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2001 agent org rev for pdf only.pdf
Agent Orange Review
Information for Veterans Who Served in Vietnam
VA Regulations on Type 2 Diabetes Take
tion to establish a presumptive service connection
Effect July 9; House Approves Changes
for Type 2 diabetes. Public comments on the pro
posal were solicited. Fourteen comments were received and considered. On May 8, 2001, the rule was adopted without change. The "final rule" was
printed in the Federal Register
on that date, with an effective date of July 9, 2001.
The Department of Veterans Affairs' (VA) "final
rule" on diabetes went into effect July 9, 2001, fol
lowing the procedure established by Public Law 102-4, the Agent Orange Act of 1991.
On July 31, 2001, the House of Representatives
passed a bill (H.R. 2540) by a unanimous vote of
That law directed VA to seek an agreement with
422-0. Among other things, this legislation would
the National Academy of Sciences (NAS) for a
add by statute Type 2 diabetes to the list of diseases
series of reviews and summaries of the scientific
presumptively service-connected. The legislation
evidence on the association between herbicide
would codify (establish in permanent law, Title 38,
exposure and diseases suspected to be associated
United States Code) the Secretary's action.
with such exposure. VA has done that, and the
Similar legislation is pending in the Senate.
NAS has issued five reports to date, including a special report that focused on Type 2 diabetes.
Reproduction by Congress of a Secretary's deci
sion to presumptively recognize a condition for
The law states that whenever the Secretary of
service connection is not new. For example, VA
Veterans Affairs determines, based on sound med
published final rules for Hodgkin's disease and por
ical and scientific evidence, that a positive associa
phyria cutanea tarda in February 1994, and multi
tion exists between herbicide exposure and a dis
ple myeloma and respiratory cancers in June 1994.
ease, the Secretary will publish regulations estab
Public Law 103-446, enacted in October 1994
lishing a presumptive service connection for that
added these conditions to the list of those presump
tively service connected for Vietnam veterans.
In October 2000, the NAS concluded that there
What is the Difference?
is "limited/suggestive evidence of an association" between herbicides used in Vietnam and Type 2
Regulatory provisions can be changed by action
diabetes. After considering all the evidence, the
of the Secretary of Veterans Affairs. Statutory pro
Secretary determined that there is a positive associ
visions are established by law and can only be
ation between exposure to herbicides and Type 2
changed by Congress. Therefore, statutory provi
diabetes, and therefore, a presumption of service
sions are considered, in a practical sense, to be
connected is warranted.
more permanent or secure because any change must be approved by Congress and the President
On January 11, 2001, VA published a "proposed
(or by Congress overriding a Presidential veto).
rule" in the Federal Register
indicating the inten
Department of Veterans Affairs
About the Review
Study Shows Diet and Exercise Lower
Risk and Delay Onset of Type 2 Diabetes
The "Agent Orange Review" is prepared by VA's
Environmental Agents Service (EAS) with substantial assistance from the VA's Compensation and Pension
At least ten million Americans at high risk for
Service. The "Review" is published to provide infor
Type 2 diabetes can sharply lower their chances of
mation on Agent Orange and related matters to
getting the disease with diet and exercise, accord
Vietnam veterans, their families, and others with con
ing to the findings of a major clinical trial conduct
cerns about herbicides used in Vietnam. It is also
ed by the Department of Veterans Affairs (VA)
/ default.htm. Back issues are also available at that site.
Puget Sound Health Care System, the University of
The first issue was released in November 1982. The
Washington, and 26 other medical centers nation
most recent edition (prior to the release of this issue) is
dated July 2001. The October 2001 release is the thirty-sixth issue. It was written in mid-October 2001 and
The same study found that treatment with the
does not include developments that occurred since that time.
oral diabetes drug metformin (Glucophage) also reduces diabetes risk for this group.
Comments or questions about the content of the
"Review" are encouraged. Suggestions and ideas for
These findings came from the Diabetes
future issues should be sent to Donald J. Rosenblum,
Prevention Program (DPP), a major experiment
Agent Orange Review, Deputy Director, Environmental Agents Service (131), VA Central Office, 810 Vermont
comparing diet and exercise with metformin in
Avenue, NW, Washington, DC 20420.
more than 3,200 people of diverse age, gender, and ethnic backgrounds with impaired glucose toler
Requests for additional copies of this and earlier
ance, a condition that often precedes diabetes. The
issues should also be directed to Mr. Rosenblum.
experiment ended a year early because the data had
Please specify the issue date and the quantity sought. A limited supply of the issues published during past
clearly answered the main research questions.
years is available.
The DPP is funded by a wide group of Federal
VA updates the "Review" mailing address listing
agencies, private associations, pharmaceutical com
annually based on IRS records. "Review" recipients
panies, and health product manufactures. The cost
who have not been filing Federal income tax returns annually and have moved to another residence are
of the DPP is $174.3 million.
encouraged to send their old and new addresses and Social Security number to the Agent Orange Review,
In October 2000, the National Academy of
Austin Automation Center (200/397A), 1615
Sciences' Institute of Medicine (IOM), an inde
Woodward Street, Austin, TX 78772-0001.
pendent scientific organization, concluded that
Questions about the Agent Orange Registry
Type 2 diabetes was associated with herbicides
nation program should be directed to the Registry
used in Vietnam. The IOM found "limited/sugges
Physician or Agent Orange Registry Coordinator at the
tive evidence" of an association between exposure
nearest VA medical center. Questions regarding eligi
to the herbicides used in Vietnam or the contami
bility for health care
should be directed to the hospital
nant dioxin and Type 2 diabetes.
administration service at the nearest VA medical center.
Questions regarding VA benefit programs, including disability compensation,
should be referred to a veter
VA then concluded that the evidence in support
ans benefits counselor at the nearest VA facility. The
of an association between these herbicides and
telephone numbers can be found in the telephone direc
Type 2 diabetes outweighed the evidence against
tory under the "U.S. Government" listings.
an association. In May 2001, final regulations were published in the Federal Register
The national toll-free telephone number for infor
mation regarding VA benefits is 1-800-827-1000.
disease to the list of conditions presumed to be
recently established toll-free helpline for Agent Orange
service-connected. For additional information
concerns is 1-800-749-8387.
regarding this matter, see the article above and articles about diabetes in the "Agent Orange Review"
issues dated August 1999, May 2000, August 2000,
during the Vietnam era and has a disease that VA
March 2001, and July 2001.
recognizes as being associated with herbicide exposure, the veteran is presumed to have been exposed
Deputy Secretary Mackay Testifies on
to an herbicide agent during service. The presump
Agent Orange Bill
tion of herbicide exposure is a reasonable means of dealing with uncertainties concerning the extent of
On June 28, 2001, Dr. Leo S. Mackay, Jr.,
herbicide spraying and troop movements in a com
Deputy Secretary of Veterans Affairs, testified
bat zone. These uncertainties pertain equally to
before the Senate Committee on Veterans' Affairs
Vietnam veterans regardless of the disease from
on several legislative items of great interest to vet
which they may suffer. We see no basis for distin
erans. Below is the portion of his prepared state
guishing for purposes of the presumption of expo
ment relating to Agent Orange issues.
sure between Vietnam veterans who have diseases on VA's presumptive list and those who are claim
A draft bill under consideration by this
ing compensation for other diseases. Insofar as this
Committee would remove the 30-year limitation on
provision extends the presumption of herbicide
the period during which respiratory cancers must
exposure to any veteran who served in the Republic
become manifest to a degree of 10-percent or more
of Vietnam during the Vietnam era, VA supports it.
in Vietnam veterans exposed to herbicides during service in the Republic of Vietnam in order for
This bill would also extend for ten more years
service connection to be granted on a presumptive
the period over which the National Academy of
basis. At this time, the Department of Veterans
Sciences will transmit to VA reviews and evalua
Affairs (VA) is reviewing the findings of the recent
tions of the available scientific evidence regarding
Institute of Medicine report, Veterans and Agent
possible associations between diseases and expo
Orange: Update 2000
, on the issue of respiratory
sure to dioxin and other chemical compounds in
cancer. We are considering the scientific merits of
herbicides. As additional scientific and medical
the 30-year period. We will inform the Committee
evidence continues to be developed concerning the
of our position on removal of the 30-year limitation
health effects of herbicide exposure, such reviews
once our consideration of the scientific evidence is
may shed light on the effects of exposure on the
health of veterans. Accordingly, VA supports this provision.
In addition, this bill would extend the presump
tion of exposure to herbicides provided by 38
Leo S. Mackay, Jr., Ph.D., was confirmed by the
U.S.C. § 1116 to any veteran who served in the
Senate on May 24, 2001. As the VA's second in
Republic of Vietnam during the Vietnam era.
command, Dr. Mackay is the chief operating officer
Currently, there is no general presumption of expo
of the federal government's second largest depart
sure for all Vietnam veterans, either for purposes of
ment. Prior to his nomination, Mackay was Vice
compensation or health care eligibility. Pursuant to
President of the Aircraft Services Business Unit at
the Agent Orange Act of 1991, VA has established
Bell Helicopter Textron, Inc., Fort Worth, TX. A
presumptions of service connection for ten cate
1983 U.S. Naval Academy graduate, Dr. Mackay
gories of disease. See
38 C.F.R. § 3.309(e). A vet
completed pilot training in 1985, graduating at the
eran who was exposed to herbicides in service and
top of his class.
who develops one of these diseases within the applicable presumption period, if any, is presumed
His military honors include the Defense
to have incurred the disease in service, without the
Meritorious Service Medal, the Navy Achievement
necessity of submitting proof of causation.
Medal, and the Armed Forces Expeditionary Medal. He was a Kennedy Fellow at Harvard,
In addition, 38 U.S.C. § 1116(a)(3) provides
earning a master's degree in public policy from the
that, if a veteran served in the Republic of Vietnam
Kennedy School of Government and Ph.D. in polit
ical and economic analysis from the Graduate
will test the helpfulness of exposure therapy for
School of Arts and Sciences. Leaving active duty
female veterans and active duty personnel with
military service in 1995, Dr. Mackay joined the
corporate staff of Lockheed Martin, where he became Director of Market Development. He left
PTSD Common Among Women Veterans
Lockheed Martin in 1997 to join Bell Helicopter.
PTSD is a prevalent condition among women
VA Studying Women Veterans Who Have
who have military service experience. A recent
population sample of active duty Navy and Marine Corps personnel found that among women, 17.4%
Many women are traumatized while serving in
had PTSD at some time and 8.3% had current
the military. A recent study of female veterans esti
PTSD. The VA National Vietnam Veterans
mated that 60% had experienced at least one trau
Readjustment Study estimated that 26% of women
matic event during military service. The preva
who served in Vietnam had PTSD at some point
lence of serious trauma appears especially high
since their service, and 8.5% had PTSD at the time
among veterans who have served since Vietnam,
of assessment in the 1980s. Current PTSD preva
who now constitute the majority of female veter
lence in women who served in the Gulf War is 8
ans. Most often, military trauma in women
10%. Prevalence is substantially higher among
involves sexual assault or rape, but other sources
women who seek VA treatment for stress-related
are physical assault, accidents, disasters, and even
problems: one study found that 50% of these
war-zone exposure, including medical assignments
women had current PTSD.
that involve exposure to seriously injured personnel.
PTSD is associated with a range of comorbid
(occurring at the same time) conditions and func
Women also experience trauma before and after
tional difficulties, including other anxiety disorders,
entering military service. In fact, the prevalence of
depression, substance abuse, psychosocial impair
sexual assault during childhood and adolescence
ment, poor physical health, and greater service uti
appears to be higher in military women than in the
lization. Thus, PTSD has far-reaching effects on
general U.S. population.
many aspects of military and veteran women's lives.
Traumatic exposure can have profound effects
on a person's well-being and functioning, and may
A variety of drugs and psychotherapies are used
lead to the development of Post-Traumatic Stress
for treating PTSD. Among the psychotherapies,
Disorder. PTSD occurs not only in combat veter
cognitive-behavioral therapy appears to be the most
ans but also in other survivors of traumatic events
promising approach. One useful cognitive-behav
such as natural disasters and interpersonal or sexual
ioral technique is "exposure," in which a patient is
violence. Among civilian adults in the U.S., the
guided through a vivid remembering of a traumatic
lifetime prevalence of PTSD is 5% in men and
event repeatedly until the patient's emotional
response decreases through habituation.
A new research project, sponsored by the
Volunteers Sought for Study
Department of Veterans Affairs (VA) Cooperative Studies Program, and the Department of Defense,
The study will enroll 384 women, who will be
randomly assigned to receive either exposure thera
is designed to address the needs of female veterans
py or therapy that focuses on current life problems.
and active duty personnel who have PTSD. The
Both treatment will last 10 weeks, and the women
new VA study, identified as VA Cooperative Study
will be followed for 6 months after the end of treat
# 494: A Randomized Clinical Trial of
ment to evaluate how PTSD and other symptoms
Cognitive-Behavioral Therapy for Women
respond to treatment.
The study represents a collaboration between
"new calculations show that the prevalence of these
the VA and the Department of Defense. Co-Chairs
conditions in the children of Vietnam veterans, while
of the project are Paula P. Schnurr, Ph.D., and
higher than normal and suggestive of increased risk,
Matthew J. Friedman, M.D., Ph.D., from the VA's
is not raised to a statistically significant extent."
National Center for PTSD, and LTC Charles C. Engel, M.D., from Walter Reed Army Medical
In response to this announcement, in July 2001,
Center. The VA National Center for PTSD is locat
VA requested IOM to convene a committee to revisit
ed at the Veterans Affairs Medical Center in White
the issue of AML in the children of Vietnam veter
River Junction, VT, where Dr. Friedman is the
ans. The IOM committee will review the scientific
Executive Director and Dr. Schnurr is the Deputy
evidence regarding statistical association between
Director. The biostatistician is Ken James, Ph.D.,
exposure to the herbicides used in Vietnam, and their
and the study is coordinated by the VACSPCC at
contaminant dioxin, and AML in the children of vet
erans. It will prepare a report describing its work and presenting its findings to help inform the
Women will be enrolled at 11 VA sites around
Department of Veterans Affairs and other interested
the country: Albuquerque, Atlanta, Baltimore, Bay
Pines/Tampa, Boston, Cincinnati, Cleveland, Dallas, Denver, New Orleans, and Portland. There
The IOM committee held a meeting, on October
also will be a Department of Defense site in
18, 2001, to collect and discuss information on the
Washington, DC. Women who are interested in
topic. Researchers involved in relevant AML stud
participating in the trial may contact the project at:
ies presented their results during the workshop.
The scheduled completion date is March 31, 2002.
participating medical centers.
The October meeting consisted of a public
The above article was prepared and submitted
workshop and a closed session for committee
by Dr. Schnurr, identified above, especially for the
members alone. For information about the meet
ing, the contact person is Elizabeth Albrigo. Her email address is .
IOM Taking Another Look at Link
Between Herbicides and Childhood
David A. Butler, Ph.D., Senior Program Officer,
is serving as study director for the project. Dr. Butler directed Veterans and Agent Orange: Update 1998; Update 2000
; and Type 2 diabetes
The National Academy of Sciences' Institute of
The address for the National Academy of Sciences
Medicine (IOM) is reassessing one of the conclu
is 2101 Constitution Avenue, N.W., Washington,
sions in Veterans and Agent Orange: Update 2000
because of an error in one of the studies considered for its most recent report.
Congress Considers Extending Agent
In its third biennial update of Veterans and Agent
, the IOM concluded there was "limited/suggestive evidence" of an association between herbi
On June 25, 2001, the chair and ranking mem
cides used in Vietnam and a rare childhood leukemia,
ber of the Senate Committee on Veterans' Affairs
known as acute myelogenous leukemia (AML).
introduced a bill (S. 1091), to update and expand
However, in May 2001, the Australian researchers
the Agent Orange Act of 1991.
who conducted one of the principal studies that IOM relied upon in reaching its conclusion announced
This bipartisan proposal would remove all dead
they had discovered an error in the way it calculated
lines for veterans to claim disability benefits for
the expected prevalence of AML. They reported that
respiratory cancers. In June 1994, when the
Secretary of Veterans Affairs established a pre
who were exposed to Agent Orange or other herbi
sumption of service connection for respiratory can
cides during testing, transporting, or spraying of
cers, a 30-year limitation was included. That
these herbicides for military purposes.
meant that the respiratory cancer had to appear with 30 years of Agent Orange exposure (the last
VA Secretary Anthony J. Principi decided to
day of service in Vietnam) to qualify for disability
open the Registry because of his concern for U.S.
compensation. In November 1994, Public Law
service members who may have been exposed to
103-446 codified the Secretary's decision with the
herbicides containing dioxin contaminants.
On August 17, 2001, a significantly revised
The National Academy of Sciences Institute of
Department of Veterans Affairs (VA) procedures
Medicine (IOM) recently noted that there is cur
manual, known as Agent Orange Handbook 1302
rently no scientific basis for the 30-year deadline.
1, and Agent Orange code sheet 10-9009 were
This legislation would eliminate the restriction.
approved by VA's Under Secretary for Health.
The current mechanism for continuous review
of available scientific information and the updating of veterans' benefits accordingly was established in
Agent Orange Registry Examinations Total
February 1991 by the Agent Orange Act of 1991.
The two-step process begins with a review every
Most Recent Month - 1,620
other year of new dioxin research by a scientific panel organized by the National Academy of
Gulf War Registry Examination Total - 82,739
Sciences (NAS), a non-governmental organization.
Most Recent Month - 133
Then the Secretary of Veterans Affairs must respond to the NAS report and establish presump
Ionizing Radiation Examination Total - 22,219
tive service connection when he or she determines that the credible evidence for an association
Most Recent Month -- 19
between exposure to herbicides used in Vietnam and an illness is equal to or outweighs the evidence against such an association.
Prostate Cancer Facts- Part 1
Numerous conditions have been added to the
Prostate cancer is one of the conditions that VA
list of those presumed to be service connected
presumptively recognizes for service connection in
based on exposure to Agent Orange or other herbi
Vietnam veterans. The following article contains
cides used in Vietnam. Many observers have been
reprinted guidelines provided by the American
pleased with this procedure, which is expiring
Urological Association, Inc. (AUA). The organiza
soon. S. 1091 would extend the process until 2012.
tion is located at 1120 North Charles Street, Baltimore, MD 21201-5559. The web address is
In addition to Senators Rockefeller and Spector,
. Because of the length of the AUA
the Senate Majority Leader Thomas Daschle is also
brochure, we have divided the material into two
a co-sponsor of the legislation.
articles. The second article will appear in the next issue of the newsletter. It will describe treatment
Agent Orange Registry Opens to
methods, follow-up care, communicating with your
Veterans Exposed to Herbicides Outside
physician, and resources for patients. These articles are reprinted with the written permission of the
AUA, and may not be reproduced in any format without written permission of the AUA.
The Agent Orange Registry program now
offers registry examinations to any U.S. veterans
What is the Prostate?
O Growth rates for this type of cancer can vary.
Studies have shown that prostate tumors grow at
The prostate gland is part of the male reproduc
different rates in different people. While some
tive system. It is about the same size and shape as a
cancers advance rapidly, others grow slowly
walnut and weighs only about an ounce. As pictured
over many years.
in the diagram, the prostate is located below the bladder and in front of the rectum. The prostate surrounds
O The majority of newly diagnosed prostate can
a tube called the urethra that carries urine from the
cers are localized. (The tumor growth has not
bladder out through the penis. The main function of
spread beyond the prostate gland.) Given
the prostate is to produce fluid for semen.
enough time and left untreated, some of these localized tumors can grow in size and spread
What is Prostate Cancer?
outside the prostate.
There are many different types of cancer. In fact,
O Localized prostate cancer usually causes no
cancer is really a group of diseases that affects differ
symptoms. Prostate cancer usually causes no
ent cells in the body. Prostate cancer is a disease that
symptoms until it has spread beyond the
affects the cells of the prostate. Normally, cells grow
prostate. This is one reason why early detection
and divide in an orderly way. This is how the body
may be important.
grows and stays healthy. Sometimes this normal process of cell growth can go wrong. If the cells con
O When the cancer spreads beyond the prostate, it
tinue to divide when they're not supposed to, they
becomes more difficult to manage and the risk
can form a tumor. Cancerous prostate tumors can
of death rises. It is important to diagnose
block the flow of urine and, if untreated, can spread
prostate tumors at an early stage so that they
to other parts of the body.
can be watched and treated before the cancer spreads. Although all prostate cancer is potentially life-threatening, in many cases the disease can be cured.
Once prostate cancer is detected, a number of
treatment options may be recommended. Each type of treatment poses its own risks and benefits. This booklet is designed to provide information on the early detection and treatment of prostate cancer so that patients, along with their physicians, can make informed, individual decisions about the management of this disease.
Prostate Cancer: The Early Detection Tools
The goal of early detection is to find the dis
Prostate Cancer: The Facts
ease in its early stages when treatment is most likely to be effective. There are two widely used tests
Prostate cancer is one of the most common
to aid in the early detection of prostate cancer.
forms of cancer in men. It is the second leading
cause of male cancer deaths in the United States. Most men with prostate cancer do not die from this
O PSA This simple blood test measures the level
disease. Yet, prostate cancer still accounts for more
of a protein called prostate-specific antigen
than 30,000 American deaths each year.
(PSA). Normally, PSA is found in the blood at
very low levels. Elevated PSA readings can be a
physician. Patients should be aware of the advan
sign of prostate cancer.
tages and disadvantages of early detection and
O DRE The digital rectal exam (DRE) involves
treatment. Some additional information that you
the physician inserting a lubricated, gloved fin
should be aware of includes:
ger into the rectum to feel the prostate for signs
O Men with a life expectancy of less than 10
of cancer. This test is simple, safe and only
years are unlikely to benefit from early detec
tion and treatment of prostate cancer.
The most sensitive method for early detection
O Treatment of prostate cancer carries a risk of
uses both the PSA and DRE tests. Although PSA
impotence (inability to have an erection) and
will detect most high-risk cancers, there are cancers
incontinence (inability to control urine flow
that will be missed by this test and are detected by
from the bladder).
the DRE. Therefore, using both tests together will
O Studies to evaluate the benefits of early detec
give your doctor the most accurate information.
tion are in progress but not complete. Until these studies are completed, the value of early
Who is At Risk for Prostate Cancer?
diagnosis is not certain.
All men, of appropriate age, should be coun
You and your doctor should decide together
seled with regard to early detection for prostate
whether you are a good candidate for prostate can
cancer. The American Urological Association
cer testing. The AUA believes that monitoring PSA
(AUA) encourages physicians to routinely offer
levels as part of your regularly scheduled checkups
prostate cancer testing to men who have an antici
offers doctors and patients the chance to establish
pated life-span of 10 or more years and are:
O over the age of 50 years,
baseline information, detect problems, and begin treatment before a cancer spreads and becomes
O over the age of 40 years and have a family his
tory of the disease (for example, a father or
brother who was diagnosed with prostate can
How Will My Doctor Make a Diagnosis of
O over the age of 40 years and African-American
If your physician finds any warning signs with
In addition, there are a number of warning
the PSA or DRE tests and you want further evalua
signs that may indicate the presence of prostate
tion, you should be referred to a urologist.
cancer. While often due to other non-cancerous causes, you should consult your physician if
Urologists are doctors who specialize in treating
you are experiencing any of the following
prostate cancer and other conditions that affect the
urinary tract and male reproductive organs.
O difficulty with urination,
Your chances of having prostate cancer depend
on your age and your PSA level. As a rule, PSA
O frequent trips to the bathroom at night,
levels below 4.0 ng/ml are considered normal.
O pelvic discomfort,
However, about 20% of prostate cancers are found in men whose PSA level is less than 4.0 ng/ml.
O weight loss or
Further evaluation should be considered for any level over 4.0 ng/ml or if the DRE is abnormal.
O persistent back pain.
If the PSA or DRE tests suggest the presence of
Should You Be Tested for Prostate Cancer?
cancer, your urologist will discuss the option of a biopsy. A biopsy is the surgical removal of a small
Testing for prostate cancer is a personal deci
sion that should be made by each patient with his
sample of tissue. Biopsies are usually performed in the doctor's office.
When is a Prostate Biopsy Needed?
valve, hip, graft or other replacement material), you should tell your doctor. Special antibiotics may be
Although an abnormal DRE or an elevated PSA
used before, during and after the biopsy.
may suggest the presence of prostate cancer, a diagnosis of cancer can only be confirmed by a
Facing Cancer: What to Do If Cancer is
prostate biopsy. A urologist should be consulted for
a biopsy when any of the following findings is present:
If you have been diagnosed with prostate can
cer, there are a number of routine, pretreatment
O The PSA is 4.0 ng/ml or more.
tests available to tell if your disease has spread. This information is known as "staging." A thorough
O The PSA level increases significantly from one
physical examination that includes measuring your
test to the next.
PSA level can help identify whether you will benefit from these staging tests.
O The DRE is abnormal.
O Computed Tomography (CT). A CT scan is not
necessary for most patients with newly diagnosed
Biopsies are minimally invasive procedures. A
prostate cancer. This test is more useful for
small amount of prostate tissue is removed by a
patients with a PSA of greater than 25.0 ng/ml.
needle inserted through the rectum. An ultrasound probe is used to guide the needle. Usually this pro
O Magnetic Resonance Imaging (MRI). This test
cedure is performed as an outpatient procedure
is also not commonly used for patients with
Address Changed? Receiving Multiple Copies?
After the prostate tissue is removed, it is exam
If you have recently moved, please use this
ined under the microscope by a pathologist. If a
form to update our mailing list. Send completed
tumor is present, the biopsy report will give the
form to the Agent Orange Review, Austin
tumor a "grade." The tumor grade indicates how
Automation Center (200/397A), 1615 Woodward
quickly the tumor is likely to grow and spread.
Street, Austin, TX 78772-0001. Thank you.
Once a cancer is diagnosed, you and your physi
Please print your:
cian can discuss treatment options and choose the
type of treatment that is best suited to your needs.
Middle _(10)Last _(30)
What Can I Expect After the Biopsy?
After the biopsy you may have side effects such
New Street/RFD/Military Unit:
as infection and minor rectal bleeding. Serious
complications are unusual. Blood in the stool or urine usually disappears after a few days; blood in
APO/FPO: (Indicate which if applicable)
the semen usually disappears within a few weeks.
Many physicians have their patients take antibiotics for a few days around the time of the biopsy.
Alpha State/or APO/FPO Code: _
If you are taking aspirin, arthritis medicine, or
any medicine that thins the blood, you should tell
If you are receiving more than one copy of the
your doctor. Your doctor may decide to discontinue
newsletter, please let us know. Write to the Agent
these types of medicine prior to the biopsy. Also, if
Orange Review, Agent Orange Review, Austin
you have a heart murmur or any artificial or trans
Automation Center (200/397A), 1615 Woodward
planted material in your body (such as a heart
Street, Austin, TX 78772-0001. Thank you.
newly diagnosed prostate cancer. It is more
between exposure to the herbicides uses in Vietnam
often used to assess a prostate tumor when the
or the contaminant dioxin and Type 2 diabetes.
PSA is more than 25.0 ng/ml.
There was no similar finding for Type 1 diabetes. Consequently, when VA issued regulation regarding
O Bone Scan. If your urologist suspects that the
herbicides and diabetes, we found no basis on
cancer has spread, a bone scan may be recom
which to expand the regulation to include Type 1
mended. This test is generally not necessary
diabetes. The regulations are subject to change if
with localized prostate cancers when the PSA
ongoing or future scientific studies indicate that a
level is less than 20.0 ng/ml.
change is warranted.
Because your choices about treatments often
Several veterans have written asking about the
depend on these findings, it is important for you to
Vietnam Veteran Memorial in Washington, DC.
know as much as you can about your disease.
They asked how to find out if someone's name is on the Wall, and how to get someone's name added
The remainder of this brochure will be printed
in the next issue of the "Agent Orange Review."
The Vietnam Veterans Memorial Fund main
tains a web site, "The Virtual Wall", where individual names on the wall can be searched. The
The Q's and A's (Questions and Answers) fea
web site may be found at .
ture of the "Review" responds to questions and
For general information about the Wall, including
concerns that have been received from various
answers to these questions, readers can call 202
sources. Questions for future issues should be sent
to Mr. Donald J. Rosenblum, Deputy Director, Environmental Agent Service (131), VA Central
Agent Orange Brochure Now Available in
Office, 810 Vermont Avenue, N.W., Washington,
DC 20420. We cannot guarantee that all questions will be used in this column, but we will respond to
A six-page brochure, entitled Agent Orange
as many as we can!
Information for Veterans Who Served in Vietnam General Information
, dated April 2001, is now
A letter from HKH in Arlington, VA reads: I
available in Spanish.
served in Vietnam between November 1965 and June 1966. At the age of 56, I was diagnosed with
The publication explains why Agent Orange
diabetes. (I am not overweight, and I exercise reg
was used, why some veterans are concerned about
ularly). However, it is Type 1 (insulin dependent)
the long-term effects, and when and where it was
diabetes. No one else in my family has or ever has
used in Vietnam. It advises concerned Vietnam
had it. In reading the information on your Web site
veterans about what they can do, what they can
it seems that only Type 2 diabetes is to qualify for
expect from the examination, and how they will
whatever compensation is determined. Why is
benefit by taking the examination.
The brochure notes that Vietnam veterans can
Type 1 diabetes is not the same disease as Type
get medical treatment and disability compensation
2 diabetes. Type 1 is generally considered to be a
for Agent Orange-related illnesses. It lists the con
disease of insulin deficiency due to an immune dis
ditions that have been "service-connected,"
order, while Type 2 diabetes is considered to be
describes other VA efforts to help Vietnam veterans
primarily a disease of insulin resistance. Last year
who were exposed to Agent Orange, and explains
the National Academy of Sciences found that there
what other government departments and agencies
is "limited/suggestive evidence" of an association
are doing. It also describes the activities of the
National Academy of Sciences, where additional
era, describe las actividades de la National
available information can be obtained, and other
Academy of Sciences, de donde se puede obtener
información adicional sobre este tema y otros asuntos.
Distribution of this brochure to VA medical cen
La distribución de este panfleto a los Centros
ters, regional offices, and vet centers began in early
Médicos del Departamento de VA, oficinas
October 2001 with large quantities directed to facil
regionales y Centros para Veteranos, será durante la
ities and offices serving large Hispanic populations.
primera mitad del mes de octubre del presente, con un gran número de reproducciones siendo dirigidas
Copies are also available from Donald J.
a centros y oficinas que ofrecen servicios a la
Rosenblum (131), AO Brochure, Spanish,VA
Central Office, 810 Vermont Avenue, N.W.,Washington, DC 20420. Please specify the
Duplicados del folleto disponibles con el señor
Donald J. Rosenblum (131), AO Brochure Spanish, VA Central Office, 810 Vermont Avenue,
The above paragraphs are repeated in Spanish
N.W., Washington, D.C. 20420. Favor de especi
below. Translation of this article was provided by
ficar el numero de copias requeridas.
Nemo Curiel, a 2001 Summer Intern from the Hispanic Association of Colleges and Universities.
* Veterans Affairs
Folleto Sobre "Agent Orange" Ahora Disponible
New Agent Orange Educational Efforts
for VA Employees
Un folleto de seis páginas titulado "Agent
Two new Department of Veterans Affairs (VA)
Orange" - Información para Veteranos de Vietnam -
Agent Orange-related educational tools have
Información General, datada de abril del 2001, es
recently been completed and released to VA facili
disponible ahora en español.
El impreso explica por qué fue usado "Agent
1-A videotape, about 40-minutes long, presents
Orange", por qué algunos veteranos se preocupan
a general orientation to the three VA registry pro
por los efectos que este químico puede tener a
grams managed by the Environmental Agents
largo plazo y también explica dónde y cuándo fue
Service, which includes the Gulf War Health
usado éste químico en Vietnam. Así mismo, con
Registry and the Ionizing Radiation as well as the
tiene recomendaciones de cómo pueden ayudarse a
Agent Orange Registry program. It was designed
si mismos los veteranos interesados, señala lo que
to convey the basic content needed to inform cur
pueden esperar de los análisis y describe los benefi
rent and new employees. The video includes sug
cios que ellos o ellas pueden obtener al ser exami
gestions for successful completion of the most dif
nados. El folleto menciona cómo veteranos de
ficult sections of the code sheets to reduce the
Vietnam pueden obtener tratamiento medico y pen
potential for errors.
sión de incapacidad por enfermedades relacionadas con "Agent Orange". También, indica las condi
2-A 100+page independent study program is
ciones que son relacionadas con los efectos del
designed to provide an introduction to issues
químico ("service-connected"), nombra otros medi
regarding the long-term health consequences of
das que el Departamento de VA* esta tomando para
exposure to Agent Orange, VA health care,
ayudar a veteranos de Vietnam que fueron
research, disability compensation programs for
expuestos a "Agent Orange" y explica lo que otras
Vietnam veterans and common symptoms and
agencias y departamentos del gobierno están
diagnoses of these veterans. This Continuing
haciendo respecto del problema. De la misma man-
Medical Education (CME) program was designed
primarily for VA primary health care providers.
and disorders, Gulf War veterans' health, post-trau
Other health care professionals, especially those in
matic stress disorder, traumatic-amputation and
VA health care facilities are also encouraged to
prosthetics, ionizing radiation, prisoners of war,
complete the study.
and hearing and deafness/low vision and blindness.
Agent Orange Review newsletter editor Donald
Agent Orange Outreach Products
J. Rosenblum, Deputy Director, Environmental
Available from VA
Agents Service, served as subject matter expert and editor-in-chief for the CME project. John C.
The General Accounting Office (GAO) recently
Whatley, Ph.D., program manager at the
completed a program review of VA's Agent Orange
Birmingham Employee Education Resource Center,
education and outreach activities. Their review
was the Program Director.
reflected ongoing congressional interest in how well VA provides information to veterans about
The CME program is part of the Veterans
Agent Orange health care and compensation.
Health Initiative (VHI) which recognizes the con
The GAO concluded that VA's outreach materials
nection between certain health effects and military
including our newsletters, fact sheets and other publi
service, prepares health care providers to better
cations, Agent Orange web-sites, and the 800 tele
serve veterans with health problems or concerns,
phone Agent Orange hotline do a good job of cover
and provides a data base for further study. Other
ing these issues. However, GAO also concluded that
VHI study programs focus on Spinal cord injury
these outreach materials were not well utilized by VA field staff. In fact, GAO reported that many field staff
Conditions Recognized as Service-Connected
for Vietnam Veterans Based on Exposure to
they interviewed during their investigation were
Agent Orange or Other Herbicides
apparently not aware of the availability of Agent Orange resources.
1. Chloracne (Must occur within one year of
exposure to Agent Orange)
In a related development, some VA field staff have
2. Non-Hodgkin's lymphoma3. Soft tissue sarcoma (Other than osteosarcoma,
told us (in VA Central Office) about complaints from
chondrosarcoma, Kaposi's sarcoma, or
Vietnam veterans who have been unable to get any
information about VA's recent change in policy on
4. Hodgkin's disease
service connection for Type 2 diabetes.
5. Porphyria cutanea tarda (Must occur within
one year of exposure)
6. Multiple myeloma
VA's final rule establishing a presumptive service
7. Respiratory cancers, including cancers of the
connection for Type 2 diabetes and Agent Orange
lung, larynx, trachea, and bronchus (Must
exposure took effect July 9, 2001. VA has already
received about 35,000 claims for Type 2 diabetes.
within thirty years of exposure)
Over the next 18 months VA officials expect more
8. Prostate cancer 9. Acute and subacute transient peripheral neu
than 100,000 Vietnam veterans to file claims under
ropathy (Must appear within one year of expo
these new rules.
sure and resolve within two years of date ofonset)
These changes in VA policy on Type 2 diabetes
10.Type 2 diabetes (see article on page 2; and Q's
were very well explained in recent VA publications
and A's on page 10)
including the Agent Orange newsletter and the Agent
Conditions Recognized in Children of Vietnam
Orange Briefs, and on the VA's Agent Orange web
sites, and through the national telephone hotline. All VA employees were recently informed about changes
1. Spina bifida (except spina bifida occulta)
in a message printed on their "Earnings and Leave
2. Other birth defects in the children of women
Vietnam veterans (Pending; regulations
statement" (see below).
should be published soon)
About 685,000 copies of the Agent Orange
Message on "Earnings and Leave Statement" of
reviewed and analyzed 137 responses from veterans
All VA Employees (August 2001)
to the "Agent Orange Review" Readers Survey printed in the August 2000 issue of the newsletter.
Over the next 18 months, more than 100,000
Examining these responses, I gained a better under
Vietnam veterans are expected to file compensa
standing of how useful the newsletter is.
tion claims for diabetes as VA begins making payments under a new rule presuming service con
It is important to note the survey is not a scientif
nection for Type II diabetes for those exposed to Agent Orange defoliant during service in
ic study, but a compilation of all written responses to
Vietnam. Veterans with Type II diabetes who
four questions about the "Review." The results do
served in Vietnam can now receive priority eligi
not necessarily reflect the opinions of all Vietnam
bility for VA health care and, depending upon the
veterans or even all the readers of the newsletter. Of
severity of their illness, disability compensation
137 surveys assessed, 73 percent indicated the
ranging from $101 to $2,107 monthly. VA
"Review" is very informative and meets their needs
employees with service in Vietnam during the war
as Vietnam veterans, 21 percent commented that the
are reminded of their eligibility for a variety of
"Review" is not pertinent to their needs, and 6 per
related benefits including the VA Agent Orange
cent provided neutral comments.
Registry health examination and newsletter updates of ongoing scientific studies and policy developments. Vietnam veterans can call a toll-
While many readers expressed their view that the
free help line at 800-749-8387 to request the
"Review" was "very informative," some Vietnam
newsletter and get more information about VA's
veterans wrote that the newsletter did not focus on
Agent Orange program.
some more pressing issues. Some of the responding veterans said the "Review" needs to focus more on
newsletter are mailed directly to Vietnam veterans,
the overall health status of Vietnam veterans, includ
and another 150,000 copies are sent out to VA
ing breathing problems, sleeping disorders associat
Medical Centers, Regional Offices and Vet Centers as
ed with Agent Orange, and the effectiveness of medication. By gathering information from Vietnam vet
a resource for those facilities to use in answering vet
erans, the survey allows officials in VA responsible
for the newsletter to better comprehend the views and needs of its audience.
AO Review Readers' Survey Results
Martha Adell Cruz, a full-time communications /
journalism student at Austin Community College in
I come from a generation that has learned to dis
Austin, Texas, prepared the following analysis and
trust the government and to question every govern
commentary. Adell wrote this article in June 2001
mental action. I am troubled by the way Vietnam
while serving as a Summer Intern, at VA, through
veterans were treated by the American people. It
the Hispanic Association of Colleges and
seems that it was easier for the American people to
Universities (HACU) in the Environmental Agents
point their fingers at the horrors of war and reject
Service. She plans to graduate in Spring 2002 and
military service members who dedicated their lives to
looks forward to a career in journalism. Her com
free a country than it was to blame the politicians
ments are her own and do not necessarily reflect the
behind it. The government has made many mistakes
views of the Department of Veterans Affairs.
in handling the medical care services, but we have learned from those mistakes and we have been reas
After a review of the Agent Orange Review
sured that such mistakes will never allow the Nation
Readers Survey responses by the staff in the Office
to forget the price of freedom or the military person
of Public Health and Environmental Hazards,
nel who fought for it.
Veterans Affairs Central Office, I was asked to do an analysis of the survey results as part of my intern
Unfortunately, many Vietnam veterans still feel
ship in the Department of Veterans Affairs (VA). I
the pain associated with their inability to take care of
themselves. This may trigger feelings of resentment
dated January 2001, have been sent to all VA medical
due to the seeming lack of governmental support and
centers and to many other interested parties.
an inability to make a complicated process more sim
All of the fact sheets have been placed on the
ple. Having to get around one obstacle after the
other leaves a hopeless feeling that no goal can ever
. The revised "Briefs," describe a wide
range of Agent Orange-related matters. The following twenty-one "Briefs" are available:
Many Vietnam veterans have felt neglected by the
swaying tides of public opinion. Some Vietnam vet
A1. Agent Orange - General Information
erans symbolize for America an image that many
A2. Agent Orange Class Action Lawsuit
wish to ignore and forget. Time and several different administrations have begun to heal the wounds of
B1. Agent Orange Registry
Vietnam veterans. In large measure, due to their per
B2. Agent Orange - Health Care Eligibility
sistence, Vietnam veterans have not been and will not
B3. Agent Orange and VA Disability
be forgotten. This has resulted in the governmental
policies improving the lives of many veterans in the
B4. VA Information Resources on Agent Orange
latter part of the 20th century.
and Related Matters
VA has launched many new initiatives to help
C1. Agent Orange - The Problem Encountered
Vietnam veterans cope with their concerns about
exposure to Agent Orange and other herbicides used
C2. Agent Orange and Vietnam Related
in Vietnam. One initiative is the national toll free
Research - VA Efforts
number (1-800-749-8387) that allows Vietnam veter
C3. Agent Orange and Vietnam Related
ans to call about their questions and concerns about
Research - Non-VA Efforts
Agent Orange exposure and VA benefits. Another significant element of VA outreach is the expansion
D1. Agent Orange and Birth Defects
of the mailing list. VA's Veterans Benefits
D2. Agent Orange and Chloracne
Administration has added 387,000 Vietnam veterans
D3. Agent Orange and Non-Hodgkin's
to the distribution of this newsletter.
D4. Agent Orange and Soft Tissue Sarcomas
The "Review" survey is but a step in hearing
D5. Agent Orange and Peripheral Neuropathy
Vietnam veterans' opinions about VA activities. VA
D6. Agent Orange and Hodgkin's Disease
encourages all veterans to express their concerns on
D7. Agent Orange and Porphyria Cutanea
veterans' issues and to send any suggestions on how
VA can better serve Vietnam veterans, including how
D8. Agent Orange and Multiple Myeloma
the "Review" might better serve their needs.
D9. Agent Orange and Respiratory Cancers
Comments and suggestions regarding the "Review"
D10. Agent Orange and Prostate Cancer
should be sent to Mr. Donald J. Rosenblum, Deputy
D11. Agent Orange and Spina Bifida
Director, Environmental Agents Service (131),
D12. Agent Orange and Diabetes
ATTN: AGENT ORANGE REVIEW, VA Central
was added to this Brief in May 2001)
Office, 810 Vermont Avenue, N.W., Washington, DC 20420.
Changes in law, research developments, and com
pensation policy have necessitated changes in the
For More Information
Briefs. The revised fact sheets includes information about the report of the National Academy of
Early this year, the Environmental Agents Service
Sciences' Institute of Medicine on Agent Orange and
(EAS) in VA Central Office in Washington, DC,
Type 2 diabetes, VA's decision to provide service-
updated a series of Agent Orange fact sheets, known
connection to Vietnam veterans with diabetes, the
as "Agent Orange Briefs." The updated fact sheets,
Where to Get Help
Vietnam veterans with questions or concerns about
The counselors have information about the wide range of
Agent Orange -
contact VA's Gulf War/Agent Orange
benefit programs administered by VA. The national toll-
The national toll-free telephone number is 800
free number is 1-800-827-1000.
A great deal of information is also available
on our web page. It is located at
Vietnam veterans who encounter difficulties
at a VA
medical center - contact the "patient advocate" at that facility for assistance in resolving the problem. Ask the
Vietnam veterans (plus veterans who served in Korea
medical center telephone operator for the patient advo
in 1968 or 1969), or were exposed to Agent Orange or
cate or representative.
other herbicides elsewhere during the testing, trans
porting or spraying of herbicides for military purpos
Vietnam veterans with children who have spina bifida
es and who are concerned
about possible long-term
contact the VA national toll-free hotline at 1-888-820
health effects of Agent Orange exposure - contact the
1756, or the nearest VA regional office by calling toll-
nearest VA medical center and request an Agent Orange
free: 1-800-827-1000. Additional information on spina
Registry health examination. More than 300,000
bifida is available from the Spina Bifida Association of
Vietnam veterans have already participated in this pro
America at 4590 MacArthur Blvd., Suite 250,
Washington, DC 20007-4226; toll free telephone: 800; and web
Vietnam veterans who need medical treatment
conditions that may be related to their exposure to Agent Orange or other herbicides used in Vietnam - contact the
Representatives of veterans service organizations
nearest VA medical center for eligibility information and
including The American Legion (1-800-433-3318),
possible medical treatment.
Paralyzed Veterans of America (1-800-424-8200), Veterans of Foreign Wars of the United States (1-800
Vietnam veterans with illnesses that were incurred in
VFW-1899), Disabled American Veterans (1-877-426
or aggravated by
exposure to Agent Orange or other
2838), Vietnam Veterans of America (1-800-882-1316),
aspects of military service - contact a VA veterans servic
etc., have also been very helpful to Vietnam veterans
es representative at the nearest VA regional office or
seeking disability compensation.
health care facility and apply for disability compensation.
decision to open the Agent Orange Registry to certain
Registry Coordinator at the nearest VA medical
Vietnam-era veterans who served in Korea, and the
center, write to Agent Orange Briefs,
enactment of Public Law 106-419 which will pro
Environmental Agents Service (131), VA Central
vide monthly disability allowances, vocational
Office, 810 Vermont Avenue, NW, Washington,
training, health care to women Vietnam veterans'
or go to the above mentioned web site.
children born with certain medical problems. Some numbers were also updated.
Most of the existing "Briefs" were modified.
Earlier versions of the "Briefs" were released in October 1988, October 1989, September 1990, July 1991, February 1992, January 1993, September 1994, January 1997, December 1997, and August 1999. Copies of these outdated issues are no longer available.
For additional information or a copy of some or
all of the fact sheets, contact the Agent Orange
ISSN 1696-4403 Jordi Pomés Vives Diálogo Oriente-Occidente en la España de finales del siglo XIX. El primer teosofismo español (1888-1906): un movimiento religioso heterodoxo bien integrado en los movimientos sociales de su época1 Jordi Pomés Vives (Universitat Autònoma de Barcelona) Resumen / Resum / Abstract
International Journal Of Medical Science And Clinical Inventions Volume 2 issue 11 2015 page no. 1443-1447 e-ISSN: 2348-991X p-ISSN: 2454-9576 "A Rare Case Report Of Intestinal Hymenolepiasis And Ascariasis Double Infection In A Symptomatic Immuno-Competent Host From South India". Dr. R. Someshwaran1, SM. Nachammai2, Dr. Anbu N. Aravazhi3