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**Agent Orange Brief**

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

A1 VA Central Office, Washington, DC 20420 October 2003

##  

# AGENT ORANGE - GENERAL INFORMATION

> **What is Agent Orange?**
>
> Agent Orange was a herbicide, or defoliant, which was used in Vietnam
> to kill unwanted plant life and to remove leaves from trees which
> otherwise provided cover for the enemy. Agent Orange was a mixture of
> chemicals containing equal amounts of the two active ingredients,
> 2,4-D and 2,4,5-T. The name, \"Agent Orange,\" came from the orange
> stripe on the 55-gallon drums in which it was stored. Other
> herbicides, including Agent White and Agent Blue, were also used in
> Vietnam to a much lesser extent. Republic of Korea forces used small
> amounts of Agent Orange in 1968-69 in the area from the Civilian
> Control line to the southern bounty of the Demilitarized Zone.
> According to the Department of Defense, only Republic of Korea troops
> were involved in the actual spraying of Agent Orange in Korea. Agent
> Orange and other herbicides used in Vietnam were tested or stored
> elsewhere.
>
> **When and where was Agent Orange used in Vietnam?**
>
> Fifteen different herbicides were shipped to and used in Vietnam
> between January 1961 and 1971. Agent Orange accounted for over most of
> the herbicides sprayed in Vietnam. Agent Orange was used between
> January 1965 and April 1970. Herbicides other than Agent Orange were
> used in Vietnam prior to 1965, but to a very limited extent. However,
> a recent study released in April 2003 found that while relatively
> small amounts of highly dioxin-contaminated Agents Purple and Pink
> were sprayed in the early 1960s, these agents might have deposited a
> relatively large percentage of the total dioxin. The total area
> sprayed with herbicides between 1962 and 1965 was small, less than 7
> percent of the total acreage sprayed during the Vietnam conflict.
> Rapid increases in the annual number of acres sprayed occurred from
> 1962 to 1967. The number of acres sprayed reached a maximum in 1967,
> leveled off slightly in 1968 and 1969, and declined rapidly in 1970
> prior to the termination of spraying in 1971.
>
> During this time more than 19 million gallons of herbicides were
> sprayed over 6 million acres, some of which were sprayed more than
> once. More than 3.5 million acres of South Vietnam approximately 8.5
> percent of the country were sprayed one or more time. Spraying
> occurred in all 4 military zones of Vietnam.
>
> Heavily sprayed areas included inland forests near the demarcation
> zone; inland forests at the junction of the borders of Cambodia, Laos,
> and South Vietnam; inland forests north and northwest of Saigon;
> mangrove forests on the southernmost peninsula of Vietnam; and
> mangrove forests along major shipping channels southeast of Saigon.
> Crop destruction missions were concentrated in northern and eastern
> central areas of South Vietnam.
>
> **Why are Vietnam veterans concerned about Agent Orange?**
>
> In the 1970\'s some veterans became concerned that exposure to Agent
> Orange might cause delayed health effects. One of the chemicals
> (2,4,5-T) in Agent Orange contained minute traces of
> 2,3,7,8-tetrachlorodibenzo-[p]{.underline}-dioxin (also known as TCDD
> or dioxin), which has caused a variety of illnesses in laboratory
> animals. More recent studies have suggested that the chemical may be
> related to a number of malignancies and other disorders.
>
> **What should concerned veterans do?**
>
> In 1978, the Veterans Administration, now known as the Department of
> Veterans Affairs (VA), set up a special examination program for
> Vietnam veterans who were worried about the long-term health effects
> of exposure to Agent Orange. Vietnam veterans who are interested in
> participating in this program, known as the Agent Orange Registry,
> should contact the nearest VA medical center for an examination. Since
> September 2000, Veterans who served in Korea in 1968 or 1969 are also
> eligible for the examination. Furthermore, beginning in August 2001,
> VA has offered the Registry examination to all other U.S. veterans who
> may have been exposed to dioxin or other toxic substances in a
> herbicide during the conduct of or as a result of testing,
> transporting, or spraying of herbicides for military purposes.
>
> **What can a veteran expect from this examination?**
>
> Veterans who participate in the examination program are asked a series
> of questions about their possible exposure to herbicides in Vietnam. A
> medical history is taken, a physical examination is performed, and a
> series of basic laboratory tests, such as a chest x-ray (if
> appropriate), urinalysis, and blood tests, are done. If the examining
> physician thinks it is medically indicated, consultations with other
> physicians are scheduled.
>
> No special Agent Orange tests are offered since there is no test to
> show if Agent Orange or other herbicides used in Vietnam caused a
> veteran's medical problems. There are tests that show the level of
> dioxin in human fat and blood, but VA does not do such tests because
> there is serious question about their value to veterans. In January
> 1992, VA signed a contract with the National Academy of Sciences (NAS)
> under which, among other things, the NAS considered the feasibility
> and possible value of dioxin level blood tests for Vietnam veterans
> who apply for VA medical care or VA disability compensation. In its
> July 1993 report, the NAS concluded that individual TCDD levels in
> Vietnam veterans are usually not meaningful because of common
> background exposures to TCDD, poorly understood variations among
> individuals in TCDD metabolism, relatively large measurement errors,
> and exposure to herbicides that did not contain TCDD.
>
> **How does a veteran benefit from taking VA\'s Agent Orange Registry
> examination?**
>
> The veteran is informed of the results of the examination during a
> personal interview and gets a follow-up letter further describing the
> findings. Each veteran is given the opportunity to ask for an
> explanation and device where medically necessary, a follow-up
> examination or additional laboratory tests are scheduled. The
> examination and tests sometime reveal previously undetected medical
> problems. These discoveries permit veterans to get prompt treatment
> for their illnesses. Some veterans think they are in good health, but
> are worried that exposure to Agent Orange and other substances may
> have caused some hidden illness. The knowledge that a complete medical
> examination does not show any medical problems can be very reassuring
> or helpful to Registry participants. All examination and test results
> are kept in the veteran\'s permanent medical record. This information
> is also entered into the computerized VA Agent Orange Registry. So
> far, more than 334,000 Vietnam veterans have participated in this
> program. For more information about the VA Agent Orange Registry, see
> **Agent Orange Brief, B1.**
>
> **Can a veteran get treatment for Agent Orange-related illnesses?**
>
> Yes. Section 102, Public Law 104-262, the Veterans' Health Care
> Eligibility Reform Act of 1996, provides that VA is required to
> furnish hospital care and medical services, and may furnish nursing
> home care to veterans exposed to herbicides in Vietnam. There are some
> restrictions. VA cannot provide such care for a (1) disability which
> VA determines did **not** result from exposure to Agent Orange, or (2)
> disease which the National Academy of Sciences has determined that
> there is "limited/suggestive" evidence of **no** association between
> occurrence of the disease and exposure to a herbicide agent. For
> additional information about eligibility, see **Agent Orange Brief,
> B2.**
>
> **Can veterans get disability compensation for Agent Orange
> illnesses?**
>
> VA also pays disability compensation to many Vietnam veterans with
> injuries or illnesses incurred in or aggravated by their military
> service. Veterans do not have to prove that Agent Orange caused their
> medical problems to be eligible for compensation. Rather, VA must
> determine that the disability is \"service-connected.\" A Veterans
> Services Representative, at any VA medical center or regional office,
> can explain the compensation program in greater detail and can assist
> veterans who need help in applying. For more information about the VA
> disability compensation program, call **1-800-827-1000** or see
> **Agent Orange Brief, B3.**
>
> **What conditions have been "service-connected" based on evidence of
> an association with Agent Orange (or other herbicides used in
> Vietnam)?**
>
> The number of diseases that VA has recognized as associated with, but
> not necessarily caused by, Agent Orange exposure has expanded
> considerably during the 2000's. The following conditions are now
> presumptively recognized for service-connection for Vietnam veterans
> based on exposure to Agent Orange or other herbicides: chloracne (a
> skin disorder), porphyria cutanea tarda, acute or subacute transient
> peripheral neuropathy (a nerve disorder), Type 2 diabetes and numerous
> cancers \[non-Hodgkin's lymphoma, chronic lymphocytic leukemia, soft
> tissue sarcoma, Hodgkin's disease, multiple myeloma, prostate cancer,
> respiratory cancers (including cancers of the lung, larynx, trachea,
> and bronchus), and chronic lymphocytic leukemia\].
>
> In addition, Vietnam veterans' children with the birth defect spina
> bifida are eligible for certain benefits and services. In 1999, VA
> announced that statutory authority would be sought for similar
> benefits and services for children with birth defects who were born to
> women Vietnam veterans. Legislation was enacted November 1, 2000.
> Implementing regulations, published in the [Federal]{.underline}
> [Register]{.underline} on July 31, 2002, December 6, 2002, and January
> 3, 2003, are retroactive to December 1, 2001.
>
> **What else is VA doing?**
>
> In addition to the efforts described above (that is, Agent Orange
> Registry examination program, medical treatment eligibility, and
> disability compensation), VA is doing research to learn more about the
> possible adverse health effects of Agent Orange exposure.
>
> The Environmental Epidemiology Service (EES), in Washington, DC, is
> the premiere office for Vietnam/Agent Orange-related research within
> VA. EES investigators have completed two studies about possible
> connections between Vietnam service and specific kinds of cancers
> called soft tissue sarcomas, a large scale study of mortality among
> Vietnam veterans, a study regarding the relationship between Vietnam
> service and non-Hodgkin\'s lymphomas, a study of dioxin in adipose
> (fat) tissue, several mortality study follow-up efforts, mortality
> studies of individuals in the Army Chemical Corps in Vietnam, an
> analysis of post-traumatic stress disorder (PTSD) among Vietnam
> veterans in the Agent Orange Registry, a study of the relationship
> between Vietnam service and Hodgkin's disease, a study of the
> relationship between military service in Vietnam and the risk of death
> from trauma and selected cancers, an analysis of testicular cancer
> among Agent Orange Registry participants, a study of suicide among
> wounded Vietnam veterans, and a study of the relationship between lung
> cancer and military service in Vietnam. EES had assistance from others
> on several of these research projects. For information about these
> studies and ongoing VA research efforts, see **Agent Orange Brief,
> C2**
>
> In 1981, VA published a two-volume report reviewing scientific
> literature on herbicides in the United States and throughout the
> world. This publication was updated with an additional two volumes in
> 1984, 1985, 1986, l987, 1988, 1989, 1990, 1991, 1992, 1993 and 1994.
> (These annual updates were discontinued to avoid duplication of the
> ongoing scientific literature review by the National Academy of
> Sciences, a non-governmental organization under contract with VA.) Lay
> language summaries of the VA's scientific reviews have been published
> to help non-scientists understand this complex issue. VA has also
> published a series of monographs regarding Agent Orange-related
> matters. For additional information on these publications, see **Agent
> Orange Brief, B4.** From 1979 to 1994, VA was part of an interagency
> group monitoring and coordinating Agent Orange-related and
> dioxin-related research within the Federal government. The interagency
> group ceased operation in 1994. VA also has been aided by two
> VA-administered advisory committees, which made valuable
> recommendations to the Administrator/Secretary of Veterans Affairs
> regarding appropriate policy for compensation, research, outreach, and
> related matters.
>
> **What are other government departments and agencies doing?**
>
> Many other Federal departments and agencies have pursued and/or are
> also conducted scientific studies on this subject. The Centers for
> Disease Control and Prevention (CDC), Air Force (USAF), National
> Institute for Occupational Safety and Health (NIOSH), National Cancer
> Institute (NCI), and Environmental Protection Agency (EPA) have all
> been involved in research. The CDC published an important study,
> partially funded by VA, in 1984 regarding Vietnam veterans\' risks of
> fathering babies with birth defects. CDC investigators found that
> overall Vietnam veterans were not at increased risk of fathering a
> child with birth defects. VA also funded the CDC Vietnam Experience
> Study published in 1997 and 1988, and the CDC Selected Cancers Study
> published in 1990. The USAF is conducting a long-term study of
> mortality and morbidity among the men involved in the herbicide
> spraying missions. Air Force researchers have issued numerous reports
> regarding their findings in this ongoing project. NIOSH is maintaining
> a registry of individuals exposed to dioxins and other chemicals in
> the workplace. NCI has studied the health effects of herbicides on
> selected agricultural workers. EPA worked with VA on the determination
> of dioxin in adipose tissue. The Armed Forces Institute of Pathology
> collaborated with VA on soft tissue sarcoma research.
>
> Obviously, Federal departments and agencies have undertaken a
> considerable amount of research. According to the final report of the
> Domestic Policy Council\'s Agent Orange Working Group issued in 1994,
> \"There are 38 ongoing projects and 189 completed projects.\" The
> report indicates, \"over \$127 million has been spent on the completed
> projects, an additional \$86 million has been spent\" on the ongoing
> projects, and that \"\$70 million is estimated to be necessary over
> the next ten years to complete the current ongoing projects.\"
>
> Several States also have undertaken research efforts to learn more
> about the possible health effects of Agent Orange and the Vietnam
> experience upon our nation\'s veterans. Research being done by non-VA
> agencies and organizations is more fully described in **Agent Orange
> Brief, C3.**
>
> **What is the National Academy of Sciences doing regarding this
> issue?**
>
> The National Academy of Sciences (NAS), a non-governmental
> organization, is reviewing all relevant scientific literature and
> providing advice to the Secretary of Veterans Affairs on a wide range
> of issues relative to herbicides and dioxin. The NAS project is being
> undertaken in accordance with Public Law 102-4, the Agent Orange Act
> of 1991, signed by President Bush on February 6, 1991. The NAS
> reported its initial findings to VA and Congress in July 1993. The
> first update report was released on March 14, 1996. The second update
> was released on February 11, 1999. A special report on the
> relationship between herbicides used in Vietnam and Agent Orange was
> released on October 11, 2000. The third update was released on April
> 19, 2001. The fourth update was released on January 23, 2003. A second
> special report was issued on February 27, 2002. This special report,
> the sixth overall, reassessed the relationship between herbicides and
> acute myelogenous leukemia in the children of Vietnam veterans. Future
> reports are anticipated biennially. For a number of years, the NAS was
> also considering the feasibility of developing a historical herbicide
> exposure reconstruction model that could be used in Agent
> Orange-related research efforts. In April 2003, the NAS concluded that
> with the current technology, a study is feasible. (Copies of these
> reports are available at [www.nap.edu](http://www.nap.edu/).)

## Where is additional information available?

> A great deal of information can be obtained from our web site:
> [www.va.gov/AgentOrange](http://www.va.gov/AgentOrange). There is an
> "Environmental Health Clinician" at each VA medical center who is
> responsible for the conduct of Agent Orange Registry examinations.
> These individuals participate in regularly scheduled nationwide
> conference calls and receive periodic mailings from VA headquarters
> updating them on the latest developments on Agent Orange. Each
> facility also has an "Environmental Health Coordinator" to facilitate
> the Agent Orange program.
>
> As indicated above, other Agent Orange Briefs provide additional
> information on specific Agent Orange concerns and issues. The Agent
> Orange Briefs are available including the one that you are reading at
> VA medical centers nationwide. The following Agent Orange Briefs are
> now available: **A1**. Agent Orange General Information; **A2**.Agent
> Orange Class Action Lawsuit; **B1**.Agent Orange Registry;
> **B2**.Agent Orange -- Health Care Eligibility; **B3**.Agent Orange
> and VA Disability Compensation; **B4**.VA Information Resources on
> Agent Orange and Related Matters; **C1**.Agent Orange -- The Problem
> Encountered in Research; **C2**.Agent Orange and Vietnam Related
> Research -- VA Projects; **C3**.Agent Orange and Vietnam Related
> Research -- Non-VA Projects; **D1**.Agent Orange and Birth Defects;
> **D2**.Agent Orange and Chloracne; **D3**.Agent Orange and
> Non-Hodgkin's Lymphoma; **D4**.Agent Orange and Soft Tissue Sarcomas;
> **D5**.Agent Orange and Peripheral Neuropathy; **D6**.Agent Orange and
> Hodgkin's Disease; **D7**.Agent Orange and Porphyria Cutanea Tarda;
> **D8**.Agent Orange and Multiple Myeloma; **D9**.Agent Orange and
> Respiratory Cancers; **D10**.Agent Orange and Prostate Cancer;
> **D11**.Agent Orange and Spina Bifida; **D12.**Agent Orange and
> Diabetes; and **D13**.Agent Orange and Chronic Lymphocytic Leukemia.
>
> The Environmental Agents Service (131), Department of Veterans
> Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420, is another
> good source of information on this subject. The telephone number is
> 202-273-8580. The Environmental Agents Service used to be known as the
> Environmental Medicine Office. (It was also previously named the Agent
> Orange Projects Office.)
>
> Veteran's service organizations (such as The American Legion, Veterans
> of Foreign Wars of the United States, Disabled American Veterans,
> Vietnam Veterans of America, AMVETS, and VietNow) and State government
> entities (including Agent Orange Commissions, Departments or Divisions
> of Veterans Affairs, Departments of Health) have also provided helpful
> information to individuals seeking information on this subject.
>
> The initial NAS report, an 800+page document, and the updates are
> available for purchase from the National Academy Press, 2101
> Constitution Avenue, N.W., Lockbox 285, Washington, DC 20055. The
> telephone numbers are 1-800-624-6242 and 202-334-3313. Copies of these
> reports were sent to all VA medical center libraries.
>
> Congressional committees, especially the House Committee on Veterans'
> Affairs and the Senate Committee on Veterans' Affairs, have conducted
> numerous hearings regarding the long-term health effects of exposure
> to Agent Orange. A great deal of information has been gathered during
> these hearings. Both committees are located in Washington, DC. The zip
> code for the Senate Committee is 20510. The zip code for the House
> Committee is 20515.
>
> **This fact sheet was updated in late October 2003 and does not
> include any subsequent developments.**