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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 Regulatory Action
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 Statutory
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 exami­
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 adding this The national toll-free telephone number for infor­ mation regarding VA benefits is 1-800-827-1000. The
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, also
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, Leukemia
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 Orange Act
Orange, 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. 30-year restriction. 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 Registry Statistics
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 of Vietnam
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 slightly uncomfortable. 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
Prostate Cancer?
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 Diagnosed 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 without anesthesia. 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 Q. 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." A. 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, Spanish (Español)
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 Q. 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 A. 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 población Hispana. Central Office, 810 Vermont Avenue, N.W.,Washington, DC 20420. Please specify the Duplicados del folleto disponibles con el señor quantity needed. 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
En Español
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. ties nationwide. 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 Veterans
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 erans questions. for the newsletter to better comprehend the views and needs of its audience. AO Review Readers' Survey Results
My Commentary
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 default.htm. The revised "Briefs," describe a wide
be accomplished. 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 in Research
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. Lymphoma
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 (an addendum
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- Helpline. The national toll-free telephone number is 800­
free number is 1-800-827-1000.
749-8387. 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 for
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' DC 20420 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


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 época.pdf

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

Cite as: "a rare case report of intestinal hymenolepiasis and ascariasis double infection in a symptomatic immuno-competent host from south india".; vol. 2 issue 11 pg:1443-1447

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