Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-14-15108/USCOURTS-ca9-14-15108-1/pdf.json

Nature of Suit Code: 890
Nature of Suit: Other Statutory Actions
Cause of Action: 

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FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

VIETNAM VETERANS OF AMERICA;

SWORDS TO PLOWSHARES, Veterans

Rights Organization; TIM MICHAEL

JOSEPHS; WILLIAM BLAZINSKI;

BRUCE PRICE; FRANKLIN D.

ROCHELLE; LARRY MEIROW; ERIC P.

MUTH; DAVID C. DUFRANE;

KATHRYN MCMILLAN-FORREST,

Plaintiffs-Appellants–

Cross-Appellees,

v.

CENTRAL INTELLIGENCE AGENCY;

JOHN BRENNAN, Director of the

Central Intelligence Agency; UNITED

STATES DEPARTMENT OF DEFENSE;

ASHTON CARTER, Secretary of

Defense; UNITED STATES

DEPARTMENT OF THE ARMY; JOHN

M. MCHUGH, Secretary of the Army;

UNITED STATES OF AMERICA;

UNITED STATES DEPARTMENT OF

VETERAN AFFAIRS; ROBERT A.

MCDONALD, Secretary of Veterans

Affairs,

Defendants-Appellees–

Cross-Appellants.

Nos. 13-17430

14-15108

D.C. No.

4:09-cv-00037-

CW

ORDER AND

AMENDED

OPINION

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2 VIETNAM VETERANS OF AMERICA V. CIA

Appeal from the United States District Court

for the Northern District of California

Claudia Wilken, District Judge, Presiding

Argued and Submitted

September 11, 2014—San Francisco, California

Filed June 30, 2015

Amended January 26, 2016

Before: J. Clifford Wallace, Mary M. Schroeder,

and William A. Fletcher, Circuit Judges.

Opinion by Judge W. Fletcher;

Partial Concurrence and Partial Dissent by Judge Wallace

SUMMARY*

Veterans Affairs

The panel filed an amended opinion affirming in part and

reversing in part the district court’s judgment and injunction

entered in an action brought by veterans organizations and

individuals who were subjects in chemical and biological

weapons experiments conducted by the United States

military, seeking declaratory and injunctive relief against

federal agencies; denied the petition for panel rehearing; and

denied on behalf of the court the petition for rehearing en

banc.

* This summary constitutes no part of the opinion of the court. It has

been prepared by court staff for the convenience of the reader.

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VIETNAM VETERANS OF AMERICA V. CIA 3

The panel agreed with the district court that the U.S.

Army had an ongoing duty under Army Regulation 70-25 to

provide former test subjects with newly available information

relating to their health, and that this duty was judicially

enforceable under § 706(1) of the Administrative Procedure

Act. The panel held that the district court did not abuse its

discretion in entering its injunction to enforce that duty.

The panel also agreed with the district court that the Army

had an ongoing duty to provide medical care. The panel

disagreed with the district court’s denial of relief on the

ground that the Department of Veterans Affairs provided

medical care that to some degree duplicated the care the

Army was obligated to provide. The panel held that the

district court may not, in the absence of mootness,

categorically deny injunctive relief to former volunteer

subjects seeking necessarymedical care because some former

subjects may be entitled to receive medical care from another

government agency. The panel vacated the district court’s

summary judgment for the government on this claim and

remanded to the district court.

JudgeWallace joined the majority in affirming the district

court’s judgment and injunction compelling the Army to

comply with Army Regulation 70-25’s clear regulatory

mandate, but wrote separately in concurrence because he did

not join the majority’s analysis of regulatory history to

support its textual analysis. Judge Wallace dissented from

the majority’s conclusion that Army Regulation 70-25 also

contained a command that the Army provide medical care to

former research volunteers. He would affirm the district

court’s summary judgment against plaintiffs on their claims

for medical care, but on the alternative ground that their claim

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4 VIETNAM VETERANS OF AMERICA V. CIA

was not judicially enforceable under § 706(1) of the

Administrative Procedure Act.

COUNSEL

James Patrick Bennett, Eugene G. Illovsky, Benjamin F.

Patterson (argued), and Stacey Michelle Sprenkel, Morrison

& Foerster LLP, San Francisco, California, for PlaintiffsAppellants–Cross-Appellees.

Melinda L. Haag, United States Attorney, Stuart F. Delery,

Assistant Attorney General, Charles W. Scarborough

(argued), Brigham John Bowen, Anthony Joseph Coppolino,

and Mark B. Stern, Appellate Staff, Civil Division, United

States Department of Justice, Washington, D.C., for

Defendants-Appellees–Cross-Appellants.

ORDER

The opinion filed on June 30, 2015 and published at

791 F.3d 1122 is hereby amended. The amended opinion is

filed concurrently with this order.

With these amendments, Judges Schroeder and W.

Fletcher voted to deny the petition for rehearing. Judge

Wallace voted to grant the petition for rehearing. Judge W.

Fletcher voted to deny the petition for rehearing en banc, and

Judge Schroeder so recommended. Judge Wallace

recommended granting the petition for rehearing en banc.

The full court was advised of the petition for rehearing en

banc. A judge requested a vote on whether to rehear the

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VIETNAM VETERANS OF AMERICA V. CIA 5

matter en banc, and the matter failed to receive a majority of

the votes of the nonrecused active judges in favor of en banc

consideration. Fed. R. App. P. 35.

The petition for panel rehearing and the petition for

rehearing en banc are DENIED.

Future petitions for panel rehearing and petitions for

rehearing en banc will not be entertained.

OPINION

W. FLETCHER, Circuit Judge:

From the inception of the United States’ chemical

weapons program during World War I until the mid-1970s,

the United States military conducted chemical and biological

weapons experiments on human subjects. In these

experiments, tens of thousands of members of the United

States armed services were intentionally exposed to a range

of chemical and biological agents.

Plaintiffs are veterans’ organizations and individuals who

were subjects in these experiments. They filed an individual

and class action complaint seeking declaratory and injunctive

relief against the Department of Defense (“DOD”), the Army,

the Central Intelligence Agency (“CIA”), and the Department

of Veterans Affairs (“VA”). The class comprises “[a]ll

current or former members of the armed forces, who, while

serving in the armed forces, were test subjects” in these

experimentation programs. Two of Plaintiffs’ claims,

brought under § 706(1) of the Administrative Procedure Act

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(“APA”), are at issue in this appeal. Plaintiffs claim, first,

that the Army has unlawfully failed to notify test subjects of

new medical and scientific information relating to their health

as it becomes available. They claim, second, that the Army

has unlawfully withheld medical care for diseases or

conditions proximately caused by their exposures during the

experiments.

On cross-motions for summary judgment, the district

court held that ArmyRegulation 70-25 (“AR 70-25”) imposes

on the Army an ongoing duty to notify former test subjects of

relevant new health information as it becomes available. The

court issued an injunction requiring the Army to comply with

that duty. The court held, further, that AR 70-25 imposes on

the Army an ongoing duty to provide medical care, but the

court declined to compel the Army to provide such care on

the ground that Plaintiffs could seek medical care from the

VA.

We affirm in part and reverse in part. We agree with the

district court that the Army has an ongoing duty under AR

70-25 to provide former test subjects with newly available

information relating to their health, and that this duty is

judicially enforceable under § 706(1). We also agree with the

district court that the Army has an ongoing duty to provide

medical care. However, the district court denied relief on the

ground that the VA provides medical care that to some degree

duplicates the care the Army is obligated to provide. We

disagree with the district court that relief should have been

denied on this ground.

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VIETNAM VETERANS OF AMERICA V. CIA 7

I. Background

As relevant to this suit, beginning in 1942 the War

Department (as it was then called) approved the use of human

subjects in experiments to test the effects of chemical

weapons. Some experiments tested the effectiveness of

various chemical agents, while others tested the effectiveness

of protective clothing and other defenses. By the end of

World War II, more than 60,000 service members had served

as experimental subjects in the United States’ chemical

weapons research program.

During the World War II-era tests, “soldier volunteers”

were intentionally exposed to a variety of chemical agents. 

According to a 1993 report by the National Academy of

Sciences, they were exposed to Lewisite (an arsenic-based

blister agent) and mustard gas, as well as other “gases such as

phosgene (a choking agent), hydrogen cyanide and cyanogen

chloride (blood poisoning agents), and chloroacetophenone

(tear gas).” A 2006 VA report recounted that these subjects

“were exposed commonly to acutely toxic levels . . . of agents

via small drops applied to the arm or to clothing, or in gas

chambers, sometimes without protective clothing.” “Some

experiments apparently involved less protected subjects who

were reported to have experienced severe burns to the genital

areas, including cases of crusted lesions to the scrotum . . . .

Documented injuries among experimental subjects . . . [were]

initially ‘quite high’—one study of accidental injuries

identified over 1,000 cases of acute mustard agent toxicity

resulting in eye, ear, nose and throat symptoms . . . over a 2-

year period.”

In the 1950s, DOD conducted a new wave of chemical

weapons research and experimentation, focusing on “agents

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perceived to pose greater threats than sulfur mustard or

Lewisite,” such as nerve agents and chemicals with “intense

psychoactive properties.” These experiments were conducted

over the course of about twenty years, from 1955 to 1975. 

During the course of this research, DOD exposed about 6,700

experimental human subjects to more than 250 different

chemical and biological agents.

Beginning in the 1950s, the Armyestablished policies and

issued regulations governing the use of human test subjects. 

On February 26, 1953, Secretary of Defense Charles Wilson

sent a memorandum (“the Wilson Directive”) to the

Secretaries of the Army, Navy, and Air Force. The Wilson

Directive set conditions for “the use of human volunteers by

the Department of Defense in experimental research in the

fields of atomic, biological and/or chemical warfare.” It

stated that “[t]he voluntary consent of the human subject is

absolutely essential,” and instructed that a volunteer subject

“should have sufficient knowledge and comprehension of the

elements of the subject matter involved as to enable him to

make an understanding and enlightened decision” about

participating.

On June 30, 1953, Brigadier General John Oakes,

Secretary of the General Staff of the Army, sent a

memorandum (“CS:385”) to the Army’s Chief Chemical

Officer, the Army Surgeon General, and other top Army

officials, reiterating the policies articulated in the Wilson

Directive. CS:385 provided that “[a]gents used in research

must have” several “limiting characteristics,” including

“[c]ontrollable lethality,” “[n]o serious chronicity

anticipated,” “[e]ffective therapy available,” and “[a]dequate

background of animal experimentation.” The memorandum

provided further, that “[a]s added protection for volunteers,

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[other] safeguards will be provided,” including that “[a]ll

apparatus and instruments necessary to deal with any

emergency situations must be available,” and that “[m]edical

treatment and hospitalization will be provided for all

casualties of the experimentation as required.”

In 1962, the Army promulgated AR 70-25, a regulation

prescribing policies and procedures to govern the use of

volunteers in Army research involving human subjects. AR

70-25 reiterated the policies in the Wilson Directive,

including the requirement of voluntary consent. The

regulation provided:

[The volunteer] will be told as much of the

nature, duration, and purpose of the

experiment, the method, and means by which

it is to be conducted, and the inconveniences

and hazards to be expected, as will not

invalidate the results. He will be fully

informed of the effects upon his health or

person which may possibly come from his

participation in the experiment.

The regulation also provided, in language similar to CS:385,

that “[a]ll apparatus and instruments necessary to deal with

likely emergency situations will be available,” “[r]equired

medical treatment and hospitalization will be provided for all

casualties,” and “[a] physician approved by The Surgeon

General will be responsible for the medical care of

volunteers.” The Army reissued AR 70-25 in 1974 with the

foregoing language unchanged.

In 1975, the Army ceased performing large scale

experiments exposing human subjects to chemical agents. In

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the late 1970s, against a backdrop of mounting public concern

about the long-term effects of such experiments, Army

officials exchanged a series of memoranda outlining a

program for notifying past subjects about the health

consequences of their participation in the experiments. On

August 8, 1979, Army General Counsel Jill Wine-Volner

wrote a memorandum to a number of high-level Army

officials and to the Army Surgeon General. She wrote that

the Secretary of the Army

has concluded that, as a policy matter, some

type of notification program is necessary. 

Moreover, the legal necessity for a

notification program is not open to dispute. 

The Department of Justice has concluded that

another Federal agency ‘may well be held to

have a legal duty to notify those . . . drugtesting subjects whose health [it] has reason to

believe may still be adversely affected by

their prior involvement in [the] drug-testing

program.’

(Omission and alterations in original.)

On September 24, 1979, Wine-Volner wrote another

memorandum, this time to the Director of the Army Staff,

providing “broad guidance” about “a program to notify

participants in Army drug or chemical/biological agent

research programs.” The memorandum provided, inter alia:

The Army should review all research

programs, regardless of whether conducted by

the Army or on behalf of the Army by

independent contractors, that were initiated to

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VIETNAM VETERANS OF AMERICA V. CIA 11

study possible military, rather than medical,

applications of various drugs and chemical/

biological agents. If there is reason to believe

that any participants in such research

programs face the risk of continuing injury,

those participants should be notified of their

participation and the information known today

concerning the substance they received. This

notification should be [e]ffected regardless of

whether the individuals were fully informed

volunteers at the time the research was

undertaken.

On October 25, 1979,Lieutenant General John McGiffert,

Director of the Army Staff, wrote a memorandum to the

heads of Army staff agencies, “establish[ing] Army Staff

responsibilities for review of past Army research involving

possible military applications of drug or chemical/biological

agents.” He wrote, “The objective of this effort is to identify

and notify those research participants who may face the risk

of continuing injury.” He continued,

Participants in those projects who are

considered by medical authority to be subject

to the possible risk of a continuing injury are

to be notified. In the event that long-term

hazards of a substance are not known, The

Surgeon General (TSG) should continue to

monitor research developments, and if at

some future time more information makes it

necessary to take some action, TSG should

recommend appropriate action, including

notification.

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In 1981 and 1986, the Army took two actions relevant to

the notification program: amending one record system and

creating another. The first system, the Research and

Experimental Case Files, as amended in 1981, compiled a

database about “[v]olunteers (military members, Federal

civilian employees, state prisoners) who participated in Army

tests of potential chemical agents and/or antidotes from the

early 1950’s until the program ended in 1975.” Privacy Act

of 1974; Amendment to System Notice, 46 Fed. Reg. 60,639,

60,640 (Dec. 11, 1981). The purposes of the system were

“(1) to follow up on individuals who voluntarily participated

in Army chemical/biological agent research projects for the

purpose of assessing risks/hazards to them, and (2) for

retrospective medical/scientific evaluation and future

scientific and legal significance.” Id. The second system, the

Medical Research Volunteer Registry, newly created in 1986,

was designed to maintain “[r]ecords of military members,

civilian employees, and non-DOD civilian volunteers

participating in current and future research sponsored by the

U.S. Army Medical Research and Development Command.” 

Privacy Act of 1974; New Record System, 51 Fed. Reg.

23,576, 23,577 (June 30, 1986). One of the stated purposes

of the second system was “[t]o assure that the U.S. Army

Medical Research andDevelopmentCommand (USAMRDC)

can contact individuals who participated in research

conducted/sponsored by the Command in order to provide

them with newly acquired information, which may have an

impact on their health.” Id.

In 1988, the Army reissued AR 70-25. Chapter 2–5(j) of

the reissued regulation provided that the Army Surgeon

General “will . . . [d]irect medical followup, when

appropriate, on research subjects to ensure that any longrange problems are detected and treated.” Chapter 2–8(c)

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provided that “commanders will . . . [e]nsure that research

volunteers are adequately informed concerning the risks

associated with their participation, and provide them with any

newly acquired information that may affect their well-being

when that information becomes available.”

Chapter 3–2(h) (“subsection (h)”) of the reissued

regulation specified:

Duty to warn. Commanders have an

obligation to ensure that research volunteers

are adequately informed concerning the risks

involved with their participation in research,

and to provide them with any newly acquired

information that may affect their well-being

when that information becomes available. 

The duty to warn exists even after the

individual volunteer has completed his or her

participation in research. To accomplish this,

the MACOM [(Major Army Commands)] or

agency conducting or sponsoring research

must establish a system which will permit the

identification of volunteers who have

participated in research conducted or

sponsored by that command or agency, and

take actions to notify volunteers of newly

acquired information.

Chapter 3–1(k) (“subsection (k)”) specified, “Volunteers are

authorized all necessary medical care for injury or disease

that is a proximate result of their participation in research.”

Finally, in what the Army later conceded was a “serious”

editing error, Appendix F of the reissued regulation provided

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that “[r]esearch involving deliberate exposure of human

subjects to nuclear weapons effect, to chemical warfare

agents, or to biological warfare agents” was “exempt from

this regulation.”

The Army revised and reissued AR 70-25 two years later. 

This 1990 revision remains in force today. This revision was,

in all relevant respects but one, the same as the 1988 revision. 

There was, however, one important change — the correction

of the erroneous exemption from coverage of human subjects

who had been deliberately exposed to “nuclear weapon

effect” and to chemical and biological agents. The 1990

“Summary of Change” specified, “This change is published

to correct a serious error that occurred during the final editing

of the current revision. In attempting to respond to guidance

from the Office of The Judge Advocate General that a

subparagraph be moved from the text of the regulation to

appendix F, the wrong sub-paragraph was moved.” Chapter

1–4(d)(4) of AR 70-25 was changed in 1990 to state

explicitly, “The guidance in this regulation pertains to . . .

[r]esearch involving deliberate exposure of human subjects to

nuclear weapons effect, to chemical warfare agents, or to

biological warfare agents.”

In the decades since the termination of biological and

chemical testing on human subjects, Defendants have

identified, contacted, and notified some of the former

subjects. For example, in 1990 DOD contacted 128 veterans

who had participated in World War II mustard gas testing. In

2004, DOD identified 6,387 individuals who had been

exposed to mustard gas or other agents during World War IIera experiments. Beginning in March 2005, the VA sent

letters to the 319 of those individuals for whom it could find

contact information.

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In 2009, Plaintiffs filed suit against DOD, the Army, the

CIA, the VA, and a number of individuals in their official

capacities. The complaint alleged that the Army was

required, on an ongoing basis, to (1) provide notice to former

test subjects about their exposures to biological and chemical

agents and the currently known health effects of those agents,

and (2) provide medical care to these test subjects for

diseases or conditions proximately caused by their

participation in military experiments.

The district court granted in part and denied in part

Plaintiffs’ motion for partial summary judgment, and granted

in part and denied in part Defendants’ cross-motion for

summary judgment. The court held that the Army has an

ongoing duty to notify former test subjects about newly

available medical and scientific information relating to their

health, and that the Army has not fully complied with that

duty. The court issued an injunction requiring the Army to

comply. The court also concluded that the Army has an

ongoing duty to provide test subjects with medical care, but

it declined to issue an injunction enforcing compliance with

that duty on the ground that medical care was available from

the VA.

The parties cross-appealed.

II. Standard of Review

We review a district court’s summary judgment de novo. 

Or. Natural Res. Council v. Allen, 476 F.3d 1031, 1036 (9th

Cir. 2007). A permanent injunction “‘involves factual, legal,

and discretionary components,’” so we “review a decision to

grant such relief under several different standards.” Momot

v. Mastro, 652 F.3d 982, 986 (9th Cir. 2011) (quoting Walters

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v. Reno, 145 F.3d 1032, 1047 (9th Cir. 1998)). We review

legal conclusions underlying the summary judgment de novo,

factual findings for clear error, and the scope of the injunction

for abuse of discretion. Id.

III. Discussion

Section 706(1) of the APA provides that a court “shall

compel agency action unlawfully withheld or unreasonably

delayed.” 5 U.S.C. § 706(1). A court can compel agency

action under this section only if there is “a specific,

unequivocal command” placed on the agency to take a

“discrete agency action,” and the agency has failed to take

that action. Norton v. S. Utah Wilderness Alliance (SUWA),

542 U.S. 55, 63–64 (2004) (citation omitted). The agency

action must be pursuant to a legal obligation “so clearly set

forth that it could traditionally have been enforced through a

writ of mandamus.” Hells Canyon Pres. Council v. U.S.

Forest Serv., 593 F.3d 923, 932 (9th Cir. 2010). Plaintiffs

argue that AR 70-25 unequivocally commands the Army to

provide former test subjects with current information about

their health, and to provide medical care for harm and

diseases caused by the experiments. We agree.

A. Duty to Warn

We conclude that Chapter 3–2(h) of AR 70-25

(“subsection (h)”), as promulgated in 1988 and again in 1990,

requires the Army to provide former test subjects with “newly

acquired information” regarding their health as that

information becomes available. We agree with the district

court that this “duty to warn” applies not only to future

human subjects, but also to test subjects who participated in

experiments predating the regulation. We hold, further, that

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the district court did not abuse its discretion in issuing an

injunction enforcing this duty.

1. Duty to Warn Under AR 70-25

AR 70-25 requires the Army to warn volunteers of the

risks of participating in the experiments, and to provide them

with new information “that may affect their well-being” as it

becomes available. Subsection (h) of AR 70-25 provides:

Duty to warn. Commanders have an

obligation to ensure that research volunteers

are adequately informed concerning the risks

involved with their participation in research,

and to provide them with any newly acquired

information that may affect their well-being

when that information becomes available. 

The duty to warn exists even after the

individual volunteer has completed his or her

participation in research. To accomplish this,

the MACOM [(Major Army Commands)] or

agency conducting or sponsoring research

must establish a system which will permit the

identification of volunteers who have

participated in research conducted or

sponsored by that command or agency, and

take actions to notify volunteers of newly

acquired information.

Subsection (h) was added to AR 70-25 in 1988. The

Army contends in this litigation that Section (h) has merely

prospective effect, applying only to human subjects on whom

experiments were performed after 1988. We disagree.

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The text of subsection (h) makes clear that the duty to

provide notice applies not only to possible future human test

subjects but also to former test subjects. There is nothing in

the text that limits the application of subsection (h) to those

who volunteered in experiments after the promulgation of the

regulation in 1998. Indeed, subsection (h) specifically

requires Army commanders to identify the volunteers “who

have participated in research conducted or sponsored by that

command or agency, and take actions to notify volunteers of

newly acquired information.” (Emphasis added.) Similarly,

subsection (h) provides that “[t]he duty to warn exists even

after the individual volunteer has completed his or her

participation in research.”

The Army’s revision of AR 70-25 in 1990 makes even

more compelling this reading of subsection (h). The 1990

version retains the provision of the 1988 regulation that

requires notice to human subjects. But the Army made an

important change in 1990 in stating explicitly that the notice

requirement under AR 70-25 applies to “[r]esearch involving

deliberate exposure of human subjects to nuclear weapons

effect, to chemical warfare agents, or to biological warfare

agents.” Chapter 1–4(d)(4). The 1990 revision would have

made little sense if the notice requirement applied only

prospectively. The only subjects to whom Chapter 1–4(d)(4)

could apply are those who had previously been part of Army

experiments. As the district court stated, “Because the Army

did not [in 1988 or 1990] — and does not — engage in such

ongoing testing, there would have been no reason to add this

language to AR 70-25 in 1990 if the regulation did not

encompass those who had alreadybecome such test subjects.”

This reading of AR 70-25 is consistent with the internal

agency discussions in the years leading up to the 1988 and

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VIETNAM VETERANS OF AMERICA V. CIA 19

1990 revisions of the regulation. Army memoranda

discussing proposed notification programs all recognized an

obligation to warn individuals who had been subjects in past

research and testing about the potential long-term health

risks, as well as to provide additional information about those

risks when such information became available. For example,

Army General Counsel Jill Wine-Volner wrote in her August

1979 memorandum that “the legal necessity for a notification

program is not open to dispute.” That led Wine-Volner to

write a second memorandum in September 1979 stating that

“[i]f there is reason to believe that any participants in [the

biological and chemical weapons testing] programs face the

risk of continuing injury, those participants should be notified

of their participation and the information known today

concerning the substance they received.” She wrote, further,

“This notification should be [e]ffected regardless of whether

the individuals were fully informed volunteers at the time the

research was undertaken.”

This reading of subsection (h) is also consistent with the

amending and creating of databases in 1981 and 1986. As we

describe above, in 1981 the Army amended a database that

included members of the military who had previously

volunteered for human testing in order “to follow up on

individuals who voluntarily participated in Army

chemical/biological agent research projects for the purpose of

assessing risks/hazards to them.” Privacy Act of 1974;

Amendment to System Notice, 46 Fed. Reg. 60,639, 60,640

(Dec. 11, 1981). Then, in 1986, the Army created a new

database that included members of the military “participating

in current and future research” in order to “contact

individuals who participated” in such research in order to

provide them with “newly acquired information, which may

have an impact on their health.” Privacy Act of 1974; New

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Record System, 51 Fed. Reg. 23,576, 23,577 (June 30, 1986). 

The Armyclearlyanticipated using these databases to provide

ongoing medical health information to the volunteers who

had participated in the Army’s chemical and biological

research experiments. Subsection (h) was first promulgated

in 1988, seven years after the amendment of the first of the

databases and two years after the creation of the other. In

other words, subsection (h) was promulgated only after the

Army had already concluded it had a duty to provide ongoing

medical care notifications, even to past participants.

Despite the foregoing, the government contends that

subsection (h) applies only to human subjects upon whom

experiments were performed after 1988. They contend that

subsection (h) is ambiguous and that under Auer v. Robbins,

519 U.S. 452 (1997), we must defer to the interpretation that

the Army has proposed during this litigation. We find no

ambiguity in the text of subsection (h). But even if

subsection (h) were ambiguous, Auer deference is

inappropriate.

Under Auer, “[a]n administrative rule may receive

substantial deference if it interprets the issuing agency’s own

ambiguous regulation.” Gonzales v. Oregon, 546 U.S. 243,

255 (2006). Auer deference is not warranted in all

circumstances. Deference is not warranted “when there is

reason to suspect that the agency’s interpretation ‘does not

reflect the agency’s fair and considered judgment on the

matter in question.’” Christopher v. SmithKline Beecham

Corp., 132 S. Ct. 2156, 2166 (2012) (quoting Auer, 519 U.S.

at 462). “This might occur when . . . it appears that the

interpretation is nothing more than a ‘convenient litigating

position,’” id. (quotingBowen v. Georgetown Univ. Hospital,

488 U.S. 204, 213 (1988)), or a “‘post hoc rationalizatio[n]’

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advanced by an agency seeking to defend past agency action

against attack,” id. (quoting Auer, 519 U.S. at 462) (emphasis

and alteration in original).

The government’s proposed interpretation of subsection

(h) is a “convenient litigating position” that does not warrant

Auer deference. The government acknowledges in its

briefing to us that no court has previously had occasion to

construe the notice provision of AR 70-25, and it points to no

prior interpretation of this provision by the Army, in litigation

or otherwise. Indeed, the district court noted that the Army

admitted that it “developed [its] interpretation only in the

context of this litigation.”

We do not believe that the interpretation of the notice

provision of AR 70-25 that the government now advances is

the “agency’s fair and considered judgment on the matter in

question.” Auer, 519 U.S. at 462. In the district court, the

government supported its interpretation of AR 70-25 by

relying on the testimony of Dr. Michael Kilpatrick, Director

of Strategic Communications for the Office of the Under

Secretary of Defense for Health Affairs. However, we have

reason to doubt Dr. Kilpatrick’s analysis. As the district court

observed, “Notably, the agency representative upon whose

interpretation Defendants relywas mistaken about the date on

which the operative parts of the regulation were amended,

suggesting that he did not have a clear understanding of the

context in which these changes were made.”

The text of AR 70-25 requires the Army to provide

ongoing notice to volunteers who “have participated” in the

Army’s testing programs. We conclude that this duty applies

to human subjects in the pre-1990 experiments.

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2. Enforceability Under § 706(1)

Even though AR 70-25 imposes a duty on the Army to

provide notice to prior test subjects of information regarding

their well-being, we can enforce that duty only if the text of

the regulation is a “specific, unequivocal command” to take

“discrete agency action.” SUWA, 542 U.S. at 63–64 (citation

omitted). The duty to warn contained in subsection (h) is

such a command.

We recognize that § 706(1) poses an obstacle for parties

seeking to compel agency action. In SUWA, the Court

explained that parties are entitled to relief under § 706(1)

only if the agency “failed to take a discrete agency action that

it is required to take,” id. at 64, such as “the failure to

promulgate a rule or take some decision by a statutory

deadline,” id. at 63. The plaintiff in that case, the Southern

Utah Wilderness Alliance, alleged that the Bureau of Land

Management (“BLM”) had failed to manage wilderness study

areas “in a manner so as not to impair the suitability of such

areas for preservation as wilderness,” id. at 65 (quoting 43

U.S.C. § 1782(c)), and that BLM had failed to “manage the

public lands . . . in accordance with the land use plans,” id. at

67 (quoting 43 U.S.C. § 1732(a)). The Court held that the

failures to meet these statutory obligations were “[g]eneral

deficiencies in compliance” rather than failures to comply

with commands to perform discrete actions. Id. at 66. 

Therefore, these obligations “lack[ed] the specificityrequisite

for agency action.” Id.

“It is clear that section 706(1) applies to the situation

where a federal agency refuses to act in disregard of its legal

duty to act.” Equal Employment Opportunity Comm’n v.

Liberty Loan Corp., 584 F.2d 853, 856 (8th Cir. 1978). 

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Unlike the plaintiffs in SUWA, Plaintiffs have alleged both a

legal duty to perform a discrete agency action and a failure to

perform that action. They assert that the Army has an

ongoing “duty to warn” under subsection (h) of AR 70-25 and

that the Army has refused to perform that duty.

The precise efforts the Army must take to identify human

subjects in past experiments, and the precise content of the

notice to those subjects who have been identified, necessarily

entail some discretionary judgment. But discretion in the

manner in which the duty may be carried out does not mean

that the Army does not have a duty to perform a “discrete

action” within the meaning of § 706(a) and SUWA. See

SUWA, 542 U.S. at 65 (“[W]hen an agency is compelled by

law to act . . . but the manner of its action is left to the

agency’s discretion, a court can compel the agency to act, but

has no power to specify what the action must be.”);

Firebaugh Canal Co. v. United States, 203 F.3d 568, 578 (9th

Cir. 2000) (“Although the district court can compel the

Department of Interior to provide drainage service as

mandated by the San Luis Act, the district court cannot

eliminate agency discretion as to how it satisfies the drainage

requirement.”).

3. The District Court’s Injunction

The government argues that the district court’s injunction

is improper in its scope and duration. We disagree.

Under the district court’s injunction, the Army must

provide

individuals who, while serving in the armed

forces, were test subjects in any testing

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program in which humans were exposed to a

chemical or biological substance for the

purpose of studying or observing the effects

of such exposure (that was sponsored,

overseen, directed, funded, and/or conducted

by the Department of the Army) . . . with

newly acquired information that may affect

their well-being that it has learned since its

original notification, now and in the future as

it becomes available[.]

Specifically, the injunction directs the Army to provide to

members of the class any information that may affect their

well-being that has been acquired by the Army and/or its

agents since June 30, 2006, or will be acquired in the future. 

The injunction directs the Army to file with the court a report

“describing the efforts it has undertaken to locate the Newly

Acquired Information,” “confirming whether Newly

Acquired Information has been found and describing

generally its nature,” “explaining the plan it has in its

discretion developed for transmitting Newly Acquired

Information to the class members entitled to notification,”

“committing to transmit the Newly Acquired Information”

within 120 days of the entry of the injunction, and “outlining

the plan and policies it has in its discretion developed for

(i) periodically collecting and transmitting Newly Acquired

Information that becomes available to it after the Entry Date

and (ii) providing any necessary update reports to the Court

regarding such future efforts.”

We hold that the injunction is appropriately tailored to

direct the Army to carry out its duty to warn, and that the

district court acted within its discretion. In requiring the

Army to tell former test subjects about “newly acquired

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information that may affect their well-being,” the injunction

reiterates the plain language of AR 70-25’s duty to warn. As

subsection (h) stated, “Commanders have an obligation to

ensure that research volunteers are adequately informed

concerning the risks involved with their participation in

research, and to provide them with any newly acquired

information that may affect their well-being when that

information becomes available.”

The injunction expressly preserves the Army’s ability to

act “in its discretion” to develop the appropriate policies in

order to carry out that duty. It does not prescribe particular

policies that the Army should follow. It does not even

specify the means by which the Army must give that notice. 

In this respect, the injunction does not amount to

programmatic oversight or “judicial entanglement in abstract

policy disagreements which courts lack both expertise and

information to solve.” SUWA, 542 U.S. at 66. The injunction

simply directs the Army to fulfill its duty under subsection

(h).

B. Duty to Provide Medical Care

Chapter 3–1(k) of AR 70-25 (“subsection (k)”) provides,

“Volunteers are authorized all necessary medical care for

injury or disease that is a proximate result of their

participation in research.” Plaintiffs seek an injunction that

would require the Army to provide that care. The parties

agree that the government does not currently provide medical

care to former test subjects “in the absence of those

[individuals] being retirees of the military, medical retirees,

reservists or active duty military.”

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We conclude that subsection (k), as promulgated in 1988

and 1990, requires the Army to provide former test subjects

with medical care for any injuries or diseases that were

proximately caused by Army experiments in which they

participated. The fact that the VA provides medical care to

some former test subjects, for reasons independent of AR 70-

25, does not relieve the Army of its duty under that

subsection.

1. Duty to Provide Care Under AR 70-25

The text of subsection (k) compels the conclusion that the

Army must provide care to former test subjects. It provides

that “[v]olunteers are authorized all necessary medical care”

for any injuries or diseases that are the proximate result of

their participation in Army experiments. In its brief to this

court, the government concedes that subsection (k) requires

the Army to provide medical care to research volunteers. It

contends, however, that the duty to provide medical care is

time-limited, such that the duty exists only during the

duration of the actual experiment. We disagree that

subsection (k) contains this time limitation.

Subsection (k) uses the word “authorized” in describing

the duty of the Army — “[v]olunteers are authorized all

necessary medical care.” (Emphasis added.) The natural

reading of the word “authorized” is that the volunteers are

entitled to receive the “necessary medical care” specified in

the subsection. To take a familiar example, when a collective

bargaining agreement says that an employee is authorized a

certain amount of sick leave, the employee is entitled to that

leave. She must show that she is actually sick — just as test

subjects must show they suffer from diseases that are a

proximate result of their participation in government

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experiments — but if she can do so, she is entitled to take

time off for sick leave. The meaning of “authorized” is no

different here.

The government, agreeing with this reading of the word

“authorized,” concedes in its brief to us that the Army has a

duty under subsection (k) to provide necessary medical care. 

However, the government contends that the Army’s duty to

provide medical care ends as soon as the experiment ends. It

argues in its brief that “the early versions of AR 70-25 make

clear that the only medical care contemplated under that

regulation was care during the pendency of the relevant

testing program itself. Nothing in any of the later versions of

AR 70-25 expands the limited scope of medical care available

beyond the period that an individual is participating in a

specific experiment.” We disagree.

There is nothing in the text of the current version of AR

70-25, first promulgated in 1988, that supports a conclusion

that the Army has a duty to provide medical care, but that the

duty ceases as soon as the experiment ends. The

government’s argument is inconsistent with the plain text of

subsection (k), which states, “Volunteers are authorized all

necessary medical care for injury or disease that is a

proximate result of their participation in research.” 

(Emphasis added.) There is nothing in this language to

suggest that “all” means anything other than “all.” Nor is

there anything in this language that states or even suggests a

temporal restriction on volunteers’ entitlement to receive

medical care. Not only is the government’s argument

inconsistent with the text, but it also makes little sense. If the

government is right, volunteers were entitled to medical care

if they became sick during the actual experiment, but not if

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they fell sick as a result of the experiment the day after it

ended.

In sum, we agree with the government that subsection (k)

requires the Army to provide medical care to all of those

authorized to receive it. However, we disagree as to the

period during which the care must be provided. The temporal

limitation for which the government argues cannot be found

in the text of subsection (k). Instead, the text compels the

conclusion that the only limitation is causal. We hold, as did

the district court, that “AR 70-25 entitles [Plaintiffs] to

medical care for disabilities, injuries or illnesses caused by

their participation in government experiments,” not only

during the course of the experiment but also after the

experiment has ended.

2. Injunction to Provide Medical Care

Section 706(1) of the APA provides that a reviewing

court “shall . . . compel agency action unlawfully withheld.” 

The word “shall” requires a court to compel agency action

when, as here, there is a “specific, unequivocal command”

that the agency must act. SUWA, 542 U.S. at 63–64 (citation

omitted). “The term ‘shall’ is usually regarded as making a

provision mandatory, and the rules of statutory construction

presume that the term is used in its ordinary sense unless

there is clear evidence to the contrary.” Firebaugh Canal

Co., 203 F.3d at 573–74; cf. United States v. Monsanto,

491 U.S. 600, 607 (1989) (finding that “Congress could not

have chosen stronger words to express its intent that

forfeiture be mandatory” than to state that a court “shall”

order forfeiture).

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We recognize that the operation of § 706(1) is restricted

to discrete actions that are unequivocally compelled by

statute or regulation. Courts are not permitted under § 706(1)

to enter “general orders compelling compliance with broad

statutory mandates.” SUWA, 542 U.S. at 66. In its petition

for rehearing and rehearing en banc, the government argues

for the first time that an injunction ordering the Army to

comply with its duty under subsection (k) is inconsistent with

§ 706(1) because such an injunction would require a “broad

restructuring of Army programs and operations.” The

government substantially exaggerates the impact of an

injunction requiring the Army to provide medical care to

human test subjects who were harmed by DOD experiments.

Between 1955 and 1975, DOD exposed about 6,700

human subjects to chemical and biological agents. DOD has

since terminated these programs. The group of plaintiffs

therefore cannot expand, and some of these 6,700 veterans

have undoubtedly died. DOD also exposed numerous human

subjects to chemical agents during World War II. We cannot

determine from the record in this case how many of these

subjects are still living, but the number cannot be large. In

fact, as of 2005, the Army had identified contact information

for only 319 World War II human test subjects. Requiring

the provision of medical care to this limited population would

hardly require a “broad restructuring of Army programs and

operations.” Instead, the Army would be required to provide

medical care to a relatively small group of living veterans

who were injured as a proximate result of the government’s

conduct. This is a discrete action specifically mandated by

subsection (k) of AR 70-25, for which judicial enforcement

pursuant to § 706(1) is required.

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The district court concluded that the Army is required

under subsection (k) to provide necessary medical care on an

ongoing basis, but held that an injunction was unnecessary,

given the availability of medical care from the VA. The court

explained that it would “not enjoin one government agency

to provide health care when another agency has been

congressionally mandated to do so.” Notably, however, the

district court did not hold that the availability of medical care

from the VA rendered Plaintiffs’ request for an injunction

moot. Nor does the government argue to us that the

availability of medical care from the VA renders the

Plaintiffs’ request moot. We can readily see why it does not

make such an argument, for there is nothing in the record

upon which to base a conclusion that the medical care

available from the VA would be equal in scope and quality to

the medical care that Plaintiffs claim is owed to them by the

Army. Indeed, the government admitted in the district court

that it does not provide medical care to former test subjects

“in the absence of those [former subjects] being retirees of

the military, medical retirees, reservists or active duty

military.” In the absence of mootness, we cannot agree that

the Army’s duty to provide care is excused by the availability

of medical care from another government agency, even if that

care that would overlap to some degree and in some manner

with the care that the Army is required to provide.

We hold that the district court may not, in the absence of

mootness, categorically deny injunctive relief to former

volunteer subjects seeking necessary medical care because

some former subjects may be entitled to receive medical care

from another government agency. Given the present posture

of the case, however, we do not address whether and in what

manner the district court might nonetheless take the VA’s

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provision of medical care into account in formulating an

injunction on remand.

Conclusion

We hold that Chapter 3–2(h) of AR 70-25 imposes a duty

on the Army to provide all former test subjects with newly

acquired information that may affect their well-being, and

that this duty is judicially enforceable under § 706(1). We

hold that the district court did not abuse its discretion in

entering its injunction to enforce that duty. We hold, further,

that the district court was right to find that Chapter 3–1(k)

imposes a duty to provide medical care. The district court

should not, however, have declined to compel the provision

of medical care on the ground that another agency was

providing similar care to some former test subjects. We

therefore vacate the district court’s summary judgment for the

government on this claim and remand to the district court.

AFFIRMED in part, REVERSED and REMANDED in

part.

WALLACE, Circuit Judge, concurring in part and dissenting

in part:

I agree that the text of AR 70-25 unequivocally

commands the Army to provide certain newly acquired

information to all former research volunteers when that

information becomes available. Because the Army has

“unlawfully withheld” agency action by denying that it owes

this duty to certain past volunteers, I join the majority in

affirming the district court’s judgment and injunction

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compelling the Army to comply with AR 70-25’s clear

regulatory mandate. See 5 U.S.C. § 706(1). I write separately

in concurrence on this point only because I do not join the

majority’s analysis of regulatory history to support its textual

analysis.

I dissent, however, from the majority’s conclusion that

AR70-25 also contains a “specific, unequivocal command”

that the Army provide medical care to former research

volunteers. I would affirm the district court’s decision to

grant summary judgment against Plaintiffs on their claims for

medical care, but on the alternative ground that their claim is

not judicially enforceable under section 706(1) of the

Administrative Procedure Act (APA).

I.

“Section 706(1) of the APA . . . serves important interests,

but [it] does not give us license to ‘compel agency action’

whenever the agency is withholding or delaying an action we

think it should take.” Hells Canyon Pres. Council v. U.S.

Forest Serv., 593 F.3d 923, 932 (9th Cir. 2010). Rather, our

authority to “compel agency action” is “carefully

circumscribed to situations where an agency has ignored a

specific . . . command,” id., that is located in a federal statute

or “agency regulation[] that ha[s] the force of law,” Norton v.

S. Utah Wilderness Alliance (SUWA), 542 U.S. 55, 65 (2004).

Moreover, the “purportedly withheld action must not only be

‘discrete,’” Hells Canyon, 593 F.3d at 932, meaning that it

must be a “precise, definite act,” SUWA, 542 U.S. at 63, “but

also ‘legally required,’” 593 F.3d at 932, meaning that the

text of the statute or regulation contains an “unequivocal

command” about which an official has “no discretion

whatever,” 542 U.S. at 63 (internal quotation marks omitted),

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such that the duty “could traditionally have been enforced

through a writ of mandamus.” Hells Canyon, 593 F.3d at 932.

A.

Our analysis must focus exclusively on the text of the

relevant statutes or regulations to determine whether this

standard is satisfied. This purely textual approach, amounting

to a “clear-statement rule,” is not unique to the section 706(1)

context. It is indispensable whenever a statute requires us to

determine whether a particular text obligates agency actors to

assume a specific duty or to perform a discrete act.

Like an action brought under section 706(1) of the APA,

for example, a citizen suit may be brought under section

505(a)(2) of the Clean Water Act only where plaintiffs

“allege[] a failure of the [EPA] Administrator to perform any

act or duty under this chapter which is not discretionary with

the Administrator.” 33 U.S.C. § 1365(a)(2). If plaintiffs are

to succeed in their citizen suit against the Administrator, we

have held that “the nondiscretionary nature of the duty must

be clear-cut—that is, readily ascertainable from the statute

allegedly giving rise to the duty.” WildEarth Guardians v.

McCarthy, 772 F.3d 1179, 1182 (9th Cir. 2014). In other

words, “[w]e must be able to identify a ‘specific, unequivocal

command’ from the text of the statute at issue using

traditional tools of statutory interpretation; it’s not enough

that such a command could be teased out ‘from an

amalgamation of disputed statutory provisions and legislative

history coupled with the [agency’s] own earlier

interpretation.’” Id. (emphasis added), quoting Our

Children’s Earth Found. v. E.P.A., 527 F.3d 842, 851 (9th

Cir. 2008) (stating that plaintiffs must “point to a

nondiscretionary duty that is readily-ascertainable and not

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only [] the product of a set of inferences based on the overall

statutory scheme” (alteration in original) (internal quotation

marks omitted)).

B.

Because our inquiry under section 706(1) is necessarily

limited to whether the text of the relevant Army regulations

states a specific, unequivocal command to take discrete

agency action, I cannot join the majority’s perusal of

“internal agency discussions in the years leading up to the

1988 and 1990 revisions of [AR 70-25],” nor its discussion of

the Army’s creation of volunteer databases in 1981 and 1986.

The majority includes these historical observations because

it believes they support our reading of AR 70-25. They do, of

course, but that is irrelevant. Our job is to determine only

whether a statute or regulation itself objectively creates a

mandatory duty. As we have previously held, it is

inappropriate “for us to divine a ‘specific, unequivocal

command,’ from an amalgamation of disputed statutory

provisions and legislative history coupled with the [agency’s]

own earlier interpretation.” Our Children’s Earth Found.,

527 F.3d at 851, quoting SUWA, 542 U.S. at 63. To be sure,

the majority does not rely exclusively—or even chiefly—on

non-textual sources in concluding that the Army has an

unequivocal duty to warn. But by including a discussion of

regulatory history and historical facts in support of its textual

analysis, the majority improperly suggests that these extratextual sources and observations have some bearing on

whether we are authorized to compel unlawfully withheld

agency action under section 706(1). I write separately to

dispel any doubt: they do not. I thus join in the result but not

that part of the majority’s analysis.

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II.

I dissent from the majority’s conclusion that AR 70-25

creates an unequivocal duty for the Army, enforceable under

section 706(1), to provide medical care to former research

volunteers. As stated above, the Supreme Court’s standard

under section 706(1) for compelling agency action is

demanding. See SUWA, 542 U.S. at 63. We ourselves have

explained that we can compel agency action only when the

legal obligation is “so clearly set forth that it could

traditionally have been enforced through a writ of

mandamus.” Hells Canyon, 593 F.3d at 932.

Only two provisions of AR 70-25, as promulgated in

1988, could potentially provide the basis for a judicially

enforceable duty to provide medical care. Neither does.

A.

1.

The first is Chapter 3–1(k) (subsection (k)), which

provides, “Volunteers are authorized all necessary medical

care for injury or disease that is a proximate result of their

participation in research.” This subsection is not an

“unequivocal command” to provide medical care. That is,

while the authorization in subsection (k) certainly removes a

barrier to volunteers’ receipt of medical care—making it

clear, at least, that volunteers should not be denied medical

care for lack of authorization—it does not clearly require the

Army to provide medical care. This is a far cry from the

typical mandatory language we usually require in section

706(1) cases. See Rivas v. Napolitano, 714 F.3d 1108, 1111

(9th Cir. 2013) (observing that “[t]he mandatory language

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used in the regulation makes the act of reconsideration nondiscretionary”).

The majority, of course, believes the more “natural

reading” of the word “authorized” is that “the volunteers are

entitled to receive the ‘necessary medical care’ specified in

the subsection.” But regardless of how “natural” the majority

believes its reading to be, it is not the only plausible reading.

The only thing that subsection (k) makes clear is that

volunteers are authorized to receive medical care, which is

one or two logical steps away from the majority’s conclusion

that the Army has a legal obligation to provide them with that

medical care. Although it is possible to read into the text of

subsection (k) the assumption that the authorization is the

only thing volunteers need in order to be entitled to medical

care, and the assumption that the Army has a duty to provide

medical care to anyone who is entitled to it, it is also possible

to read the text of subsection (k) without those assumptions.

Because the text is reasonably open to interpretation, it does

not state an unequivocal command.

2.

Subsection (k)’s “authorization” for medical care, in

addition to not being legally required, also is not discrete

agency action. Discrete agency action for purposes of section

706(1) is a “precise, definite act,” like the promulgating of a

rule or the taking of some decision by a statutory deadline.

SUWA, 542 U.S. at 63. The phrase “[v]olunteers are

authorized all necessary medical care for injury or disease

that is a proximate result of their participation in research,”

does not qualify as “the ordering of a ‘precise, definite act . . .

about which [an official] ha[s] no discretion whatever.’” Id.

This is most easilydemonstrated by comparing subsection (k)

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to subsection (h)—the “duty to warn” subsection—which

does command discrete agency action.

Subsection (h) unambiguously identifies which agency or

officers (“Commanders”; “MACOM”) are “legally required”

(“have an obligation”; “must establish”) to perform a

“discrete action,” (“provide [volunteers] with any newly

acquired information”) which is described “precise[ly]” and

“definite[ly]”:

• What: “information that may affect their wellbeing”;

• When: “when [it] becomes available” and “even

after the individual volunteer has completed his or

her participation in research”;

• To Whom: “research volunteers”—“[t]o

accomplish this, [the Army] must establish a

system which will permit identification of

volunteers who have participated in research . . .

and take actions to notify volunteers of newly

acquired information.”

Subsection (k), in contrast, leaves us to guess at which

agency officer is obligated to provide the medical care

(assuming, of course, that “authorized” means “required”—it

does not), what such medical care would consist of, or when

and how long medical care must be provided (only during

research? only in “emergency” situations? forever?). As a

result, subsection (k) “lack[s] the specificity requisite for

agency action.” SUWA, 542 U.S. at 66.

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38 VIETNAM VETERANS OF AMERICA V. CIA

B.

Only one other provision of AR 70-25 could possibly

provide the basis for a judicially enforceable duty to provide

medical care: Chapter 2–5(j) (subsection (j)). Subsection (j)

provides, “The Surgeon General . . . will . . . [d]irect medical

followup, when appropriate, on research subjects to ensure

that any long-range problems are detected and treated.”

Subsection (j), like subsection (k), lacks the usual language

of obligation. Subsection (j) contemplates action by the Army

Surgeon General only “when appropriate.” That grant of

discretion prevents us from concluding that this language

represents a “specific, unequivocal command” directing the

Surgeon General to provide medical care.

C.

For these reasons I would affirm the district court’s

summary judgment against Plaintiffs on their claims for

medical care, but on the alternative ground that their claim is

not judicially enforceable under section 706(1) of the APA.

I am not unsympathetic to the notion that those who have

served our country—especially those who have risked their

health and well-being in that service—should have access to

appropriate medical care. However, the Supreme Court has

counseled us, and we have recognized, that “[e]ven if a court

believes that the agency is withholding or delaying an action

the court believes it should take, the ‘ability to compel agency

action is carefully circumscribed to situations where an

agency has ignored a specific legislative command.’”

Gardner v. U.S. Bureau of Land Mgmt., 638 F.3d 1217,

1221–22 (9th Cir. 2011), quoting Hells Canyon, 593 F.3d at

932. “As much as we as citizens are concerned with the plight

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VIETNAM VETERANS OF AMERICA V. CIA 39

of veterans seeking the prompt provision of the health care

and benefits . . . as judges we may not exceed our

jurisdiction.” Veterans for Common Sense v. Shinseki,

678 F.3d 1013, 1016 (9th Cir. 2012) (en banc). I am therefore

compelled to dissent from this part of the majority opinion.

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