+-----------------------------------------------------------------------+
| #                                                                     |
|                                                                       |
| #  Department of                                                      |
|                                                                       |
| #  Veterans Affairs                                                   |
+-----------------------------------------------------------------------+

###  Agent Orange Brief

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

D6 VA Central Office, Washington, DC 20420 Aug. 2002

> **AGENT ORANGE AND HODGKIN\'S DISEASE**

**What is Hodgkin\'s disease?**

Hodgkin\'s disease is a malignant lymphoma characterized by progressive
enlargement of the lymph nodes, liver, and spleen, and by progressive
anemia.

**Why are Vietnam veterans concerned about Hodgkin\'s disease? Does
Agent Orange cause it?**

Some Vietnam veterans have been diagnosed with Hodgkin\'s disease and
others have expressed concern about developing this cancer. Some
research has suggested that Hodgkin\'s disease may be associated with
exposure to herbicides, but there is no conclusive scientific evidence
that Agent Orange or other herbicides cause this condition.

A Department of Veterans Affairs (VA) study, published in the [Annals of
Epidemiology]{.underline} in September 1995, concluded that service in
Vietnam was not associated with any significant increased risk of
Hodgkin's disease. Furthermore, other measures of potential Agent Orange
exposure, such as service in a specific military branch, in a certain
region within Vietnam, in a combat role, or extended Vietnam time, were
not associated with any significant increased risk of Hodgkin's disease.

**What did the National Academy of Sciences (NAS) conclude about
Hodgkin\'s disease in its 1993 report, entitled
[Veterans and Agent Orange -- Health Effects of
 Herbicides Used in Vietnam]{.underline}?**

The NAS reviewers reported that nearly all of the case-control and
agricultural worker studies they evaluated show increased risk for this
disease. Although only a few of these results are statistically
significant, those that are show a positive association. Those that are
not statistically significant generally indicate increased risk of
Hodgkin\'s disease, and the pattern of the results is notably
consistent.

Hodgkin\'s disease has a number of clinical features that typically
differ from other lymphomas. While there were fewer studies for
Hodgkin\'s disease than for non-Hodgkin\'s lymphoma, the NAS noted that
the pattern of results was consistent with the findings for
non-Hodgkin\'s lymphoma and concluded that there was sufficient evidence
for a positive association between exposure to the herbicides used in
Vietnam and the development of Hodgkin\'s disease.

**What was VA response to the NAS finding?**

After reviewing the NAS report and noting (1) the difficulty in
distinguishing between Hodgkin\'s disease and non-Hodgkin\'s lymphoma,
(2) the occasional development of both diseases in the same patient, and
(3) the biologic relationship between the two diseases in terms of
origin, Secretary Brown determined that there is an association between
exposure to herbicides used in Vietnam and the subsequent development of
Hodgkin\'s disease which manifests itself to a degree of ten percent at
any time after exposure.

The proposed rule on Hodgkin's disease was published for public comment
in the [Federal Register]{.underline} in September 1993. (See 58 [Fed.
Reg.]{.underline} 50524, September 28, 1993). The final rule
implementing the Secretary\'s determination was published in the
[Federal Register]{.underline} in February 1994. (See 59
[Fed. Reg.]{.underline} 5106, February 3, 1994).

**What did Public Law 103-446 do for Vietnam veterans with Hodgkin's
disease?**

Section 505, Public Law 103-446, Veterans' Benefits Improvements Act of
1994, enacted November 2, 1994, codified (established in law)
presumptions of service connection for Vietnam veterans for certain
diseases \-- including Hodgkin's disease manifested to a degree of
disability of 10 percent or more \-- associated with exposure to certain
herbicide agents.

**What did the NAS conclude about Hodgkin's disease in the 1996
update?**

The 1996 report declared the "recent evidence continues to support the
conclusions of a positive association between exposure to herbicides and
Hodgkin's disease."

**What did the NAS conclude about Hodgkin's disease in the 1998
update?**

The 1998 report stated, "...data drawn from agricultural, production,
and environmental exposures and, more recently, from Vietnam veterans
continues to support the conclusions of a positive association between
herbicides and HD."

**What did the NAS conclude about Hodgkin's diseases in the 2000
update?**

The NAS found that there is "sufficient" evidence to conclude that an
association exists between exposure to herbicides and Hodgkin's disease.

**Where can a veteran get additional information on this subject?**

Information on Hodgkin\'s disease and related matters can be obtained at
VA medical center libraries, from the Registry Physicians at every VA
medical center, or from the Environmental Agents Service (131),
Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC
20420.

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, D1 -- Birth Defects, D2 --
Chloracne, D3 -- Non-Hodgkin's Lymphoma, D4 -- Soft Tissue Sarcomas, D5
-- Peripheral Neuropathy, D7 -- Porphyria Cutanea Tarda, D8 -- Multiple
Myeloma, D9 -- Respiratory Cancers, D10 -- Prostate Cancer, D11 -- Spina
Bifida, and D12 -- Diabetes.

**This fact sheet was updated in early August 2002 and does not include
any subsequent developments.**