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."