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2010 A BUSY YEAR by Dave Barker http://davebarker.portalone.us/
Since three conditions were addressed in the most recent release (VAO Update 2009) of the National Association of Sciences I will address the rarest first which is Hairy Cell Leukemia. So another leukemia has been found linked to the herbicide Agent Orange.
The best description I have of Hairy Cell Leukemia describes a rare, slow-growing cancer of the blood in which the bone marrow makes too many B cells (lymphocytes), a type of white blood cell that fights infection. These excess B cells are abnormal and look "hairy" under a microscope because of fine projections (villi) from their surface. As leukemia cells increase, less healthy white blood cells, red blood cells and platelets are produced. Approximately 700 people are diagnosed with Hairy Cell Leukemia each year in the United States. More men are affected by Hairy Cell Leukemia than women, it occurs basically in middle aged or older adults.
Science is not sure what causes Hairy Cell Leukemia, and there is no cure. It is considered a chronic disease, because it may never completely disappear, although treatment can lead to a remission for years.
This leads us to the topic which we have been discussing and debating for several years with the VA and that is ischemic heart disease. We shall quote the report published which stated “there is a finding of ‘limited or suggestive evidence of an association” means that the evidence indicates there could be a link between exposure to a chemical and increased risk for a particular health effect, though conflicting results from studies, problems with how the studies were conducted, or other confounding factors limit the certainty of the evidence. Until now, the cumulative evidence had been inadequate to draw conclusions about whether these two conditions may be associated with veterans' exposures to herbicides or TCDD.”
Ischemic heart disease has long been associated with the former POW’s and now the possibility of the Agent orange exposed veterans being added to the list certainly makes sense to me. Over the past 30 plus years I have observed a great number of my client who were involved in herbicide exposure showing a diagnosis of ischemic heart disease which is a condition characterized by reduced blood supply to the heart. This condition often leads to a heart attack and or a stroke, or both. Since ischemic heart disease is the number one cause of death among people in industrialized countries, it is my opinion the VA will use that fact in any determination of presumption for the veterans exposed.
When VA makes a decision the preponderance is the term used, it means superiority in weight, force, importance, or influence. The bottom line being the following quote from the NAS report, “based on the preponderance of the evidence as well as biologic data beginning to show how TCDD can cause this toxic effect, the committee concluded that the evidence suggests that veterans exposed to defoliants contaminated with TCDD during the war may face a higher risk for developing ischemic heart disease.”
Those of us who have been involved in the long struggle acknowledge the major risk factors include buildup of cholesterol in the arteries, age, smoking, high blood pressure, and diabetes. It is also a fact that diabetes another Agent Orange presumptive can cause heart problems. Hopefully before we are all gone, these issues will all be completely addressed.
Finally the discussion which the “Military.com Sound Off Dave Barker Discussion Board” has carried for a considerable time was addressed as well, that being “Parkinson's disease.” Here is the direct word for word message from the NAS: “The committee's conclusion that there may be a relationship between Parkinson's disease and Agent Orange exposure stems from its review of 16 studies that looked at herbicide exposures among people with Parkinson's disease or Parkinson's-like symptoms. The finding was bolstered by several studies that have identified exposure to certain compounds similar to those in the herbicides used in the war as potential risk factors for the development of Parkinson's. The committee's review was hampered by the lack of studies investigating the occurrence of Parkinson's disease in Vietnam veterans specifically and the lack of animal studies testing the chemical components of Agent Orange for their potential to cause Parkinson's-like symptoms. The report strongly recommends that studies examining the relationship between Parkinson's incidence and exposures in the veteran population be performed. Parkinson's disease affects approximately 1 percent of people over age 60 -- some 5 million people worldwide.”
SUMMARY ON THE NEW THREE PRESUMPTIVES
We have been reporting on this issue for several years. In July 2004 when I appeared in person to testify before the committee of the National Academy of Sciences, two of these conditions were included in my oral presentation, as well as the written presentation. I reported on heart conditions and Parkinson's disease along with other neurological conditions.
I had presented before the VA in 1984, several of my clients Ischemic Heart Condition claims and several also in years following. Again the claims brought problems for me, again being labeled a 'loose cannon' by some of my fellow Ohio veteran service officers and some VA employees. All I can say about that is BOOM!
I intend to find those survivors and attempt to reopen under new and material evidence. As I stated earlier in my book several of my 1985 diabetes claims were reopened and retroactive compensation was paid.
Ischemic Heart Disease
The previous Committee responsible for Update 2006 was divided as to whether the evidence related to IHD and exposure to the compounds of interest was sufficient to advance IHD from the
category of ‘‘inadequate or insufficient evidence to determine whether an association exists’’ to the category of ‘‘limited or suggestive evidence of an association.’’ Due to the lack of consensus, the 2006 Committee left IHD in the ‘‘inadequate or insufficient evidence’’ category.
For Update 2008, the Committee revisited the entire body of evidence relating herbicide exposure to heart disease risk and placed more emphasis on studies that had been rigorously
conducted. These studies focused specifically on the chemicals of concern, compared Vietnam veterans to non-deployed Vietnam-era veterans, and had individual and reliable measures of
exposure that permitted the evaluation of dose-response, to promote the proposals.
Federal Register / Vol. 75, No. 57 / Thursday, March 25, 2010 / Proposed Rules 14393 interpretation of epidemiologic data. The Committee identified nine studies (including two new studies) that were deemed most informative. Of these nine studies, five showed strong statistically significant associations between herbicide exposure and ischemic heart disease. The studies considered by the Committee also included data from Agent Orange sprayers, occupationally exposed populations, and environmentally exposed populations that were either prevalence surveys or mortality follow-up studies. In situations where several alternative analyses were presented, the results with the greatest specificity in the dose-response relationship were given more weight.
The Committee stated that evidence of a dose-response relationship is especially helpful in interpretation of the epidemiological data, and the Committee was impressed by the fact that those studies with the best dose information all showed evidence for risk elevations in the highest exposure categories. The Committee noted that some of the study findings could be limited by the effect of selection bias or possible confounding factors. However, the Committee noted that one of the new studies showed an association that persisted after statistical adjustments for a large number of potential confounding risk factors, which is not generally available in studies of other dioxin exposed populations. The Committee
also indicated that the major potential confounders were likely inadequate to explain away the high relative risks and dose-response relationships seen in the data for IHD. Further, the Committee noted that toxicological data supports the biologic plausibility of an association between exposure to the compounds of interest and IHD.
After considering the relative strengths and weaknesses of the evidence, and emphasizing in particular the numerous studies showing a strong dose-response relationship and good toxicology data regarding IHD, the Committee concluded that there was adequate information to advance IHD from the ‘‘inadequate or insufficient evidence’’ category to the ‘‘limited or suggestive evidence’’ category.
The Secretary has determined that the available scientific and medical evidence presented in Update 2008 and other information available to the Secretary are sufficient to establish a new presumption of service connection for IHD in veterans exposed to herbicides. After considering all of the evidence, the Secretary has concluded that the credible evidence for an association between exposure to an herbicide agent and the occurrence of IHD in humans outweighs the credible evidence against such an association.
Accordingly, the Secretary has determined that a presumption of service connection for IHD is warranted pursuant to 38 U.S.C. 1116(b).
According to Harrison’s Principles of Internal Medicine (Harrison’s Online, Chapter 237, Ischemic Heart Disease,2008), IHD is a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand. Therefore, for purposes of this regulation, the term ‘‘IHD’’ includes, but is not limited to, acute, sub acute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina. Since the term refers only to heart disease, it does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke.
We are on track folks, it is not the time to relax, but time to move full steam ahead!
