Senate Reviews Agent Orange Disability Coverage

Two Department of Veterans Affairs secretaries—one past and one present—told the Senate Veterans Affairs Committee last week that they still stood behind their decisions to add diabetes, prostate cancer, heart disease, Parkinson's disease, and leukemia to the those conditions that VA officials can "presume" to be caused by Agent Orange exposure among Vietnam War veterans.

With associated cases and costs quickly rising, the Senate is panel is reviewing the landmark 1991 Agent Orange regulation that has set the tone in terms of how disability claims are handled in regard to the herbicide and defoliant widely used during the Vietnam War. By granting a “presumption," the VA creates a way to bypass the standard process for filing disability claims.

In 1991, rare conditions such as soft-tissure sarcoma or non-Hodgkin's lymphoma were included on the initial list that could be considered for service-related claims for Agent Orange exposure. About 5,000 of those claims have been filed over the years, according to figures released by Sen. James Webb (D-VA) at the hearing.

But gradually other conditions—many of which could be considered the "diseases of ordinary life"—have been added over the years, amounting to nearly a total of half a million new VA claims, Webb said.

Making these decisions had been difficult, but both secretaries agreed that that they made the best decisions based on the evidence available at the time.

Last year, the VA included ischemic heart disease under the VA's presumptive category for Agent Orange. Current VA Secretary Eric Shinseki told the Senate panel that the Agent Orange Act does not permit him to weigh cost impact or exclude a disease from consideration "on the basis that it is a common disease." Instead, it directs the VA to determine whether "a positive association exists for each disease discussed" in an Institute of Medicine (IOM) report.

Shinseki said that his determination that a positive association between herbicide exposure and ischemic heart disease was based on evaluation of the scientific and medical evidence supplied by IOM. He did note, though, that having just 60 days to reach a conclusion—as specified by the Agent Orange Act—was "a bit constraining [and] a little challenging."

Similarly, Anthony Principi, MD, who was VA secretary between 2001 and 2005, told the panel that three out of four studies provided by IOM showed a "positive association" between the onset of type II diabetes and Agent Orange.

Principi agreed, though, that additional research from IOM or a scientific review board addressing lifestyle issues (such as smoking or eating) or heredity would have helpful when making his decision about whether to include diabetes. "Better information would be useful," he said.

"It's a greater challenge for secretaries, when you're dealing with the diabetes, the prostate cancer, because we know if we live long enough, we're going to die of prostate cancer, as well as heart disease," Principi said. "And those confounding factors really make it very, very difficult for us."