Veterans Affairs:
Health Care and Benefits for Veterans Exposed toAgent Orange
SidathViranga Panangala, Analyst in Veterans Policy (spanangala@crs.loc.gov, 7-0623)
Douglas Reid
Weimer, Legislative Attorney (dweimer@crs.loc.gov,
7-7574)
August 25,
2008 (RL34370)
Contents
- Background
- Health Care
- Disability Compensation
- The Agent Orange Registry
- Non-Vietnam Veterans Exposed to Agent Orange
- Haas v. Peake (Previously Haas v. Nicholson)
- Haas v. Nicholson
- Subsequent Actions
- Haas v. Peake
- Subsequent Actions
- Proposed Legislation to Clarify Service in Vietnam
- Epidemiologic Research on Vietnam Veterans
- Centers for Disease Control and Prevention
- Air Force Health Study (AFHS)
Summary
Since the 1970s, Vietnam-era veterans have attributed
certain medical illnesses, disabilities, and birth defects to exposure to Agent
Orange and other herbicides sprayed by the U.S. Air Force to destroy enemy
crops and remove forest cover. During the last 30 years, Agent Orange
legislation has established and updated the health and disability benefits of Vietnam veterans exposed to herbicides.
The Veterans' Health Care, Training and Small Business Loan
Act (P.L. 97-72) elevated Vietnam veterans' priority status
for health care at Department of Veterans Affairs facilities by recognizing a
veteran's own report of exposure as sufficient proof to receive medical care
unless there was evidence to the contrary. The Veterans' Health Care
Eligibility Reform Act of 1996 (P.L. 104-262) completely restructured VA medical care
eligibility requirements for all veterans. Under P.L. 104-262, a veteran does not have to demonstrate a
link between a certain health condition and exposure to Agent Orange; instead,
medical care is provided unless the VA has determined that the condition did
not result from exposure to Agent Orange or the condition has been identified
by the Institute of Medicine (IOM) as having "limited/suggestive"
evidence of no
association between the occurrence of the disease and exposure to a herbicide.
The Veterans' Dioxin and Radiation Exposure Compensation
Standards Act of 1984 (P.L. 98-542) required the VA to develop regulations for
disability compensation to Vietnam veterans exposed to Agent Orange. In 1991, the Agent Orange Act (P.L. 102-4) established for the first time a
presumption of service connection for diseases associated with herbicide
exposure. P.L. 102-4 authorized the VA to contract with the IOM
to conduct a scientific review of the evidence linking certain medical
conditions to herbicide exposure. Under this law, the VA is required to review
the reports of the IOM and issue regulations, establishing a presumption of
service connection for any disease for which there is scientific evidence of a
positive association with herbicide exposure.
Navy veterans of the Vietnam Era (those who served in Vietnam between
January 9, 1962, and May 7, 1975), who served offshore and were never
physically present on Vietnamese soil, have been contesting the presumption of
service-connection for Agent Orange disability benefits. In 2006, the U.S.
Court of Appeals for Veterans Claims (CAVC) ruled in Haas v. Nicholson that
navy veterans who served offshore during the Vietnam Era were entitled to a
presumption of exposure to Agent Orange. However, in May 2008, the U.S. Court
of Appeals for the Federal Circuit reversed the prior CAVC ruling. The Agent
Orange Equity Act of 2008 (H.R. 6562), which has seen no legislative action, would
clarify service in Vietnam to include inland waterways, waters offshore, and, airspace above Vietnam.
This report will be updated as events warrant.
Background
Between 1962 and 1971, the U.S.
Air Force sprayed approximately 107 million pounds of herbicides in South Vietnam for the purpose of defoliation and crop destruction. The herbicides sprayed
during the Vietnam era contained mixtures of 2,4-dichlorophenoxyacetic acid
(2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic
acid. The most extensively used defoliant compound, a 50:50 combination of
2,4-D and 2,4,5-T, came to be known as "Agent Orange" because of the
orange-colored band placed on each chemical storage container. One of the
chemicals used in Agent Orange, 2,4,5-T, contained small amounts of dioxin.
Other herbicides employed in Vietnam such as "Agent Purple" and "Agent Green" also were
contaminated with dioxin. Collectively, these compounds were referred to as the
"rainbow defoliants." The late 1960s saw a decline in the use of
these herbicides when dioxin, already well known to be highly toxic in animals,
was implicated in birth defects seen in mice. By 1969, spraying was restricted
to remote areas, and by 1971, the Air Force ceased all spraying of Agent
Orange.
Since the 1970s, Vietnam-era
veterans have voiced concerns about how exposure to Agent Orange may have
affected their health and caused certain disabilities, including birth defects
in their children. Initially, the Department of Defense (DOD) maintained that
only a limited number of U.S. military personnel, such as those operating
aircraft or troops engaged in herbicide spraying, could be positively linked to
Agent Orange exposure. However, in 1979, the General Accounting Office, now the
Government Accountability Office (GAO), reported that ground troops had also
been exposed to Agent Orange, and DOD was forced to reconsider its prior
statements. In response to these concerns, Congress passed legislation
to research the long-term health effects on Vietnam veterans, and to provide
benefits and services to those who may have been exposed to Agent Orange.
Health Care
Prior to the 1981 Veterans' Health
Care, Training and Small Business Loan Act (P.L. 97-72), veterans who complained of Agent
Orange-related illnesses were at the lowest priority for treatment at
Department of Veterans Affairs (VA) medical facilities because these conditions
were not considered "service-connected." P.L. 97-72 elevated Vietnam veterans' priority status
for health care at VA facilities by recognizing a veteran's own report of
exposure as sufficient proof to receive medical care unless there was evidence
to the contrary. The Veterans' Health Care Eligibility Reform Act of 1996 (P.L. 104-262) completely restructured VA medical care
eligibility requirements for all veterans. Under P.L. 104-262, a veteran does not have to demonstrate a
link between a certain health condition and exposure to Agent Orange; instead,
medical care is provided unless the VA has determined that the condition did
not result from exposure to Agent Orange or the condition has been identified
by the Institute of Medicine (IOM) as having "limited/suggestive"
evidence of no association between the occurrence of the disease and
exposure to a herbicide. The research by the IOM (part of the National Academies)
and its significance is addressed below.
Disability Compensation
The Veterans' Dioxin and Radiation
Exposure Compensation Standards Act of 1984 (P.L. 98-542) required the VA to develop regulations for
disability compensation to Vietnam veterans who may have been exposed to Agent Orange. Veterans seeking
compensation for a condition they thought to be related to herbicide exposure
had to provide proof of a service-connection that established the link between
herbicide exposure and disease onset. P.L. 98-542 authorized disability compensation payments
to Vietnam veterans for the skin condition chloracne, which is associated with herbicide
exposure. In 1991, the Agent Orange Act (P.L. 102-4) established for the first time a
presumption of service connection for diseases associated with herbicide
exposure. Under the Agent Orange Act, veterans seeking disability compensation
for diseases they thought to be associated with herbicides no longer were
required to provide proof of exposure. P.L. 102-4 authorized the VA to contract with the IOM
to review and summarize the scientific evidence concerning the association
between exposure to herbicides used in support of military operations in Vietnam during
the Vietnam Era and each disease suspected to be associated with such exposure.
P.L. 102-4 mandated that IOM determine, to the extent
possible (1) whether there is a statistical association between the suspect
diseases and herbicide exposure, taking into account the strength of the
scientific evidence and the appropriateness of the methods used to detect the
association; (2) the increased risk of disease among individuals exposed to
herbicides during service in Vietnam during the Vietnam Era; and (3) whether
there is a plausible biological mechanism or other evidence of a causal
relationship between herbicide exposure and the health outcome. VA is then required to review the reports of the IOM and
issue regulations, establishing a presumption of service connection for any
disease for which there is scientific evidence of a positive association with
herbicide exposure. Once the VA has established presumption of service
connection for a certain disease or medical condition, a Vietnam veteran
with that disease is eligible for disability compensation. The amount of
compensation is based on the degree of disability and, again, veterans are
compensated only for approved conditions that have demonstrated sufficient
evidence of an association with herbicide exposure.
Currently, the conditions that are
presumptively recognized for service connection for Vietnam veterans are
chloracne (must occur within one year of exposure to Agent Orange);
non-Hodgkin's lymphoma; soft tissue sarcoma (other than osteosarcoma,
chondrosarcoma, Kaposi's sarcoma, or mesothelioma); Hodgkin's disease;
porphyria cutanea tarda (must occur within one year of exposure); multiple
myeloma; respiratory cancers, including cancers of the lung, larynx, trachea,
and bronchus; prostate cancer; acute and subacute transient peripheral
neuropathy (must appear within one year of exposure and resolve within two
years of date of onset); type II diabetes; and chronic lymphocytic leukemia. In addition, Vietnam veterans' children with the
birth defect spina bifida are eligible to receive a monthly monetary allowance
in addition to certain health care services. The Veterans Benefits and Health
Care Improvement Act of 2000 (P.L. 106-419) authorized similar benefits and services
for children with certain birth defects who were born to female Vietnam
veterans.
The Agent Orange Act of 1991 (P.L. 102-4) also mandated the VA to publish a notice
when the VA determines that a presumption of service-connection is not
warranted. On June 12, 2007, based on the 2004 IOM report on Agent Orange, the
VA issued a notice that a presumption of service-connection is not warranted based
on exposure to herbicides used in Vietnam during the Vietnam Era for the
following medical conditions: Hepatobiliary cancers; oral, nasal, and
pharyngeal cancer; bone and joint cancer; skin cancers (melanoma, basal, and
squamous cell); breast cancer; female reproductive cancer (cervix, uterus, and
ovary); testicular cancer; urinary bladder cancer; renal cancer; leukemia
(other than chronic lymphocytic leukemia [CLL]); abnormal sperm characteristics
and infertility; spontaneous abortion; neonatal or infant death and stillbirth
in offspring of exposed individuals; low birthweight in offspring of exposed
individuals; neurobehavioral disorders (cognitive and neuropsychiatric);
movement disorders, including Parkinson's disease and amyotrophic lateral
sclerosis (ALS); chronic peripheral nervous system disorders; respiratory
disorders; gastrointestinal, metabolic, and digestive disorders (changes in
liver enzymes, lipid abnormalities, ulcers); immune system disorders (immune
suppression, autoimmunity); circulatory disorders; amyloid light-chain (AL)
amyloidosis; endometriosis; effects on thyroid homeostasis; gastrointestinal
tumors (esophagus, stomach, pancreas, colon, rectum); brain tumors; and any
other condition for which the VA has not specifically determined a presumption
of service-connection.
The Agent Orange Registry
The Agent Orange Registry was
established in 1978 by the VA for Vietnam veterans concerned about
the health effects of exposure to Agent Orange. A veteran choosing to register
is eligible for an examination consisting of a medical history, a physical
examination, and a series of laboratory tests. Each veteran is also required to
answer a set of questions relevant to exposure. In September 2000, the Agent
Orange Registry was expanded to include veterans who served in Koreain 1968
and 1969. Since August 2001, the registry is accessible to all U.S. veterans
potentially exposed to dioxin or other toxic substances used in herbicides
while engaged in military activity. Participating in the registry does not give
exposed military personnel automatic access to health and disability
compensation benefits. As of September 2007, more than 490,000 veterans have
participated in the registry.
Non-Vietnam Veterans Exposed to
Agent Orange
Under current law, only Vietnam veterans who served in-country are
eligible to receive health care benefits and compensation for service "in Vietnam." However, under certain circumstances, veterans are
eligible for health care and compensation benefits for service outside of Vietnam. A
non-Vietnam veteran who claims that an injury or illness resulted from exposure
to Agent Orange while serving in the military can apply for service-connected
benefits. But unlike Vietnam veterans, they are required to prove they were exposed to Agent Orange. VA
requires the following information in the veteran's benefit application: a
medical diagnosis of a disease or condition the VA recognizes as associated
with Agent Orange; evidence of exposure to a chemical contained in the
herbicides used in Vietnam; and medical evidence that the disease began or
manifested within the designated time frame, if any, for that disease. Those veterans who served in areas such as the Korean Demilitarized
Zone (DMZ) may be eligible to apply for disability benefits. The DOD has also
published a list of areas outside of Vietnam where Agent Orange was
used.
In 2003, Congress passed the
Veterans Benefits Act of 2003 (P.L. 108-183). Among other things, the Act expanded health care and other
benefits to natural children of Korea service veterans born with spina bifida. To be eligible for benefits, the veteran must have served
in the active military, naval, or air service in or near the Korean
Demilitarized Zone (DMZ) between September 1, 1967, and August 31, 1971, and
must have been exposed to certain herbicides during such service. Furthermore, under P.L. 108-183, the determination of service in the
Korean DMZ is to performed by the VA in consultation with DOD.
Haas v. Peake
(Previously Haas v. Nicholson)17
On August 16, 2006, the U.S. Court
of Appeals for Veterans Claims (CAVC) determined that the veterans who had
served in the waters off Vietnam (this class of veterans is generally known as
"blue water" veterans) were entitled to a presumption of exposure to
Agent Orange. Prior to this CAVC decision, VA's interpretation of 38 CFR 3.307(a)(6)(iii) was that a
service member had to have actually set foot on Vietnamese soil or served on a
craft in its rivers (also known as "brown water" veterans) in order
to be entitled to the presumption of exposure to Agent Orange. The CAVC
specifically held the following: (1) the reference to service "in
Vietnam" as used in the statute was ambiguous because there are many
definitions of the territory of a nation, and (2) VA's regulation defining
Vietnam service for purposes of granting the presumption of exposure to
herbicides, 38 CFR 3.307(a)(6)(iii), was ambiguous when viewed together with 38
CFR 3.313, which also defines service in Vietnam. Because CAVC determined that
ambiguity was present, it also examined VA's Adjudication Procedure Manual
M21-1 (the M21-1 manual) provision from 1991, which stated that the receipt of a
Vietnam Service Medal (VSM) would be considered proof of Vietnam service in the
absence of "contradictory evidence." In 2002, VA issued a new M21-1
provision advising VA benefit adjudicators that the receipt of the VSM could
indicate service on land in Vietnam but, by itself, was not proof of service in
Vietnam because a veteran may have received this medal for service in locations
other than Vietnam. The CAVC determined the M21-1 provision to be a
substantive rule establishing entitlement to the presumption of exposure to
herbicides, and held that VA's "attempted rescissions" of that M21-1
provision were void because they failed to comply with the notice and comment
requirements of the Administrative Procedures Act (APA).
Subsequent Actions
On September 21, 2006, Secretary
Nicholson issued a memorandum directing the Board of Veterans Appeals (BVA) to
withhold adjudicating all service-connected claims based on exposure to
herbicides in which the only evidence of exposure is the receipt of the Vietnam
Service Medal or service on a vessel off the shore of Vietnam.
On December 11, 2006, VA issued a memorandum to its regional offices,
instructing them that claims related to Haas v. Nicholson decision should not
be adjudicated until the litigation is resolved. As a result, at this time, BVA
has suspended action on Haas v. Nicholson claims.
VA appealed the CAVC decision to
the U.S. Court of Appeals for the Federal Circuit in Washington, D.C. Oral argument was held on November 7, 2007.
On November 27, 2007, VA published
a Federal Register notice proposing to rescind provisions of
its Adjudication Procedures Manual, M21-1 (M21-1), that were found by the CAVC
not to have been properly rescinded under the APA. This action was taken by the VA as a preemptive measure in
the event the Department did not prevail on appeal in Haas v.
Nicholson.
Haas v. Peake
Haas v. Peake is the case name on appeal of the previously discussed Haas v.
Nicholson. On May 8, 2008, the U.S. Court of Appeals for the
Federal Circuit (the "court") issued a decision reversing the prior
CAVC ruling. The court concluded that the VA's interpretation of "service
in Vietnam" as
requiring the servicemember's presence at some point on the landmass or the
inland waters of Vietnam was based on a permissible construction of the statute. The court also stated in its opinion that "Mr. Haas
is free to pursue his claim that he was actually exposed to herbicides while on
board his ship as it traveled near the Vietnamese coast." However,
according to the court's opinion, he is not entitled to the benefit of a
presumption related to Agent Orange exposure.
Subsequent Actions
On June 23, 2008, the attorneys
for Haas filed a petition with the U.S. Court of Appeals for the Federal
Circuit (the "court") for a Panel Rehearing or a Rehearing En Banc
(that is, the whole panel of judges of the court). The court may grant or deny the petition. If granted, the
court may have a rehearing of the case. If denied, the court will not rehear
the case.
Following a final decision of the
court, either the veteran or the VA may petition the U.S. Supreme
Court for certiorari within 90 days of the court's final action. In the present case, there does not appear to be an
immediate judicial resolution of the issues, and a decision of the court may be
appealed to the U.S. Supreme Court. However, it is possible that congressional
legislative activity, in the meantime, may render moot the judicial issues;
that is, congressional legislative actions may resolve the legal issues in
controversy.
Proposed Legislation to Clarify
Service in Vietnam
Representative Filner, the
Chairman of the House Veterans' Affairs Committee, has introduced the Agent
Orange Equity Act of 2008 (H.R. 6562). This legislation, if enacted, would clarify service in Vietnam to include inland waterways, waters
offshore, and airspace above Vietnam.
In addition, Senator Akaka, the
Chairman of the Senate Veterans' Affairs Committee, introduced the Agent Orange
Compensation Act (S. 2026) for consideration at the request of the
Administration. If enacted, this legislation would clarify that the
presumption of herbicide exposure applies only to veterans who served in Vietnam on land or on Vietnam's inland waterways and not
to those who served only in waters offshore or in airspace above.
Epidemiologic Research on Vietnam Veterans
Because of the controversy
surrounding the use of herbicides in Vietnam, significant research on
the health effects of Agent Orange and dioxin exposure has occurred over the
last 30 years. The majority of studies have focused on morbidity and mortality
of Vietnam veterans and are conducted by the VA, the Centers for Disease Control and
Prevention (CDC), the U.S. Air Force, and the various veteran service
organizations (VSOs). Despite the abundance of research completed,
epidemiologic studies on Agent Orange are historically burdened by the lack of
reliable exposure data. The lack of accurate data remains a continued source of
frustration for researchers, government officials, and Vietnam-era veterans
seeking conclusive information on the health risks of exposure to Agent Orange.
Below is a brief description of epidemiologic research conducted by the various
agencies.
Centers for Disease Control and
Prevention
In 1979, the VA was authorized to
conduct an epidemiologic study to determine the association between Agent
Orange and the medical concerns of Vietnam-era veterans. In carrying out the
congressional mandate, the VA was faced with substantial challenges in
determining study design and research protocol, and in 1982, responsibility for
the research was transferred from the VA to the CDC. The CDC also faced its own
obstacles in research design and were delayed by the lack of exposure data. In
response to the difficulty in obtaining exposure data, the CDC attempted an
Agent Orange Validation Study to see if indirect estimates of exposure from
military records and self-reports could be compared to dioxin serum levels in
veterans as a method of determining true exposure. After investigation, the CDC
reported that military records and self-reports obtained from the Agent Orange
Validation Study were inadequate for identifying the exposed individuals
necessary for a large epidemiologic study of dioxin effects. Secondary to the
problems faced by the VA and the CDC, a group of government panels and advisory
boards determined that the congressionally mandated Agent Orange Study was
improbable, and the CDC investigation ended.
Air Force Health Study (AFHS)
Operation Ranch Hand was
responsible for spraying herbicides in Vietnam between 1962 and 1971. In
1982, Air Force investigators began a study investigating the long-term health
problems of pilots and ground crews engaged in spraying herbicides in Vietnam. The
study cohort consisted of more than 1,200 Ranch Hand veterans and more than
19,000 comparison Air Force veterans who did not spray herbicides. AFHS data
collected between 1979 and 1993 revealed no statistically significant differences
between the Ranch Hand personnel and the comparison cohort both for all-cause
mortality and for cause-specific mortality. The exception was an increased
mortality rate for circulatory diseases seen in enlisted ground crew personnel,
a group at higher risk for skin exposure to herbicides. In 2005, an AFHS update
reviewing 20 years of epidemiologic data on mortality rates reported a small,
but significant, increase in all-cause death rates for Ranch Hand veterans.
This was the first published research to find a statistically significant
increase in the relative risk for all-cause mortality among Ranch Hand
veterans. After 20 years of analysis, data collection, and review, a
recent IOM publication indicated that diabetes presented as the most serious
health problem observed in the AFHS. Type II diabetes was added to the list of
service-connected diseases for Vietnam veterans exposed to Agent Orange in 2001. The long-standing AFHS ended on September 30, 2006.
Section 714 of the John Warner
National Defense Authorization Act, 2007 (P.L. 109-364), requires the Secretary of the Air Force
to transfer custody of the AFHS data to the IOM. This decision to retain the
AFHS materials was based on the scientific merit of maintaining herbicide
exposure records as a valuable source of medical and epidemiologic data as
recommended by the IOM study. Furthermore, P.L. 109-364 required the Secretary of Defense to make
$850,000 available to the Air Force in preparation for the transfer of study
data to the IOM. An additional $200,000 was to be reimbursed from the DOD to
the IOM for costs related to the transfer of study materials from the Air
Force. Under this provision, the Air Force is required to submit
a report on the transfer to the Armed Services Committees of Congress.
Footnotes
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1.
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U.S. General Accounting Office, Ground Troops in South Vietnam were
in Areas Sprayed with Herbicide Orange, GAO 80-23, November 1979,
p. 1.
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2.
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The term "service-connected"
means, with respect to disability, that such disability was incurred or
aggravated in the line of duty in the active military, naval, or air service.
VA determines whether veterans have service-connected disabilities, and for
those with such disabilities, assigns ratings from 0% to 100% based on the
severity of the disability. Percentages are assigned in increments of 10%.
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3.
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"Limited/suggestive" evidence of
no association is when several adequate studies, covering the full range of
levels of exposure that human beings are known to encounter, are consistent
in not showing a positive association between any magnitude of exposure to
herbicides and the outcome of disease.
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4.
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For detailed information on eligibility for
VA health care, see CRS Report RL34598, Veterans Medical Care: FY2009 Appropriations,
by Sidath Viranga Panangala.
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5.
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This comprehensive review by the IOM has
been repeated at least every two years since 1994 and is authorized to
continue until October 2014. Veterans
and Agent Orange weighs the strengths and limitations of the
complete body of epidemiologic evidence on herbicide exposure and
manifestation of certain health outcomes. This review then assigns the
investigated medical conditions to one of four categories ranging from
"sufficient evidence of an association" to "limited or
suggestive evidence of no association." For example, in the 2006 Veterans and Agent Orange
update, this information is available in Table S-1. The latest update was
compiled in 2006 and released in July 2007, at http://www.nap.edu/.
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6.
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38.C.F.R. §3.309(e). In 2003, based on 2002
update of the IOM report Veterans
and Agent Orange, the VA issued regulation designating chronic
lymphocytic leukemia ("CLL") and other medical conditions as
diseases associated with dioxin. CLL was therefore to be considered
"service connected." However, the VA did not re-adjudicate prior
claims for CLL, nor did it pay retroactive benefits, arguing that
compensation was not applicable to diseases determined to be
service-connected after September 20, 2002, the original sunset date of the
Agent Orange Act of 1991. Following extensive litigation, the U.S. Court of
Appeals for the Ninth Circuit (Nehmer
v. VA, 494 F.3d 846 (9th Cir. Cal. 2007)) affirmed the district
court decision (Nehmer v.
VA, 32 F.Supp. 2d 1175 (N.D. Cal. 1999)) and, in effect,
confirmed that the VA was obligated to pay disability benefits to all
"Agent Orange" veterans with CLL, including those diagnosed after
September 20, 2002.
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7.
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38 C.F.R. §3.815. For detailed information
on eligibility for disability compensation, see CRS Report RL33113, Veterans Affairs: Basic Eligibility for Disability
Benefit Programs, by Douglas Reid Weimer.
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8.
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U.S. Department of
Veterans Affairs, "Health Outcomes Not Associated With Exposure to
Certain Herbicide Agents." Federal
Register, vol. 72, no.112 (June 12, 2007), pp 32395-32407.
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9.
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There were a total of 439,849 initial
examinations, and 50,487 follow-up examinations.
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10.
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Service in the Republic of Vietnamincludes service in the
waters offshore and services in other locations if conditions of service
involved duty or visitation in the Republic of Vietnam. 38 C.F.R.
§3.313(a); 38 C.F.R. 3.307(a)(6)(iii).
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11.
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If a veteran did not serve in the Republic
of Vietnam, but was exposed to an herbicide agent defined in 38 CFR
3.307(a)(6) during active military service, has a disease on the list of
diseases subject to presumptive service-connection, VA will presume that the disease
is due to the exposure to herbicides. Additional information on benefits and
compensation for veterans exposed to Agent Orange is available at the U.S.
Department of Veterans Affairs, "VA's Guide on Agent Orange Claims,
Compensation and Pension Service," updated April 27, 2004, pp. 1-7, at http://www.vba.va.gov/bln/21/Benefits/Herbicide/AOno3.htm.
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12.
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http://www1.va.gov/agentorange/docs/Report_on_DoD_Herbicides_Outside_of_Vietnam.pdf.
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13.
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P.L. 108-183, among other the bills, contained
provisions from H.R. 2297 (H.Rept. 108-211) and S. 1132 (S.Rept. 108-169).
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14.
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This applies to all forms and
manifestations of spina bifida, except spina bifida occulta.
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15.
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38 U.S.C. §1821.
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16.
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525 F.3d 1168 (Fed. Cir. 2008).
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17.
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20 Vet. App. 257 (2006). Jonathan L. Haas
was a member of the U.S. Navy Reserve components that served in the waters
off Vietnam and received the Vietnam Service Medal (VSM). He claimed that his diabetes
mellitus and resulting medical complications were related to his exposure to
Agent Orange that drifted offshore, and filed a disability claim with the VA.
VA denied the claim on the grounds that servicemembers had to have actually
set foot on Vietnamese soil in order to be eligible for benefits.
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18.
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For further information on the CAVC, CRS
Report RS22561, Veterans Affairs: The U.S. Court of Appeals for Veterans
Claims—Judicial Review of VA Decision Making, by Douglas Reid
Weimer.
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19.
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U.S. Court of Appeals
for Veterans Claims (CAVC), 20 Vet. App. 257 (2006).
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20.
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The M21-1 is an internal manual used to
provide guidance to VA benefit adjudicators on procedures for adjudicating
claims for compensation, pension, dependency and indemnity compensation,
accrued benefits, and burial allowance.
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21.
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The VSM was awarded to all members of the
Armed Forces who served between July 3, 1965, and March 28, 1973, either (1)
in Vietnamand contiguous
waters and airspace thereover, or (2) in Thailand,
Laos, or Cambodia, or airspace thereover, in direct
support of operations in Vietnam.
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22.
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5 U.S.C. §706(2)(A).
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23.
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For further details on the BVA, see CRS
Report RL33704, Veterans Affairs: The Appeal Process for Veterans'
Claims, by Douglas Reid Weimer.
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24.
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Department of Veterans Affairs,
"Rescission of Manual M21-1 Provisions Related To Exposure to Herbicides
Based on Receipt of the Vietnam Service Medal," Federal
Register, vol. 72, no 227 (November 27, 2007), pp. 66218-66219.
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25.
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Haas v. Peake, 525 F.3d 1168
(Fed. Cir. 2008).
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26.
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No. 2007-7037.
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27.
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In this case, the final decision may be a
decision based upon the merits of the case following the grant of a motion
for rehearing or the denial of the petition for rehearing.
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28.
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38 U.S.C. § 7292(c)). A petition for
certiorari is a request for the Supreme Court to review the decision of the
lower court. If the petition is granted, the Supreme Court will review the
case.
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29.
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The bill was introduced on July 22, 2008,
and was referred to the House Committee on Veterans' Affairs on that date.
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30.
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The bill was introduced on September 6,
2007, and was referred to the Committee on Veterans' affairs on that date.
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31.
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The government panel and advisory groups
included the CDC advisory group, the Science Panel of the Domestic Policy
Council's Agent Orange Working Group, and the Agent Orange Advisory Panel of
the Congressional Office of Technology Assessment.
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32.
|
Norma Ketchum and Joel Michalek,
"Postservice Mortality of Air Force Veterans Occupationally Exposed to
Herbicides During the Vietnam War: 20-year follow-up results," Military Medicine, vol.
170, no. 5 (May 2005), pp. 406-413.
|
|
33.
|
National Academies, Instituteof Medicine,
Disposition of the Air
Force Health Study, 2006, p. 55.
|
|
34.
|
Ibid., p. 4.
|
|
35.
|
U.S. Congress, Conference Committees, National Defense Authorization Act
for Fiscal Year 2007, a report to accompany H.R. 5122, 109th Congress, 2nd sess., H.Rept. 109-702. Congressional
Record, daily edition, vol. 152 (September 29, 2006), pp.
H8061-H8536.
|
|
