DEPARTMENT OF VETERANS AFFAIRS

Veterans Health Administration

Washington DC  20420

 

 

 

                                                                                                            IL 10-2006-010  

                                                                                                            In Reply Refer To:  13

August 14, 2006

 

UNDER SECRETARY FOR HEALTH INFORMATION LETTER

 

POTENTIAL HEALTH EFFECTS AMONG VETERANS INVOLVED IN

MILITARY CHEMICAL WARFARE AGENT EXPERIMENTS

CONDUCTED FROM 1955 TO 1975

 

1.  This Under Secretary for Health’s Information Letter (IL) provides information to clinicians who examine and provide care to veterans who may have been exposed to various chemical warfare agents as part of human experiments conducted by the Department of Defense (DOD) from 1955 to 1975.

 

2.  Background

 

      a.  On June 30, 2006, the Veterans Benefits Administration (VBA) released the first in a series of notification letters to DOD-identified veterans who were exposed to chemical warfare and related agents as test subjects in military experiments.  These experiments took place primarily at military facilities in Edgewood, MD, from 1955 to 1975.  The letter informs veterans of benefits to which they may be entitled and advises them to discuss any health concerns they may have with their VA health care providers. 

 

      b.  The United States (U.S.) military has had an active chemical warfare program since World War I that included experiments using “soldier volunteers” to test protective clothing and masks, and the potential impact of chemical warfare agents on military personnel.  In earlier experiments concluded by the end of World War II, about 60,000 U.S. service members had been experimentally exposed to mustard and Lewisite blister agents.  NOTE:  Veterans Health Administration (VHA) policy, historical background and relevant clinical information on the military mustard and Lewisite experiments, is available at: http://www.va.gov/EnvironAgents/docs/USHInfoLetterIL10-2005-004_March_14_2005.pdf. 

      c.  More recently, the focus has been on experiments conducted by DOD with a wide range of newer chemical warfare agents, conducted at the U.S. Army Laboratories, Aberdeen Proving Ground, Edgewood, MD (Edgewood-Aberdeen) and other military facilities, from about 1955 to 1975.  Potential long-term health effects among the veterans affected by these experiments are the focus of the current VBA outreach letter writing campaign.

 

      d.  The Edgewood-Aberdeen experiments involved at least 6,700 “soldier volunteers” exposed from about 1955 to 1975 to more than 250 different agents.  The agents tested involved about half a dozen pharmacological classes, including common approved pharmaceuticals or similar compounds, anticholinesterase nerve agents (e.g., sarin and common organophosphorus (OP) and carbamate pesticides), glycolate anticholinergic agents (e.g., nerve agent antidotes atropine and scopolamine), nerve agent reactivators (e.g., the common OP antidote 2-PAM [2-pyridine aldoxime methyl chloride] and related compounds), psychoactive compounds (e.g., LSD [D-lysergic acid diethylamide] and PCP [phencyclidine]), cannabinoids (related to the active ingredient of marijuana), and irritants (e.g., tear gases).  Although records are poor and often incomplete, some veterans were exposed only to placebos such as saline, or other common substances such as alcohol or caffeine. 

 

      e.  Originally conducted in secret, there is a great deal of information today describing these experiments in open literature, including congressional hearings, media accounts, and reviews and epidemiological studies from scientific organizations, including the National Academy of Sciences and others.  Importantly, DOD has declassified many of the details of these experiments that are relevant to benefits claims of the veterans who participated. 

 

      f.  Although no longer secret, many health care providers are not aware of this history and how these experiments may have affected the health of veteran patients today.  This Under Secretary for Health Information Letter is intended to inform health care providers who may see such veterans as patients.

 

3.  Guidance

 

      a.  VA health care providers can be assisted when they are providing care to veterans who may have been exposed to chemical warfare agents as part of human experiments conducted by DOD, by referring to www.va.gov/EnvironAgents/docs/Fact_Sheet_Edgewood-aberdeen_Chemical_Agent_Experiments_Information_Paper.pdf.  There are no tests available today that can confirm exposure to these agents decades in the past.  Therefore, medical care providers need to focus upon the current health of the veteran, i.e., taking a thorough military and medical history, including information on participation in chemical warfare agent experiments, along with a basic medical examination that includes appropriate laboratory tests relating to the veteran’s complaints and medical findings.  NOTE:  A VA pocket card on taking a military service history is available at www.va.gov/oaa/pocketcard/.

 

      b.  Review of the literature and VA policy (described more fully at www.va.gov/EnvironAgents/docs/Fact_Sheet_Edgewood-Aberdeen_Chemical_Agent_Experiments_Information_Paper.pdf.) does recognize a number of illnesses as presumptively service-connected among veterans with “full-body” exposure to mustard agents (used in some of the Edgewood-Aberdeen experiments) and Lewisite (used in early experiments through the end of World War II), which should be considered during a medical examination.  These include:
 

 

      (1)  Chronic conjunctivitis, keratitis, corneal opacities, scar formation, or the following cancers: nasopharyngeal, laryngeal, lung (except mesothelioma), or squamous cell carcinoma of the skin (from exposure to nitrogen and sulfur mustard agents only). 

 

      (2)  Chronic laryngitis, bronchitis, emphysema, asthma or chronic obstructive pulmonary disease (from exposure to nitrogen and sulfur mustard agents and to Lewisite). 

 

      (3)  Acute non-lymphocytic leukemia (from exposure to nitrogen mustard only).

 

      c.  Veterans need to be informed that seeking care for conditions possibly related to exposure to mustard agents and Lewisite does not constitute a claim for compensation, although the findings of clinical examinations can aid in the adjudication of compensation claims.  NOTE: Veterans wishing to file a compensation claim need to be referred to a Veterans Benefits Counselor, or be advised to contact the appropriate VA Regional Office at 1-800-827-1000.

 

      d.  Treatment of the diseases VA presumes to be from the long-term consequences of mustard agents and Lewisite exposure, such as bronchitis, cataracts, etc. is the same as the treatment of those same diseases from other causes.  

      e.  VA does not presumptively recognize any long-term health consequences from exposure to other classes of agents tested in the Edgewood-Aberdeen experiments including conventional pharmaceuticals, anticholinesterase nerve agents such as sarin and common organophosphorus pesticides, glycolate anticholinergic agents such as atropine and scopolamine, nerve agent reactivators such as 2-PAM, psychoactive compounds such as LSD and PCP, cannabinoids, or irritants such as tear gases.  However, specific health problems may be linked to service-related chemical exposures on an individual basis when there is evidence of a causal link to military service. 

      f.  Review of the literature (described in the document “Chemical Warfare Agent Experiments Among U.S. Service Members,” available at www.va.gov/EnvironAgents/docs/Fact_Sheet_Edgewood-Aberdeen_Chemical_Agent_Experiments_Information_Paper.pdf) indicates that many veterans involved in the Edgewood-Aberdeen experiments exhibited signs and symptoms of acute toxicity when experimentally exposed to these agents.  Available evidence and follow-up study in general does not support significant long-term, physical harm among subjects exposed to acutely toxic amounts of these agents other than mustard agents and Lewisite.  Long-term psychological consequences, however, are possible from the trauma associated with being a human test subject.  Consequently, veterans presenting with health concerns should be handled on a case-by-case basis, supported by the relevant history, relevant epidemiological evidence and clinical information for long-term health concerns related to these experiments and described in the on-line document.

 

      g.  For more information, veterans can be informed about DOD’s hotline number at 1- 800- 497-6261, which is also included in the letter that they are receiving from VBA. 
 

 

4.  Contact.  Questions regarding this information letter may be addressed to the Environmental Agents Service (131) at (202) 273-8579. 

 

 

 

 

 

 

Michael J. Kussman, MD, MS, MACP

 

Acting Under Secretary for Health

 

DISTRIBUTION:

CO:

E-mailed 8/15/06

 

FLD:

VISN, MA, DO, OC, OCRO, and 200 – E-mailed 8/15/06