Agent Orange

2011
Science, Politics, Policy and Practice

Overview
What is/are dioxin(s)
VHA response to Vietnam War
Presumptive conditions
Exposures of special groups
The future
Resources
Questions

Herbicide (Agent) Orange

(1)
1:1 mixture of 2,4-dichlorophenoxy acetic

acid (2,4-D, 50%) and 2,4,5trichlorphenoxyacetic acid (2,4,5-T, 50%)

2,4,5-T was used extensively as an herbicide

in forestry and agriculture domestically and

abroad starting in the 1940s.

Shipped to Vietnam in 55-gallon steel drums

with an orange stripe around the middle

~12/19x106 gallons used in Vietnam = A.O.

Herbicide (Agent) Orange

(2)
2,4-D

2,4,5-T

Other Herbicides Used in

Vietnam
Picloram

Cacodilic Acid

Dibenzofurans

Heavily Sprayed Areas Map

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

Mangrove forests along major shipping

channels southeast of Saigon

Dioxins
A group of chlorinated dibenzo-p-dioxins

(CDDs) with 75 isomeric forms of 2,3,7,8tetrachlorobenzo-p-dioxin (TCDD)

A condensation reaction occurred during

production of 2,4,5-trichlorophenol
resulting in the creation of TCDD, a
contaminant.

(TCDD)c varied by lot: 1-50 ppm

Handout

Dioxins Pharmacology
Entry skin, respiratory and GI tracts
Extremely lipophilic fat, liver.
T1/2 7 to 10 years
Ah (aromatic hydrocarbon) receptor

activation in mouse and humans

Aryl Hydrocarbon Hydroxylase (AHH) -

inducible enzyme

Excretion - ?bile or urine

Dioxins - Toxicology
Varies by species
Involves many systems skin, endocrine,

reproductive (female,) liver, CNS (?)

Human toxicity determined variously

Chloracne - clinical:dose/response toxicity

Lymphoma domestic agriculture

Reproductive Seveso, Italy et. al.
Diabetes - Epidemiology

Politics
Congress ordered the end of Herbicide

Orange spraying when two studies showed

birth defects and other endocrine-related
pathology in rats

For the purposes of policy re: presumptive

conditions, the Department of Veterans

Affairs does not require the same order of
proof of toxicity as do scientists.

Federal Response to
Vietnam
1970s - Agent Orange examination and

Agent Orange Review

1980s Epidemiology/Case law/Legislation

VHA EES; CDC

1991 Agent Orange Act

1960s 2011 Scientific Study
1980s Air Force Ranch Hand
1990s et. seq. NAS/IOM biennial AO

Report

Presumptive
Conditions (1)
Acute and Subacute Peripheral Neuropathy
A nervous system condition that causes numbn
ess, tingling, and motor weakness. Under VA's
rating regulations, it must be at least 10%
disabling within 1 year of exposure to herbic
ides and resolve within 2 years after the dat
e it began.
AL Amyloidosis
A rare disease caused when an abnormal prote
in, amyloid, enters tissues or organs.

Chloracne (or Similar Acneform Disease)

A skin condition that occurs soon after expo
sure to chemicalsand looks like common forms
of acne seen in teenagers. Under VA's rating
regulations, chloracne (or other acneform di
sease similar to chloracne) must be at least
10% disabling within 1 year of exposure to he
rbicides.

Presumptive Conditions
(2)
Chronic B-cell Leukemias

A type of cancer which affects white b

lood cells.

Diabetes Mellitus (Type 2)

A disease characterized by high blood

sugar levels resulting from the body
s inability to respond properly to the
hormone insulin.
Hodgkins Disease
A malignant lymphoma (cancer) charac
terized by progressive enlargement of
the lymph nodes, liver, and spleen,
and by progressive anemia.

Presumptive Conditions
(3)
Ischemic Heart Disease

A disease characterized by a reduced

supply of blood to the heart, that lea
ds to chest pain.

Multiple Myeloma

A cancer of plasma cells, a type of wh

ite blood cell in bone marrow.

Non-Hodgkins Lymphoma

A group of cancers that affect the ly

mph glands and other lymphatic tissue.

Presumptive Conditoins
(4)
Porphyria Cutanea Tarda

A disorder characterized by liver dys

function and by thinning and blisterin
g of the skin in sun-exposed areas. Un
der VA's rating regulations, it must b
e at least 10% disabling within 1 year
of exposure to herbicides.
Prostate Cancer
Cancer of the prostate; one of the
most common cancers among men.

Presumptive Conditions
(5)
Respiratory Cancers

Cancers of the lung, larynx, trachea,

and bronchus.

Soft Tissue Sarcoma (other than Ost

eosarcoma, Chondrosarcoma, Kaposis

sarcoma, or Mesothelioma)
A group of different types of cancers
in body tissues such as muscle, fat,
blood and lymph vessels, and connectiv
e tissues.

Other Military
Exposures
Korea
Waterways
Inland
Costal
On-shore
Blue water*

*Requires specific information

Women Veterans and

Offspring

Am J Ind Med. 2000 Oct;38(4):447-54.

Pregnancy outcomes among U.S. women Vietnam

veterans.

Kang HK, Mahan CM, Lee KY, Magee CA, Mather SH, Matanoski
G.

A comparison of self-reported pregnancy outcomes for 4,140

women Vietnam veterans with those of 4,140 contemporary
women veterans who were not deployed to Vietnam.

There was no statistically significant association between

military service in Vietnam and index pregnancies resulting in
miscarriage or stillbirth, low birth weight, pre-term delivery, or
infant death. The risk of having children with "moderate-tosevere" birth defects was significantly elevated among
Vietnam veterans (adjusted OR = 1.46, 95% CI = 1.06-2.02).

Covered Birth
Defects (1)
Achondroplasia
Cleft lip and cleft palate
Congenital heart disease
Congenital talipes equinovarus (clubfoot)
Esophageal and intestinal atresia
Hallerman-Streiff syndrome

Covered Birth
Defects (2)
Hip dysplasia
Hirschprung's disease (congenital

megacolon)

Hydrocephalus due to aqueductal stenosis

Hypospadias
Imperforate anus
Neural tube defects

Covered Birth
Defects (3)
Poland syndrome
Pyloric stenosis
Syndactyly (fused digits)
Tracheoesophageal fistula
Undescended testicle
Williams syndrome

Death from Agent Orange

Surviving spouses, dependent children

and dependent parents of Veterans who

were exposed to Agent Orange and died
as the result of diseases related toAgent
Orange exposure may be eligible
forsurvivors' benefits.

http://www.publichealth.va.gov/exposures/

agentorange/survivors-benefits.asp

NAS/IOM Veterans and

Agent Orange 2010
Veterans and Agent Orange: Update 2010

Released: September 29, 2011

Veterans Review of the Health Effects in

Vietnam Veterans of Exposure to

Herbicides (Eighth) Biennial Update

Resources
VHA Agent Orange Home Page
http://www.publichealth.va.gov/exposures/ag
entorange

Vietnam Veterans of America Home Page

http://VVA.org