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###  Agent Orange Brief

**Prepared by the Environmental Agents Service (131)**

D1 VA Central Office, Washington, DC 20420 Aug. 2002

> **AGENT ORANGE AND BIRTH DEFECTS**

**Does exposure to Agent Orange or service in Vietnam increase the
likelihood of a veteran fathering a child with birth defects?**

One of the most emotional aspects of the Agent Orange issue is the
concern that exposure to herbicides in Vietnam may have caused or
contributed to the risks of having babies with birth defects. Literally
thousands of Vietnam veterans have children with abnormalities.
Considering the fact that approximately 2.6 million veterans served in
Vietnam and the fact that 3-6 percent of all children are born with some
kind of defect, scientists expect many children with abnormalities among
the offspring of Vietnam veterans. Unfortunately, in many instances
scientists cannot explain what caused these birth defects.

Research has been conducted to determine whether exposure to Agent
Orange or military service in Vietnam may have increased the risk of
having children with birth defects. Based on the research completed to
date, the overall answer seems to be \"apparently not.\" In 1996, the
National Academy of Sciences found that there is "limited/suggestive"
evidence of an association between herbicide exposure and one rare birth
defect, spina bifida. For information about spina bifida, see **Agent
Orange Brief, D11**. The Australian birth defects study, the Centers for
Disease Control (CDC) birth defects study, the Air Force Health Study
(Ranch Hand), and the CDC Vietnam Experience Study all suggest that
Agent Orange is not the most likely cause of the birth defects. Each of
these investigations is briefly summarized below.

**[Case-Control Study of Congenital Anomalies and Vietnam Service (Birth]{.underline}
[Defects Study)]{.underline}** - Report to the Minister for Veterans\'
Affairs - January 1983 - Prepared by J. W. Donovan and others. This
Australian investigation involved examination of the hospital and
laboratory records of infants born with birth defects in three populous
areas of Australia between the years 1966 and 1979.

In all, 34 hospitals and 4 laboratories cooperated fully with the
investigating team. Whenever the birth of an infant with a defect was
found, it was matched to a healthy control infant born in the same
hospital, to a mother of similar age, and as close as possible in time
to

the birth of the child with the defect. The fathers of both cases (for
this study, a case is a baby with a birth defect) and controls (for this
study, a control is a baby without a birth defect) were identified in
8,517 instances and those identified were compared with a list of every
man who served in the Australian Army between 1962 and 1972, the period
of Australian involvement in Vietnam. Fathers who served in the Army
during this period were then classified according to whether they had
served in Vietnam.

The important finding of the study is that 127 of the fathers of
children with birth defects were Vietnam veterans and 123 veterans were
among the fathers of healthy children. This indicates that there is no
evidence that Army service in Vietnam increased the risk of fathering a
child with a birth defect.

**[Vietnam Veterans\' Risks for Fathering Babies with Birth Defects]{.underline}** -
August 1984 - U.S. Department of Health and Human Services, Public
Health Service, Centers for Disease Control, Center for Environmental
Health. Vietnam veterans\' risks for fathering babies with major
structural birth defects were assessed using a case-control study.
Information regarding military service in Vietnam was obtained from
interviews with mothers and fathers of babies in case and control groups
and from review of military records.

Vietnam veterans did not have an increased risk of fathering babies with
defects. Furthermore, Vietnam veterans who had greater estimated
opportunities for Agent Orange exposure were not at greater risk for
fathering babies with **all types of defects combined**.

**[Air Force Health Study (Project Ranch Hand II) - An Epidemiologic]{.underline}
[Investigation of Health Effects in Air Force Personnel Following
Exposure]{.underline} [to Herbicides]{.underline}** - Periodic reports
on morbidity (health problems). The February 1984 Baseline Morbidity
Study Results indicated that there were no significant differences
between the Ranch Hand (the military unit that did most of the herbicide
spraying in Vietnam) and control groups with regard to severe or
moderate birth defects. Based on parental reports, however, Ranch Hand
offspring showed significantly more minor birth defects (birth marks,
etc.).

In 1992, the Air Force study compared blood dioxin levels with
reproductive outcomes. All of the 791 Ranch Hands and 942 comparison
subjects who have measured levels of dioxin in their blood were included
in the study. It analyzed miscarriages, total adverse outcomes, total
conceptions, birth weights, birth defects, birth defect severity,
specific and multiple birth defects, and infant and neonatal deaths. In
addition, the study looked at sperm counts and the percentage of
abnormal sperm of study participants.

Investigations found no adverse relationship between dioxin and any of
these reproductive outcomes, nor between dioxin and sperm count or
percentage of abnormal sperm.

**[Health Status of Vietnam Veterans - Reproductive Outcomes and Child
Health]{.underline}** - The Centers for Disease Control Vietnam
Experience Study - May 1988. The Vietnam Experience Study was a
multidimensional assessment of the health of Vietnam veterans. From a
random sample of enlisted men who entered the U.S. Army from 1965
through 1971, 7,924 Vietnam and 7,364 non-Vietnam veterans participated
in a telephone interview; a random subsample of 2,490 Vietnam and 1,972
non-Vietnam veterans also underwent a comprehensive medical examination.
Children of Vietnam veterans were not more likely to have birth defects
recorded on hospital birth records than were children of non-Vietnam
veterans. The rates of total, major, minor, and suspected defects were
similar among children of Vietnam and non-Vietnam veterans.

**What did the National Academy of Sciences conclude about birth defects
in its 1993 report, entitled
[Veterans and Agent Orange - Health Effects of Herbicides
Used]{.underline}**

**[in Vietnam]{.underline}?**

The 832-page NAS report included the following statements:

There is little evidence of a statistical association between father\'s
occupational exposure to herbicides or dioxin and birth defects among
offspring. The available epidemiologic studies have been limited by a
number of problems, especially inadequate statistical power for the
evaluation of specific birth defects. Studies involving environmental
exposure have yielded inconsistent results; furthermore, given the
ecologic nature of the studies, the limited sample sizes (for specific
defects), and the failure to verify reported birth defects, the evidence
can be considered inadequate for an association.

> The results of available epidemiologic studies of Vietnam veterans are
> also inconsistent; some studies suggest a potential association with
> defects of the central nervous system and other systems, although
> others find no increased risk. As noted for other end points, the
> veteran studies were generally limited by inadequate size, marginal
> magnitude of the increased risk, and the failure to exclude bias and
> chance. Moreover, uncertainty regarding the assessment of exposure
> among Vietnam veterans and the limited evidence from other cohorts do
> not permit one to draw a conclusion about an increased risk of birth
> defects among the offspring of men exposed to herbicides in Vietnam.
> Future analyses of the Ranch Hand data may contribute important
> evidence regarding an increased risk of birth defects.

**What did the NAS conclude about birth defects in its 1996 update?**

The 1996 update included the following statements:

There is limited/suggestive evidence between exposure to the herbicides
considered in this report and spina bifida. There is inadequate or
insufficient evidence to determine whether an association exists between
exposure to herbicides and all other birth defects. The evidence
regarding association is drawn from occupation and other studies in
which subjects were exposed to a variety of herbicides and herbicide
components.

Since the strongest associations are from studies of Vietnam veterans
and there are some data suggesting that the highest risks were for those
veterans estimated to have had exposure to Agent Orange (e.g., Ranch
Hands), it therefore follows that there is limited/suggestive evidence
for an increased risk in Vietnam veterans of spina bifida in offspring.

**What did the NAS conclude about birth defects in its 1998 update?**

The 1998 update included the following statements:

There are no changes from Update 1996. In Update 1996, there was
limited/suggestive evidence of an association between exposure to the
herbicides considered in this report and spina bifida. There is
inadequate or insufficient evidence to determine whether an association
exists between exposure to herbicides and other birth defects.

Laboratory studies, using adult male animals, of the potential
male-mediated developmental toxicity of TCDD or herbicides, specifically
with regard to birth defects are too limited to permit conclusions....

Wh**at did the NAS conclude about birth defects in its 2000 update**?

The 2000 update included the following statement: There is no
information reviewed in this report to change the conclusion that there
is inadequate or insufficient evidence to determine whether an
association exists between exposure to herbicides ... and other \[than
spina bifida\] birth defects.

W**hat can a Vietnam veteran now assume about the risks of birth
defects?**

The critical question is \"Are Vietnam veterans more likely than other
individuals to produce children with birth defects?\" Based on all we
know from the scientific research described above and studies of
dioxin-contaminated areas in Times Beach, Missouri, and Seveso, Italy
(where investigators concluded \"that the data collected contain no
evidence \... that in the population of the Seveso area exposed to
dioxin, there was greater risk of producing congenitally malformed
offspring.\"), Vietnam veteran men do not seem to be at increased risk
of fathering children with birth defects (with the possible exception of
spina bifida, for which there is "limited/suggestive" evidence of an
association).

On the other hand, in a recently completed VA study, women Vietnam
veterans reported significantly more babies born with birth defects as
compared to non-Vietnam women veterans. In this study, the risk of
having children with birth defects was also significantly elevated among
women Vietnam veterans after investigators made adjustments for
demographic and military characteristics, and smoking and drinking
histories of mothers. Similarly, the risk of having children with severe
birth defects was significantly elevated among women Vietnam veterans.
Over-reporting or selective recalls by women Vietnam veterans are
considered unlikely explanations for these findings. A relatively small
number of women served in Vietnam. Based on this evidence Secretary West
asked Congress for statutory authority to provide certain benefits and
service to children with birth defects who were born to women Vietnam
veterans. The authority was granted in Public Law 106-419, signed by
President Clinton on November 1, 2000. Implementing regulations,
published July 31, 2002, are retroactive to December 1, 2001.

**Where can a concerned veteran get additional information about birth
defects?**

In October 1985, VA published a monograph entitled \"Birth Defects and
Genetic Counseling.\" This publication was distributed to all VA medical
center libraries in 1985. The March of Dimes Birth Defects Foundation is
a source of information on this subject. The address is Professional
Education, March of Dimes Birth Defects Foundation, and 1275 Mamaroneck
Avenue, White Plains, New York 10605. Other sources of information
include the Easter Seal Society and the Spina Bifida Association of
America.

**Where can a veteran obtain additional information about Agent
Orange-related issues?**

The following Agent Orange fact sheets (including the one you are
reading) are available on the World Wide Web at
[www.va.gov/agentorange](http://www.va.gov/agentorange). Hard copies can
be obtained from local VA medical centers or from the VA Central Office
at the Environmental Agents Service (131), Department of Veterans
Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420. The briefs are
A1 -- General Information, A2 - Class Action Lawsuit, B1 -- Registry, B2
-- Health Care Eligibility, B3 -- VA Disability Compensation, B4 -- VA
Information on Agent Orange and Related Matters, C1 -- The Problems
Encountered in Research, C2 - Vietnam Related Research VA Efforts, C3 --
Vietnam Related Research - Non-VA Efforts, D2 -- Chloracne, D3 --
Non--Hodgkin's Lymphoma, D4 -- Soft Tissue Sarcomas, D5 -- Peripheral
Neuropathy, D6 -- Hodgkin's Disease, D7 -- Porphyria Cutanea Tarda, D8
-- Multiple Myeloma, D9 -- Respiratory Cancers, D10 -- Prostate Cancer,
D11 -- Spina Bifida, and D12 -- Diabetes.

This fact sheet was prepared in early August 2002 and does not include
subsequent developments.