Public Health

Agent Orange Newsletter - 2024

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In this issue:

• Your Military History: What to Tell Your Health Care Provider
• Diagnostic Testing and Military Environmental Exposures
• PACT Act introduces two new presumptions for Vietnam Veterans
• Resources on PublicHealth.va.gov: A Guide for Vietnam Veterans
• The Agent Orange Newsletter: A Retrospective

Your Military History: What to Tell Your Health Care Provider

Any time you meet with a health care provider, you have limited time to share information and discuss your health concerns. Sharing your military history during your appointment can help providers address your specific health concerns.  Here are some tips on what to tell your provider about your military history.

Share if you were deployed, and where and when you served. Let your provider know if you deployed since not all Veterans did. If you were deployed, you should tell your provider where you served and when. This will help your provider identify what exposures you may have experienced.

For deployed Veterans, your provider may suggest getting a toxic exposure screen to start the conversation about exposures and your health. This screening includes a series of questions that take about 5-10 minutes. This screening is not meant for diagnostic purposes but can address concerns about your health and deployment.

In addition, your provider may suggest that you have an environmental health registry evaluation. Registry evaluations are free assessments offered to Veterans who were deployed to certain countries during specific times. If you’ve already had any environmental health registry exams, let your provider know to avoid being referred to a registry exam that you’ve already undergone. Also, if you’ve already had an exam and have new concerns, sharing those concerns with your provider can help them address them. Registry exams are used for research and are not needed for care or benefits. 

Share where you were stationed for garrison training.  You should share the location of your basic training and duty station, as well as the timeframe for your training. Based on where and when you trained, you may have been exposed to certain environmental factors that you should be aware of and may want to discuss with your provider.

Share your military occupational specialty (MOS) and your job duties. You may have had certain environmental exposures based not just on your job title but also the kind of day-to-day work you performed while in the military.

Share your non-military work and life history. Your non-military work and life history may reveal possible environmental exposures outside of military service that you may want to talk about during your medical appointment. You should tell your provider about any civilian work experience or home exposures (such as second-hand smoke or hobbies) that might lead to exposures. It may also help your provider to identify any ongoing exposures, for example, if you were a mechanic in the military, and you are still a mechanic.

Keep your providers updated. You will not need to repeat your entire history with every follow-up appointment, but you should keep your provider updated if anything has changed. For example, you should let your provider know if you have changed jobs or if there is something new in your life that may impact your health or create a change in your symptoms. Remember to have recommended screenings and inform your providers about any results.

It is important to share your military and exposure experiences not just with your VA health care providers, but also with your civilian health care providers. If a civilian provider needs help addressing specific military concerns, they can refer you to the nearest VA and use VA’s Exposure Ed app. Exposure Ed is a free VA-designed mobile app that assists health care providers with making an informed discussion about a Veteran’s individual exposure-related concerns and potential impacts on their health.

Diagnostic Testing and Military Environmental Exposures

By Veterans Exposure Team-Health Outcomes Military Exposures (VET-HOME) Clinicians

What is Diagnostic Testing?
Diagnostic testing allows health care providers to identify medical problems. Your health care provider may ask you about your work history, deployments, and family medical history to determine if diagnostic testing is appropriate. Diagnostic testing may include things like blood tests, swabs, x-rays, or other procedures.

Can Testing Show If I Have Been Exposed to Toxic Substances? 
Most of the time, testing to detect toxic substances is not used for medical care. There are several reasons for this: 

• The body eliminates the substance over time. Your kidneys and liver break down toxic substances so they can be eliminated in exhaled breath, urine, or stool. Some substances, like vinyl chloride, are eliminated from the body so quickly that they may not be detected by testing if significant time has passed since the exposure occurred. 

• Inability to determine timing and source of exposure. Testing cannot tell when or how you were exposed to a substance. Some chemicals are very common in the environment. For instance, there are thousands of per- and polyfluoroalkyl substances (also known as PFAS or “forever chemicals”) in the environment. While a test for PFAS can detect abnormal levels of PFAS in the body, they cannot determine the timing or source(s) of your PFAS exposure.

• Uncertainty of health impact. Exposure to a toxic substance does not necessarily predict harmful health outcomes. Testing cannot determine whether the exposure will cause harm. Not all smokers get lung cancer, for instance. Factors such as family history and general health also influence the risk of developing health problems.  

Can I Be Tested for Presumptive Conditions? 
During an environmental health registry evaluation or other health care appointment, you may be concerned about an exposure that you have had and worry that you will get one or more of the presumptive medical conditions for that exposure in the future. It is normal to want to be tested for all possible health conditions.

However, it is important to remember that just because a condition is presumed to be related to an exposure in a certain location at a certain time, it does not mean that you will experience or even be at high risk of getting that condition. It just means that VA will assume that if you do develop the condition, that it was caused by your military service, and you will not be required to prove that relationship to receive VA benefits. 

What Are the Pros and Cons of Testing?
 Diagnostic testing may lead to finding a medical issue early.  Spotting a problem early can lead to disease prevention and treatment. Early treatment can lead to better health outcomes as well as peace of mind for you and your loved ones.  
On the other hand, there are some downsides to testing. Some tests use radiation, and certain procedures may cause harm. Occasionally, a test might suggest that you have a condition, when in fact, you do not. This may lead to more unnecessary tests and treatments. Sometimes a medical condition that is not causing any harm may be found. This may lead to unnecessary treatment and worry for you and your family.

How Do I Decide About Being Tested? 
The decision to test should be made together by you and your health care provider, based on your individual situation. Factors to consider include family history, environmental exposures, existing health conditions, and guidelines from professional medical groups. Talking with your health care provider is the best place to start.  

PACT Act introduces two new presumptions for Vietnam Veterans

As a part of the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of 2022, or PACT Act, VA added two new conditions to the list of presumptive conditions related to Agent Orange exposure. Veterans with qualifying military service who have these conditions are now automatically eligible for disability benefits:

• Monoclonal Gammopathy of Undetermined Significance (MGUS) – MGUS is a condition in which a person is a higher level of a protein called M protein in the blood. Those with MGUS have a higher risk of developing cancer.
• Hypertension, also known as high blood pressure – Many older Americans and Veterans have high blood pressure.  Agent Orange exposure may be a risk factor.  

There are now more than twenty Agent Orange Presumptive Conditions.  Learn more about these conditions at: https://www.publichealth.va.gov/exposures/agentorange/conditions/index.asp
Learn more about expanded eligibility for Vietnam Veterans through the PACT Act at:  https://www.va.gov/resources/the-pact-act-and-your-va-benefits/#vietnam-era-veteran-eligibility 

Presumptive conditions associated with Agent Orange exposure:

• AL Amyloidosis
• Bladder Cancer
• Chronic B-cell Leukemias
• Chloracne (or similar acneform disease)
• Diabetes Mellitus Type 2
• Hypertension
• Hodgkin’s Disease
• Hypothyroidism (new)
• Ischemic Heart Disease
• Monoclonal Gammopathy of Undetermined Significance (MGUS) (new)
• Multiple Myeloma
• Non-Hodgkin’s Lymphoma
• Parkinsonism
• Parkinson’s Disease
• Peripheral Neuropathy, Early-Onset
• Porphyria Cutanea Tarda
• Prostate Cancer
• Respiratory Cancers
• Soft Tissue Sarcomas

Resources on PublicHealth.va.gov: A Guide for Vietnam Veterans

If you or a loved one in your life is a Vietnam Veteran, what appears below can serve as the first step in addressing exposure-related health concerns. The VA Health Outcomes Military Exposures’ (HOME’s) website, https://www.publichealth.va.gov/exposures, offers Vietnam Veterans a variety of resources on one of the most common military environmental exposure concerns: Agent Orange. The Agent Orange portion of this website presents resources under the following categories: “Related Diseases,” “Benefits,” “Exposure Locations,” “Provider Resources,” “Research Studies,” and “Publications & Reports,” and this article will navigate through these categories. 

The opening paragraphs of HOME’s Agent Orange homepage connect Veterans to both informational and action-oriented pages about this tactical herbicide. Veterans may click hyperlinks to learn more in-depth information about Agent Orange and other tactical herbicides and where this herbicide was used, including Vietnam. Veterans may also click on the Agent Orange Registry Health Exam to learn more about their registry eligibility and the steps they can take to join. Lastly, the homepage includes links to a page devoted to Diseases Associated with Agent Orange including spina bifida, which may affect the children of Veterans exposed to Agent Orange.

From the Agent Orange homepage, Vietnam Veterans have access to a key category of exposure-related materials at their fingertips: Related Diseases. VA assumes that certain diseases may be related to exposure to Agent Orange and other herbicides during military service. On this “Related Diseases” page, Veterans may not only see a list of these diseases but also click on them for more information (for example, the relationship between Parkinson’s disease and Agent Orange is spelled out here). Certain birth defects in Vietnam Veterans’ children are associated with service, and concerned family members may find information on this page.

Under the “Exposure Locations” section on the homepage, Vietnam Veterans may click Vietnam to learn more detailed information about where and when Agent Orange exposures were possible while serving in Vietnam. Veterans who served anywhere in Vietnam between January 9, 1962, and May 7, 1975, are presumed to have been exposed to herbicides. This includes those who served on a vessel operating within 12 nautical miles seaward from the demarcation line of the waters of Vietnam and Cambodia (Blue Water Navy Veterans) as well as on the inland waterways of Vietnam. Additionally, if you served on a C-123 airplane during the Vietnam War, please visit this page to learn about potential exposures and how you may be eligible for benefits based on the timing and location of your service. 

To find where Agent Orange and other herbicides were used outside of Vietnam, go to the Herbicide Tests and Storage Outside Vietnam page. The DoD updates the list of locations as new information becomes available. You can request that DoD consider a new location where tactical herbicides were used, tested, or stored, by providing documentation to the DoD Armed Forces Pest Management Board (AFPMB). Contact information for the AFPMB is on this page. 

In returning to the Agent Orange homepage, Vietnam Veterans may navigate to the “Benefits” section, which is broken into three subsections: Benefits Overview, Registry Exam, and Health Care. Under the Benefits Overview page, Veterans may gain a high-level view of health care benefits, disability compensation, benefits for children with birth defects, and survivors’ benefits related to Agent Orange exposure. Each of the linked pages above provides more depth regarding eligibility and what actions Veterans can take to make the most of their benefits and care options. Also, VA’s Agent Orange Registry health exam alerts Veterans to possible long-term health problems that may be related to Agent Orange exposure during their military service. Veterans may learn more here.

The Agent Orange homepage also allows Veterans to view resources that HOME’s Program Office offers to health care providers. As a Vietnam Veteran, understanding these resources gives you a lens into what information your provider has access to regarding Agent Orange. For example, these topics include Diagnosis & Treatment, Patient Education, and Research Studies. In fact, Vietnam Veterans may access summaries of dozens of studies on Vietnam Veterans and health. Finally, Vietnam Veterans can navigate to view related publications and materials provided by HOME that guide the public, Veterans, and health care professionals. HOME’s War Related Illness and Injury Study Center (WRIISC) also provides resources for Vietnam Veterans.

Each Vietnam Veteran has health needs associated with their own lived experience, so the outlined items above should not be considered an exhaustive list of what every Veteran needs regarding their exposure-informed care; however, we encourage all Veterans to speak with their primary care providers and contact their local environmental health coordinator to address any environmental health concerns that may arise.

The Agent Orange Newsletter: A Retrospective

Since 1982, the Agent Orange Newsletter, formerly the Agent Orange Review, has provided information to Vietnam Veterans. Throughout the years, the themes of the articles have shared a common purpose: to provide useful information and report on the possible health effects of, news about, and latest research on Agent Orange. 

Past issues are available online. Below are highlights of the topics covered by the Agent Orange Review and Agent Orange Newsletter.  

1982-1989
VA released the first newsletter issue in November 1982. This issue promoted the Agent Orange Registry, an effort that continues to this day. It also contained a question and answer forum about Agent Orange and its possible health effects. 
Subsequent editions of the Agent Orange Review promoted the Agent Orange Registry and provided information about the impact of Agent Orange on long-term health. They also provided overviews of research studies. Article topics included:

• Discussion of efforts for a presumption of service connection for cancer of soft tissue organs, porphyria cutanea tarda, and chloracne.
• Overviews of research studies, including the Air Force “Ranch Hand” health study, Vietnam Experience Twin Study, CDC National Institute for Occupational Safety (NIOSH) birth defects study, VA mortality studies, Women Vietnam Veterans Mortality Study, and Army Chemical Corps Mortality Stud. 
• Coverage of VA Secretary Edward J. Derwinski’s (1989- 1992) commitment to Veterans exposed to Agent Orange and concerns about Agent Orange exposure and policy. 
• Information about the 1984 passing of Veterans’ Dioxin and Radiation Exposure Compensation Standards Act and its impact on disability compensation to Veterans.

1990-1999
Throughout the 1990s, VA was involved in many research endeavors to gain a deeper understanding of the long-term health impacts of Agent Orange and other herbicides for Vietnam Veterans. The Agent Orange Review provided news to Veterans about research initiatives and results, changing benefits for exposures, and new legislation. Topics covered in the review during this time included:

• Changes in compensation and rules and regulations for specific diagnoses related to Agent Orange exposure or Vietnam service, including service connection for non-Hodgkin’s lymphoma, respiratory cancers, multiple myeloma, soft tissue sarcomas, chloracne,  Hodgkin’s disease, prostate cancer, peripheral neuropathy, and porphyria cutanea tarda.
• Ongoing research updates from the Institute of Medicine (IOM) report on the impact of Agent Orange (The IOM issued its first report on the medical effects of exposure to Agent Orange in 1994.)
• The passing of the Agent Orange Act of 1991 and its impact on VA research, health benefits, and compensation for Veterans.
• Updates and findings from various research programs about the long-term health impacts of Agent Orange and other herbicides.
• Coverage of Secretary of Veterans Affairs Togo D. West Jr.’s (1998-2000) push for benefits for children with birth defects who were born to women Vietnam Veterans.

2000-2009
Building on the research and legislation of the 1990s, throughout the early-mid 2000s, VA re-evaluated and expanded the presumptive conditions related to Agent Orange. Themes explored during this decade included:

• An update about the research and legislative efforts for the biological children of women who served in Vietnam.
• Announcements regarding the changing qualifications for the Agent Orange Registry including expanding eligibility to include those who served in Korea from 1968-69.
• Notifications about new IOM reports on Veterans and Agent Orange.
• An exploration throughout the decade of the changing research about the connections between Type 2 Diabetes and expanded benefits coverage related to a diabetes diagnosis.
• Ongoing reporting on Agent Orange Registry enrollment and statistics. 

In addition, the Agent Orange Review provided public health information and educational articles about many conditions and diseases including diabetes, childhood leukemia, and prostate cancer, among others. 

2010-2012
From 2010-2012 there was an emphasis on more registry enrollment and greater awareness of presumptive conditions to support Veterans in accessing care. While the Agent Orange Review continued to offer information about Agent Orange exposure, the publication expanded to provide information about services available to all Veterans, including suicide prevention efforts, mortgage assistance programs, and smoking prevention. Topics included during this period were:

• Expansion to benefits and presumptive illnesses related to Agent Orange exposure to include Parkinson’s disease, ischemic heart disease, and all chronic B-cell leukemias.
• Updates on ongoing research and court rulings about Blue Water Veterans (Blue Water Veterans served during the Vietnam War on open sea ships, generally in the Navy or Coast Guard.) 
• An explanation of VA efforts to fast-track Agent Orange claims in anticipation of more than 100,000 Vietnam Veterans filing disability claims over two years due to an expanding presumptive illnesses list. 
• Updates about presumptive illnesses connected to Agent Orange and service in Vietnam and Korea.

2015- Present
The Agent Orange Newsletter Today
The final issue of the Agent Orange Review was published in the winter of 2012. In the summer of 2015, the publication returned as the Agent Orange Newsletter. Since 2015, the Agent Orange Newsletter has provided information on advancement in Agent Orange and other military environmental exposure research. The newsletter is a leading source of information about the Agent Orange Registry, changes to disability eligibility, and other VA news impacting Veterans. 
Recent topics include:

• Announcement of the expansion of benefits to included people living at the U.S. Marine Corps Base Camp Lejeune in North Carolina from the 1950s through the 1980s who may have been exposed to contaminated drinking water.
• Ongoing information about how to enroll in the Agent Orange Registry and the Ionizing Radiation Registry and access registry health exams. 
• Updates on the registry eligibility and disability claim eligibility for Blue Water Veterans.
• Information about the PACT Act with a focus on how it impacts Vietnam Veterans.

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