayed in Vietnam and the most heavily exposed were probably already dead and if this study had been done 30 years ago the scales of significance factors would have tipped the other way. In addition, those Vietnam Veterans that had already participated in the previous questionable study as to cohort selection; where not allowed in this study.

Doing a study 40 years after the fact and not considering those that are no longer with us or those that may have been the worst off is nothing but introduced bias, when considering the persistent effects of dioxin.

“Vietnam service in general” …I have no idea what this means in a quantitative objective data point! Does this once again go back to the actual significance level not being given? Does in general mean a significance factor of p>0.051 and in general terms of scientific notations does not cross the threshold of being significant? Many statisticians will tell you that if it is close to significance it should be considered given some of the introduced errors that denies a valid significance.

Epidemiological studies are normally done to prove one thing, not the real facts. That one thing is normally being paid for by the interested party. There are many ways to introduce error rates that have no bearing on the actual findings.

The positive finding of an association between phenoxyherbicide exposure and circulatory diseases (including hypertension requiring medication) is also consistent with the results reported in other occupational/community cohorts. An increased risk of death due to heart diseases was reported in the expanded IARC international cohorts (RR=1.7, 95% CI=1.2-2.3), the NIOSH occupational cohort (SMR=1.1, 95%CI=1.0 -1.2), enlisted Ranch Hand personnel, 15-year follow-up (SMR=1.5, 95%CI=1.0-2.2), 20-year follow-up (RR=1.7, 95%CI=1.2-2.4), and the Seveso community cohort (heart disease RR=3.0, 95%CI=1.2-7.3; hypertensive disease RR=3.6, 95%CI=1.2-11.4) {HOLY RISK RATIO BATMAN^&%$*(()&!} [(Vena et al., 1998; Steenland et al., 1999; Michalek, et al., 1998; Ketchum and Michalek, 2005; Pesatori et al., 1998]. In animal studies, dioxin was reported to cause disturbances in lipid metabolism and cardiovascular functions, and morphologic changes in peripheral vessels [Schiller et al., 1985; Hermansky et al., 1988; Kociba et al., 1978].

Vietnam service and chronic health conditions:

Table II shows the prevalence of selected chronic health conditions among 1,499

Vietnam veterans and 1,428 non-Vietnam veterans who participated in the study. The odds ratios, adjusted for age, race, BMI and current smoking status, were significantly elevated for hepatitis, all cancer, respiratory problems, “poor” current health status, and work limitation among Vietnam veterans as compared to non-Vietnam veterans. The other outcomes such as diabetes, heart conditions, and hypertension were also elevated, but were not statistically significant (p> 0.05).

Lets review the highlights again: The odds ratios were significantly elevated among Vietnam veterans as compared to non-Vietnam veterans.

(p> 0.05). Once again we do not know how significant or how close to significance and the influencing factors that may or may not have been considered this late in any study where the worst from Vietnam are probably dead.

As described above shown in the below chart you will notice in every category the Vietnam Veteran is worse off than their counterparts who sprayed outside of Vietnam (although we do not know where!)

TABLE II. Prevalence and adjusted odds ratios for selected health conditions among U.S. Army Chemical Corps veterans associated with Vietnam service.

(a) = Adjusted odds ratio and 95% confidence interval for each disease condition associated with Vietnam service was derived from a logistic regression model with adjustment for age, race, body mass index, rank and regular smoking.

(b) = The condition category “All Cancer” excludes non-melanoma skin cancers.

(c) = The condition category “All Respiratory Problems” includes all non-malignant respiratory conditions.

However, this seems to indicate the significant difference between Sprayers and not the Vietnam Veteran versus the non-Vietnam Veterans who were not sprayers. That has been the question now for decades that congress has allowed the DoD/VA/IOM to tip toe around. Did the Vietnam Veteran or herbicide era veteran suffer increased risk of incidence factors from that service in Vietnam in what we know for a fact was in a government created toxic herbicide(s) chemical environment with increased toxicity and increased dose rate (6 to 25 times) per acre.

“In summary, almost three decades after Vietnam service, U.S. Army veterans who were occupationally exposed to phenoxyherbicide in Vietnam experienced significantly higher risks of diabetes, heart disease, hypertension and non-malignant lung diseases than other veterans who were not exposed to herbicides.”

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

The Act noted above is the Veterans’ Dioxin and Radiation Exposure Compensation Standards Act, Pub. L. 98—542, Oct. 24, 1984, 98 Stat. 2727.

Prior to the massive issues with the herbicides It has always been the policy of the Veterans Administration and is the policy of the United States, with respect to individual claims for service connection of diseases and disabilities, that when, after consideration of all the evidence and material of record, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of a claim, the benefit of the doubt in resolving each such issue shall be given to the claimant.

VA changed the rules specified by Dioxin Standards Act; the VA not only confounded the 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, increased risk of service associated diseases in an area such as a third world country where normal diseases such a TB had been wiped out here but after returning from say Turkey or the Azores where TB was rampant in an Air Force assignment or even in confinement such as POW; promulgating instead the more stringent requirement that compensation depends on establishing a cause and effect relationship directly to one single dioxin and that being TCDD. No fairness in this deal and certainly prejudicial against the Veteran/Widow/Orphan.

Then we have other studies that were totally blind analysis that demonstrates clear data in comparing Vietnam Veterans regardless of MOS versus Non-Vietnam Veterans regardless of MOS.

“Abstract: In order to determine whether Agent Orange exposure was associated with increased frequency of medical problems we conducted a cross-sectional epidemiological study of Korean Veterans during 1995 – 1996. Exposure to Agent Orange was assessed by structural in-depth interview on the participants’ history of service n Vietnam. Health outcomes were assessed by a standardized comprehensive clinical investigation by a group of clinical specialists. The differences in the prevalence of various medical diagnoses were assessed by Cochran-Mantel-Haenszel chi-square tests comparing the exposure levels of Vietnam veterans, adjusting for age. Multiple logistic regression was performed to estimate the effect of “service in Vietnam” adjusting for age, smoking, alcohol, body mass index, education, and marital status. Vietnam veterans had an increased frequency of eczema (odds ratio [OR] = 6.54), radiculopathy (OR= 3.98), diabetes (OR = 2.69), peripheral neuropathy (OR= 2.39), and hypertension (OR = 2.29), compared to non-Vietnam veterans adjusting for potential confounders. In addition, higher levels of exposure among Vietnam veterans were associated with increased frequency of ischemic heart disease (p<0.01), valvular heart disease (p<0.01), and retinopathy (p<0.01).

We concluded that exposure to Agent Orange is associated with various health impacts in Korean Vietnam veterans.”

"The patterns of the medical problems among Vietnam Veterans in our study appear to be somewhat consistent with previous reports from Operation Ranch Hand study and others. However we observed an additional pattern that hypertension and ischemic heart disease were associated with exposure levels.

Odds Ratio for Hypertension OR = 2.29 (95% CI = 1.33-3.95) with a found association to exposure status of p = 0.003."

Add in the Seveso study mentioned above by Dr. Kang for Hypertension with a Risk Ratio of RR=3.6, 95%CI=1.2-11.4 then it becomes somewhat obvious there is a connection.

Now whether a study uses Risk Ratio or Odds Ratio they both mean the incidence odds ratio and anything above the number 1 or even, given the 95% confidence levels, is an increase in incidence to the comparison of 1.

“The results were consistent with the results from stratified analysis. Eczema showed a strongest association with Vietnam Veterans compared to Non-Vietnam Veterans and radiculopathy had the next strongest associations, followed by diabetes, peripheral neuropathy, and hypertension.”

“We observed excess frequencies of several medical problems such as diabetes mellitus, eczema, hypertension, peripheral neuropathy, and radiculopathy, among Vietnam veterans compared to non-Vietnam veterans. The increased frequencies of these diseases remained significant even after adjusting for age, smoking, alcohol, body mass index, education, and marital status. Also increased were vasculopathy and brain infarction. In addition, ischemic heart disease, valvular heart disease, and retinopathy were significantly associated with the levels of exposure to Agent Orange, among Vietnam veterans. These findings coherently suggest that Vietnam veterans have higher frequency of vasculopathy in association with Agent Orange exposure.”

Then Kurt found this study late last night by Dr Michalek using Ranch Hand Data which in a previous e-mail regarding IOM, Dr. Michalek had agreed the cohort comparison data and assumptions was invalid and the previous media reports on this subject I had posted at: http://www.2ndbattalion94thartillery.com/Chas/mediareports.htm

ABSTRACT

We studied the risk of hypertension and exposure to 2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD) in Veterans of Operation Ranch Hand, the Air Force unit responsible for the aerial spraying of Agent Orange and other TCDD contaminated herbicides in Vietnam. We included a Comparison group of other Air Force Veterans who flew or serviced C-130 aircraft in Southeast Asia during the same calendar period that the Ranch Hand unit was active in Vietnam (1962-1971) but were not involved with spraying. We measured TCDD serum level in 1987, 1992, and 1997. There was no overall increase in the risk of hypertension in the Ranch Hand cohort, however, within both cohorts, the risk of hypertension was markedly increased with TCDD. …

While the lack of an overall between group differences in hypertension risk suggested that TCDD was not a risk factor for hypertension, these within-group associations suggested the mechanisms regulating TCDD uptake and clearance were associated to body weight and the pathophysiology of hypertension.

The data above reflects the cohort invalidating issues that we know are factual. The abstract denotes no increase in hypertension when comparing Ranch Hand to other Vietnam Veterans but then turns around and says both cohorts the risk of hypertension was markedly increased with respect to the dioxin, TCDD.

What is the bottom line in this fiasco used by IOM to deny associations? If you served in Vietnam you were exposed to TCDD and that TCDD was found to be markedly associated with the development of hypertension in both cohorts.

This also goes back to my posting below on the comparison groups and how comparing one group to another or one contamination point to another can mislead and misrepresent the effects or that any effects were even created. Our own government studies seem to be the master of these "slight of hand" studies, swallowed hook line and sinker by IOM. http://www.2ndbattalion94thartillery.com/Chas/IOMParkinson's.htm

In the discussion below I tried to display the connection with other issues found thinking I was out on a limb but if you read some of the other statements by this study it seems I was more correct than not!

Additional from that study which in all reality had old data if you consider the persistence of dioxin and its causations. Which is where I had indicated establishing trends as associated and considered service connected that would be expected to diverge not converge with time.

Folks I have no idea what in the hell this is saying nor what in the hell it is trying to prove other than both cohorts with TCDD of at least 5 ppt are at significant risk of hypertension and are sick. Also I question the 5 ppt since the VA study used two categories of 2.5 ppt and 5 ppt. And if you ignored the TCDD dichotomy then what is this study doing if anything. I am at a loss for words on this deal.

Later on the study discussed the association of lipid issues and triglycerides that seemed to accompany this issue so maybe by extraneous pontificating analysis or suggested dioxin created co-issues creating hypertension and other vascular issues is not that far off base.

How Congress can explain all this away to the Veterans and the Widows that are left as to what Secretary Peake and the IOM is doing in some from of legalized government tyranny is the question.

Lets drop back some and look at what Ranch Hand found and probably should have been an indicator of things to come for the Vietnam Veteran.

In the 1999 August RANCH HAND Transcripts a found relationship between triglyceride levels and dioxin levels was discussed.

Now what does a relationship between dioxin levels and increased triglycerides mean in the context of hypertension?

It is clear there is a connection in medicine to increased triglycerides (blood fat) and is a strong predictor of a risk of stroke, ischemic stroke, and transient ischemic attacks (TIA) or mini-stroke. This high triglyceride issue for increased risk of stroke is beyond just cholesterol issues. For instance, the Vietnam Veteran increased triglyceride level should be considered a dioxin risk factor regardless if cholesterol is normal or slightly dysfunctional. For years now as I have been reviewing these studies and finding the connections I have said that increased triglycerides should have been monitored decades ago and treated for the Vietnam Veteran along with a semiannual blood test for vascular inflammation called hs-CRP which measures the highly sensitive C-reactive protein.

Individuals with higher than normal triglycerides usually have high blood pressure or hypertension problem and can develop into insulin resistance and even pancreatic issues.

Now we have at least some semblance of a biological plausibility with the findings of Ranch Hand directly to dioxin and triglycerides and we have the studies that show increases in hypertension to dioxin levels and/or service in Vietnam.

So how is it still denied and more recently categorically stated by the Secretary of the VA using the questionable and subjective findings of the IOM? They have the legal power to do so no matter how much evidence is submitted and supported by study findings or empirical data points.

Below are Extraneous to this discussion but a valid point I think? Not being the sharpest tack on the wall I am sure.

But lets go one step further into the biological plausibility of the dioxin-damaged nervous system creating these issues. We already know that the peripheral nervous system is affected in many ways even though the VA/IOM consortium denies what studies have found including the Ranch Hand study in PNS damages across all indices of exposures.

It would improbable and very problematic to believe that with this much evidence of the PNS being damaged that the Autonomic Nervous System ANS would not be affected at all. What many folks do not realize is the tremendous effect the Autonomic System has in unconscious functions in the body. Divided into two separate functionalities such sympathetic and parasympathetic. One of these functions in digestion is the control of Lipolysis.

Lipolysis is the breakdown of fat stored in fat cells. During this process, free fatty acids are released into the bloodstream and circulate throughout the body.

One of the functions of the Sympathetic (adrenergic) Autonomic Nervous system is to stimulate Lipolysis. If that is degraded then from above one can see how this could create increased levels of triglycerides in the blood stream as well as other issues in platelet makeup, digestion problems, insulin issues, triglyceride absorption, fat absorption, disturbance in immune and cytokine homeostasis, etc.

So it is not just a finding of increased triglycerides and dioxin levels that are at issue as a stand alone but the actual issues going forward.

The autonomic nervous system is involved in the modulation ofglucose homeostasis, coordinating gastric emptying, intestinaltransport of ingested nutrients, and coupling of glucoregulatoryhormones from the gut and pancreas

If the autonomic nervous system stimulates Glucagon-Like Peptide-1 (GLP-1) it reduces intestinal lymph flow, triglyceride absorption, and apolipoprotein production in rats.

By modulation we must remember that many of these ANS activities come in spurts of less than two minutes and are constantly being updated.

And even though this has never been done that I know of for dioxin victims and/or Vietnam Veteran versus Non-Vietnam Veteran the timing is measurable in test conditions.

This one fault tree in the ANS certainly could account for the increase in triglycerides, metabolism issues, diabetes, cardiovascular issues, hypertension, vasculopathy described previously, gastrointestinal issues, strokes, mini strokes, etc.

I do recall the mini strokes being brought up in the Ranch Hand transcripts and the vascular/cardio, ischemic heart damage issues also but as you know it would do no good for me to go back, spin my wheels and find it. IOM and VA would just deny it anyway.

Just like they have on all the overwhelming findings of PN damages not associated to diabetes but dioxin, TCDD.

Outside of VA, IOM has got to be the Veterans/Widows worst enemy. Congress has got to get to the bottom of these issues in telling us what process anyone involved in these issues is using; at least that much should be transparent so we can try and take some legal action at the constitutional level.

This should be a subject at every town hall meeting for any one running for congress that any Veteran/Spouse/Widow attends to demand some answers as to how and what is the process and how is it legal and meets the definition of legal matters in a court of law since basically that is what IOM is doing with no legal accountability to the victims.