Spina Bifida & Agent Orange

Agent Orange or Herbicide Orange (HO) is one of the herbicides and defoliants used by the U.S. military as part of its herbicidal warfare program, Operation Ranch Hand,during the Vietnam War from 1961 to 1971. Vietnam estimates 400,000 people were killed or maimed, and 500,000 children born with birth defects as a result of the use of contaminated batches of the compound. The Red Cross of Vietnam estimates that up to 1 million people are disabled or have health problems due to Agent Orange. The United States government has challenged these figures as being unreliable and unrealistically high.

A 50:50 mixture of 2,4,5-T and 2,4-D, it was manufactured for the U.S. Department of Defense primarily by Monsanto Corporation and Dow Chemical. The 2,4,5-T used to produce Agent Orange was contaminated with 2,3,7,8-tetrachlorodibenzodioxin (TCDD), an extremely toxic dioxin compound. It was given its name from the color of the orange-striped 55 US gallon barrels in which it was shipped, and was by far the most widely used of the so-called "Rainbow Herbicides".

During the Vietnam War, between 1962 and 1971, the United States military sprayed nearly 20,000,000 US gallons (76,000,000 l) of material containing chemical herbicides and defoliants mixed with jet fuel in Vietnam, eastern Laos and parts of Cambodia, as part of Operation Ranch Hand. The program's goal was to defoliate forested and rural land, depriving guerrillas of cover; another goal was to induce forced draft urbanization, destroying the ability of peasants to support themselves in the countryside, and forcing them to flee to the U.S. dominated cities, thus depriving the guerrillas of their rural support and food supply.

The US began to target food crops in October 1962, primarily using Agent Blue. In 1965, 42 percent of all herbicide spraying was dedicated to food crops. Rural-to-urban migration rates dramatically increased in South Vietnam, as peasants escaped the war and famine in the countryside by fleeing to the U.S.-dominated cities. The urban population in South Vietnam nearly tripled: from 2.8 million people in 1958, to 8 million by 1971. The rapid flow of people led to a fast-paced and uncontrolled urbanization; an estimated 1.5 million people were living in Saigon slums.

United States Air Force records show that at least 6,542 spraying missions took place over the course of Operation Ranch Hand. By 1971, 12 percent of the total area of South Vietnam had been sprayed with defoliating chemicals, at an average concentration of 13 times the recommended USDA application rate for domestic use. In South Vietnam alone, an estimated 25 million acres, 39,000 square miles of agricultural land was ultimately destroyed. In some areas, TCDD concentrations in soil and water were hundreds of times greater than the levels considered safe by the U.S. Environmental Protection Agency. Overall, more than 20% of South Vietnam's forests were sprayed at least once over a nine-year period. 

Health Effects in Vietnam

The Vietnam Red Cross reported as many as 3 million Vietnamese people have been affected by Agent Orange, including at least 150,000 children born with birth defects. According to Vietnamese Ministry of Foreign Affairs, 4.8 million Vietnamese people were exposed to Agent Orange, resulting in 400,000 people being killed or maimed, and 500,000 children born with birth defects. Women had higher rates of miscarriage and stillbirths, as did livestock such as cattle, water buffalo, and pigs.

Children in the areas where Agent Orange was used have been affected and have multiple health problems, including cleft palate, mental disabilities, hernias, and extra fingers and toes. In the 1970s, high levels of dioxin were found in the breast milk of South Vietnamese women, and in the blood of U.S. soldiers who had served in Vietnam. The most affected zones are the mountainous area along Truong Son (Long Mountains) and the border between Vietnam and Cambodia. The affected residents are living in substandard conditions with many genetic diseases.

About 28 of the former US military bases in Vietnam where the herbicides were stored and loaded onto airplanes may still have high level of dioxins in the soil, posing a health threat to the surrounding communities. Extensive testing for dioxin contamination has been conducted at the former US airbases in Da Nang, Phu Cat and Bien Hoa. Some of the soil and sediment on the bases have extremely high levels of dioxin requiring remediation. The Da Nang Airbase has dioxin contamination up to 350 times higher than international recommendations for action. The contaminated soil and sediment continue to affect the citizens of Vietnam, poisoning their food chain and causing illnesses, serious skin diseases and a variety of cancers in the lungs, larynx, and prostate.

Effects on U.S. veterans

Some studies showed that veterans who served in the South during the war have increased rates of cancer, and nerve, digestive, skin and respiratory disorders. Veterans from the south had higher rates of throat cancer, acute/chronic leukemia, Hodgkin's lymphoma and non-Hodgkin's lymphoma, prostate cancer, lung cancer, colon cancer, soft tissue sarcoma and liver cancer. With the exception of liver cancer, these are the same conditions the US Veterans Administration has determined may be associated with exposure to Agent Orange/dioxin, and are on the list of conditions eligible for compensation and treatment.

Military personnel who loaded airplanes and helicopters used in Ranch Hand probably sustained some of the heaviest exposures. Members of the Army Chemical Corps, who stored and mixed herbicides and defoliated the perimeters of military bases, and mechanics who worked on the helicopters and planes, are also thought to have had some of the heaviest exposures. However, this same group of individuals has not shown remarkably higher incidences of the associated diseases. Others with potentially heavy exposures included members of U.S. Army Special Forces units who defoliated remote campsites, and members of U.S. Navy river units who cleared base perimeters. Military members who served on Okinawa also claim to have been exposed to the chemical but there is no verifiable evidence to corroborate these claims.

While in Vietnam, the veterans were told not to worry, and were persuaded the chemical was harmless. After returning home, Vietnam veterans began to suspect their ill health or the instances of their wives having miscarriages or children born with birth defects might be related to Agent Orange and the other toxic herbicides to which they were exposed in Vietnam. Veterans began to file claims in 1977 to the Department of Veterans Affairs for disability payments for health care for conditions they believed were associated with exposure to Agent Orange, or more specifically, dioxin, but their claims were denied unless they could prove the condition began when they were in the service or within one year of their discharge.

By April 1993, the Department of Veterans Affairs had only compensated 486 victims, although it had received disability claims from 39,419 soldiers who had been exposed to Agent Orange while serving in Vietnam.

In 1991, the US Congress enacted the Agent Orange Act, giving the Department of Veterans Affairs the authority to declare certain conditions 'presumptive' to exposure to Agent Orange/dioxin, making these veterans who served in Vietnam eligible to receive treatment and compensation for these conditions. The same law required the National Academy of Sciences to periodically review the science on dioxin and herbicides used in Vietnam to inform the Secretary of Veterans Affairs about the strength of the scientific evidence showing association between exposure to Agent Orange/dioxin and certain conditions.

Through this process, the list of 'presumptive' conditions has grown since 1991, and currently the U.S. Department of Veterans Affairs has listed prostate cancer, respiratory cancers, multiple myeloma, type II diabetes, Hodgkin's disease, non-Hodgkin's lymphoma, soft tissue sarcoma, chloracne, porphyria cutanea tarda, peripheral neuropathy, chronic lymphocytic leukemia, and spina bifida in children of veterans exposed to Agent Orange as conditions associated with exposure to the herbicide. This list now includes B cell leukemias, such as hairy cell leukemia, Parkinson's disease and ischemic heart disease, these last three having been added on August 31, 2010. Several highly placed individuals in government are voicing concerns about whether some of the diseases on the list should, in fact, actually have been included.

What is the Agent Orange Benefits Act?

The Agent Orange Benefits Act, Public Law 104-204, became law in 1996. The law established a benefits package for Vietnam veterans' children who were born with Spina Bifida, possibly as a result of exposure of one or both parents to herbicides during active service in the Republic of Vietnam during the Vietnam era.

The Act authorized the Department of Veterans Affairs to provide certain benefits effective October 1, 1997. These benefits include lifetime health care services for Spina Bifida and “any disability associated” with Spina Bifida, a monthly monetary allowance, and Veterans Affairs (VA) vocational training/rehabilitation services.

The VA defines Spina Bifida as all forms of Spina Bifida (except Spina Bifida Occulta). In establishing rules to determine the monthly monetary allowance, the VA indicated that “neurological deficit is the main determinant of disability for a person with Spina Bifida.” An estimated 10-20% of the population may have Spina Bifida Occulta; however, Occulta is not considered to have a neurological deficit according to the VA. The Women Vietnam Veterans' Children's Birth Defect Benefits Act is an act modeled after the Agent Orange Benefits Act; however, it only provides benefits to children of women Vietnam veterans whose children suffer from certain types of birth defects, with the exception of Spina Bifida.

Are any VA benefits available for children of Vietnam veterans born with Spina Bifida?

Children of Korean or Vietnam veterans born with Spina Bifida are eligible for a monthly disability allowance and for vocational training. A monthly allowance is set at three levels, depending upon the degree of disability suffered by the child. VA's Vocational Rehabilitation and Employment program administers a vocational training program to enable a qualified child to prepare for and attain suitable employment. Services may include counseling and rehabilitative services, education, training and employment services. VA pays for the costs of the services up to 24 months depending on need. For more information on Spina Bifida, please visit the VA's web site athttp://www.va.gov/hac/forbeneficiaries/spina/spina.asp or contact your local VA regional office at 1-800-827-1000.

What is the first step in establishing eligibility for VA Spina Bifida healthcare benefits?

Since VA Spina Bifida healthcare benefits are based upon eligibility determinations made by VA regional offices, prospective beneficiaries must first contact a regional office to obtain an Application for Spina Bifida Benefits (VA Form 21-0304). The local VA regional office can be contacted toll-free at 1-800-827-1000. Upon return of a completed application, the regional office will determine eligibility and notify the applicant of the determination.

Upon establishing eligibility through a VA regional office, what is the next step in obtaining VA Spina Bifida healthcare benefits?

Beneficiaries in receipt of a VA regional office Spina Bifida award should immediately contact VA's Health Administration Center (HAC) in Denver, CO, to register for health care benefits. The following information is required: name, address, and telephone number of both the beneficiary and veteran sponsor (and legal guardian when applicable); Social Security number of both the beneficiary and veteran sponsor; and, VA claim number of the veteran sponsor. Registration with HAC can be accomplished by telephone, fax, or mail

The telephone number for Spina Bifida Healthcare Benefits Information/Registration is 1-888-820-1756. The fax number is 1-303-331-7807. The address is VA Health Administration Center, Spina Bifida Healthcare Benefits, P O Box 65025, Denver, CO, 80206-9025

What other assistance is available?

The American Legion Service Officers (DSO) offer free advice and guidance for veterans who need to deal with the Department of Veterans Affairs (VA). This directory provides contact telephone numbers and addresses for the service officers in your area. Direct all correspondence to Department Service Officer. For the directory, please visit www.legion.org or call (202) 861-2700.

The National Veterans Legal Services Program specializes in legal issues and referrals for veterans. For more information, please visit www.nvlsp.org or call (202) 265-8305.

This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.

Additional resources

http://www.publichealth.va.gov/exposures/agentorange/birth_defects.asp

American Legion
www.legion.org
Help with Claims and Benefits, Health Issues Line
202- 861-2700

National Veterans Legal Services Program
PO Box 65762
Washington, DC 20035
202-265-8305
Fax 202-328-0063
Email: info@nvlsp.org
Web: www.nvlsp.org

VA Health Administration Center
Spina Bifida Healthcare Benefits Information/Registration
P O Box 65025
Denver, CO, 80206-9025
1-888-820-1756
Email: spina.inq@med.va.gov
Web: www.va.gov/hac