Since the mid-1990s, bilateral relations between the United States and Vietnam have become virtually normalized. The United States has granted Vietnam permanent normal trade relations (PNTR) status and Vietnam has become a member of the World Trade Organization (WTO)—two major objectives of the Vietnamese government following the end of the Vietnam War. As part of the bilateral agreements related to PNTR and WTO membership, Vietnam has made a number of significant changes in its trade policies, and has increased its efforts to help the United States recover the remains of U.S. soldiers and civilians who died during the Vietnam War. The two nations also have expanded their nascent cooperation on strategic and military issues to the point that Vietnam has emerged as an important partner for the United States on many issues in Asia. Although the United States remains concerned about human rights in Vietnam, tensions between the two nations are comparatively low. However, inside Vietnam, there is a long-standing issue that could continue to cause friction in the future—the condition of Vietnamese people affected by Agent Orange and its unintended byproduct, the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin, or TCDD. Agent Orange was one of several herbicides that the U.S. military used widely in southern Vietnam during the Vietnam War. According to U.S. Ambassador to Vietnam David Shear, "Agent Orange remains among the most sensitive issues in U.S.-Vietnam relations." Over the last decade, there has been a groundswell of concern among the Vietnamese people about the continuing problems of environmental damage and illnesses associated with Agent Orange. Some non-governmental organizations (NGOs) in Vietnam are seeking compensation or assistance from the U.S. government and the manufacturers of Agent Orange. Partially in response to this rising tide of popular concern, the Vietnamese government has raised the profile of this issue in various bilateral fora with U.S. officials, including the June 2008 summit between President Bush and Prime Minister Nguyen Tan Dung. Vietnam's government is divided on the issue of whether to seek greater U.S. assistance with the Agent Orange/dioxin issue. Vietnam's Ministry of Defense (MOD) and various veterans groups are among the more vocal advocates of seeking more U.S. assistance. Similarly, the Ministry of Health (MOH); the Ministry of Labour, War Invalids, and Social Affairs (MOLISA); and the Ministry of Natural Resources and the Environment (MONRE) would like to see the United States increase its assistance. However, the Ministry of Agriculture and Rural Development (MARD) is concerned that by drawing attention to the continued pervasive presence of dioxin in the Vietnam's environment, other nations may restrict or prohibit the import of Vietnamese crops, aquatic products, meats and poultry, and processed foods supposedly for health reasons. Some officials in Vietnam's Ministry of Foreign Affairs (MOFA) are also apprehensive that greater pressure on the United States on the Agent Orange/dioxin issue may have an adverse impact on other important bilateral issues, such as Vietnam's application to the U.S. Generalized System of Preference program or the ongoing Trans-Pacific Partnership (TPP) negotiations. According to one Vietnamese estimate, there are up to 5 million Vietnamese spanning three generations who have medical conditions that are purported to be related to exposure to Agent Orange and similar herbicides—and more importantly, their accompanying dioxin—that the U.S. military sprayed across much of South Vietnam as part of Operation Ranch Hand. The Vietnamese government and various Vietnamese interest groups have long sought U.S. assistance with the cleanup of the residual dioxin in Vietnam, as well as financial support to provide medical treatment to people exposed to Agent Orange. The official U.S. response to date has been to deny any legal liability and to contest that the medical conditions are related to exposure to Agent Orange and dioxin. The Vietnamese government and people have objected to these denials given the level of support provided to U.S. veterans who were presumably exposed to Agent Orange and the extensive cleanup efforts made at Love Canal, Times Beach, and other U.S. locations found to have elevated levels of dioxin in the soil. In the waning months of the George W. Bush Administration, there were some indications that the United States was becoming more flexible on this issue—just as the issue has risen in importance in Vietnam. For example, following President Bush's November 2006 meeting with President Nguyen Minh Triet, the two governments issued a joint statement that included the sentence, "The United States and Vietnam also agreed that further joint efforts to address the environmental contamination near former dioxin storage facilities would make a valuable contribution to the continued development of their bilateral relations." The joint statement also indicated that "President Triet also expressed appreciation for the U.S. Government's increasing development assistance to Vietnam and urged the U.S. side to increase humanitarian assistance including through cooperation on areas such as unexploded ordinance and continued assistance to Vietnamese with disabilities." In addition, Congress has demonstrated a willingness to provide assistance for both the dioxin cleanup and humanitarian support for Vietnamese believed to be affected by exposure to dioxin. In May 2007, the 110 th Congress appropriated $3 million to the State Department for the cleanup of dioxin in and around an ex-military base in Da Nang used as a distribution center for Agent Orange during the Vietnam War. Some of the funds were to be used to provide medical care for residents near the ex-military base. The 111 th Congress appropriated $3 million in FY2009 and an additional $15 million in FY2010 for the cleanup and related health activities in Da Nang. In April 2011, the 112 th Congress appropriated $18.5 million as part of Department of Defense and Full-Year Continuing Appropriations Act, 2011 ( P.L. 112-10 ) for Agent Orange/dioxin remediation and related health activities in Vietnam, and an additional $20.0 million in the Consolidated Appropriations Act, 2012 ( P.L. 112-74 ). Additional legislation has been introduced in 112 th Congress that would appropriate funds for Agent Orange/dioxin remediation and related health activities in Vietnam (see " Issues and Options for Congress "). Some Members of Congress have also stated that the United States has a "moral obligation" to the people of Vietnam—many of whom were either allies at the time or were innocent civilians—to help address the perceived environmental and health problems created by the use of Agent Orange during the Vietnam War. In April 2008, Senator John McCain said in regards to the Agent Orange/dioxin issue, "I believe it remains an irritant, and perhaps more than that, for some of the people of Vietnam. I think we need to continue to address the issue both in compensation for the victims as well as cleanup of areas that are clearly contaminated." Although both sides appear to be willing to discuss the issue, the legacy of Agent Orange has the potential to adversely affect U.S.-Vietnamese relations in the future. With other key issues apparently resolved, Agent Orange has emerged as one of Vietnam's top concerns. However, Vietnam's interest in forming closer economic ties with the United States—such as its formal request for inclusion in the U.S. Generalized System of Preferences (GSP) program and the ongoing negotiations of the Trans-Pacific Partnership trade agreement —may once again push the Agent Orange issue into the background. For the United States, the recent growth in bilateral trade and U.S. investment in Vietnam is providing a strong incentive to improve relations with its former enemy. According to many U.S. manufacturers, Vietnam is one of the more attractive alternative sources to China for a variety of imported products. Also, some analysts think that friendly relations with Vietnam offer a strategic counterbalance to the growth of Chinese influence in Asia. In addition, greater assistance with the cleanup of dioxin in Vietnam and/or aid in providing medical care for dioxin victims may enhance the image of the United States in Southeast Asia, as well as improve Vietnam's public environmental management and health systems. Some observers assert that if the United States continues to deny the legitimacy of Vietnam's environmental and health claims—and the responsibility to help ameliorate the damage caused by Agent Orange/dioxin—it risks causing harm to its relations with Vietnam, and possibly weakening U.S. soft power in Asia. From 1975 to about 2000, although the Agent Orange issue was on Vietnam's agenda, it was generally pushed into the background. There are many reasons for this, including Vietnam's desire for greater trade opportunities with the United States, the U.S. desire for a more complete accounting for U.S. soldiers still listed as "missing in action" (MIA) in Vietnam, Vietnam's invasion of Cambodia in 1978, and the rising tide of Vietnamese "boat people." In 1975, following North Vietnam's victory over South Vietnam, President Gerald Ford severed diplomatic relations and imposed a trade embargo on Vietnam. Although Vietnam sought to normalize relations, it was predicated on the United States honoring President Richard Nixon's "secret promise" of $3.25 billion in reconstruction assistance, which the United States was unwilling to do. Although President Jimmy Carter signaled a willingness to discuss normalization soon after his inauguration, the emotional issue of U.S. prisoners of war/missing in action (POW/MIAs), the migration of Vietnam's so-called "boat people," Vietnam's 1978 invasion of Cambodia (known at that time as Democratic Kampuchea), and Vietnam's border conflict with China made any significant warming of relations politically impossible. U.S.-Vietnamese relations became even more frosty following the signing of a mutual defense treaty between Vietnam and the Union of Soviet Socialist Republics (USSR) on November 3, 1978. These circumstances pushed the issue of Agent Orange effectively off the bilateral agenda despite Vietnamese efforts to raise the subject.