Waiting for an Army to Die

by Fred A. Wilcox

  Advising VA health personnel to approach Agent Orange complaints with extreme caution, the memo explains: “If the veteran has no objective symptoms or signs, simple reassurance should be offered. The veteran should be told that a record of the medical examination will be kept for future reference, but that if the veteran does not now have symptoms and did not previously experience any, the likelihood of herbicide poisoning is virtually zero.” It does not explain why veterans would visit VA outpatient clinics to complain about symptoms they either did not have or had not “previously experienced.”[10] But it does warn VA staff not to make any entries in a patient’s file that might indicate a relationship between an illness and defoliant exposure “unless unequivocal confirmation of such a connection has been established.”

  While publicly stating that it could not make a decision in favor of the veterans’ claims for disability, the VA had obviously come to the private conclusion that laboratory research showing dioxin to be carcinogenic, teratogenic, and fetotoxic could be dismissed by a bureaucratic edict. This particular memo is also important because it formulated just one of the many Catch-22s that would frustrate the efforts of veterans to secure disability payments. An entry into the patient’s file could not be made without “unequivocal confirmation” that the veteran’s illness was related to herbicide exposure. But according to a General Accounting Office report, “VA regional offices have been instructed to send copies of completed ratings of herbicide-related claims to headquarters for review. In addition, regional offices have been instructed to request information from a veteran’s service record to verify herbicide exposure. However, service records normally do not contain specific information on chemical exposure. As a result, responses to such questions are neither verified nor denied by military service record personnel.”4

  In order to substantiate their claims for disability, veterans were asked by the VA to produce information that did not exist.[11] It is difficult to imagine that the VA was unaware that the Department of Defense, whose records would presumably “verify” the veterans’ exposure to herbicides, had already stated that: “(1) no such personnel records were maintained, (2) it would be difficult to estimate meaningful exposure data because the potential for exposure varied widely among personnel, and (3) only a few military personnel would have been exposed directly to spraying.”5

  While VA health personnel were informed that the human body could “rapidly absorb” and “completely excrete” the herbicides, Max Cleland encouraged veterans to visit outpatient clinics for a “clinical evaluation.” These evaluations, said Cleland, would provide that basis for discovering any “unusual” health problems among Vietnam veterans. What Cleland did not say, of course, was that no matter how “unusual,” the illnesses would be treated by VA health personnel as having little or nothing to do with the massive defoliation of South Vietnam.

  In his attempts to justify the VA’s policy on Agent Orange, Cleland often referred to his agency’s “Agent Orange Program Guide,” a seven-paragraph, one-page “no health effects” document that set down the official line for denying all disability claims. The “guide’s” brevity, however, was not the only reason why veterans and their supporters rejected it as a scam sheet and hype. Demonstrating once again its predilection for cloak-and-dagger politics, the VA had drafted the document “in secret and without the participation of other government officials knowledgeable about the scientific evidence.”6

  Before long the VA faced yet another lawsuit, this time on behalf of veterans who might have been, or would be, affected by the program guide—perhaps several hundred thousand. The VA then astonished the legal observers by declaring that veterans had “no standing” to “challenge the agency’s refusal to conduct rulemaking.”7 Lawyers representing the veterans noted that the VA made “the rather incredible argument that Vietnam veterans have not been sufficiently injured by the rule to challenge the fact that public rulemaking was not conducted before the rule was adopted and used… The agency takes the extraordinary position that it has the discretion, unlike any other federal agency, to decide whether it would comply with its own regulations at 38 C.F.R.S1.12 which require the agency to conduct rulemaking… Confronting this lawless position compels the obvious remark that such a view leads to a government of men, not law.”8

  To a nation that has accepted, albeit with anger and frustration, the idea that bureaucracies are cumbersome and unreliable, the VA’s resolute stalling might not seem so extraordinary. Moreover, if one accepts the idea that bureaucracies are inherently incompetent, the fact that the VA took “only” twelve months to open its meeting to the public might be interpreted as a kind of miracle. But with its response to the Environmental Protection Agency’s ban on domestic use of 2,4,5-T, the VA demonstrated that even top-heavy bureaucracies can move swiftly when they wish to. Taking only seven days to review the EPA’s decade of research, the VA announced that the studies on which the EPA’s ban was based did not “offer definitive evidence for an adverse effect of herbicides on human health.” But when asked through a Freedom of Information Act request to provide scientific evidence supporting the VA critique, officials said that no documents were available.

  During the year following the EPA’s order, neither the VA’s Agent Orange Steering Committee nor its Agent Orange Advisory Committee discussed the matter further. When the VA held two “educational conferences” on Agent Orange for its hospital staff, representatives from the EPA were not invited. Requested by Congressman David E. Bonior (D-Mich.) and Thomas A. Daschle (D-S.D.) to consider the importance of five newly discovered human epidemiology studies on workers and others exposed to dioxin, studies the EPA had spent a great deal of time and money to evaluate, the VA again responded with astonishing speed that the studies were not persuasive enough to encourage the VA to any further action.

  While the VA argued that the suspension order was “premature” and continued to promulgate its policy of “no health effects” from Agent Orange, Cleland’s public statements were based in part on a 1974 study of herbicide use in Vietnam by the National Academy of Sciences. But in his zealous use of the NAS report Cleland seemed unaware that the academy’s president, Dr. Philip Handler, did not share his absolute certainty that Agent Orange was harmless. Testifying before the Subcommittee on Medical Facilities and Benefits of the Committee on Veterans’ Affairs, Dr. Handler said: “At the time the NAS report was issued, I foresaw the serious implications of dioxin on human health. In a letter to Secretary of State Henry Kissinger, I noted: ‘… The hazard could well be serious and indeed is so regarded by knowledgeable individuals in this country as well as in Southeast Asia …’ Many of these issues are more sharply focused today.”9

  Dr. Handler also told the committee that the “perhaps limited data collected by the NAS committee failed to indicate direct damage by herbicides to human health.” However, there were consistent, although “mostly secondhand,” reports from certain areas of acute and occasionally fatal respiratory distress, particularly in children. There were also reports of “severe irritation to the eyes and skin, as well as digestive disturbances. However, no independent medical studies of exposed populations were available from the time of spraying, to confirm or deny these reports.”10

  One rather serious methodological limitation of the NAS study was that in 1974 the war in Vietnam was still raging, and considerable portions of the country were in the hands of the Viet Cong and North Vietnamese. Visiting scientists could not have expected to find archives filled with scientific information on the effects of massive defoliation on Vietnamese peasants and US military personnel. Vietnamese doctors, farmers, and mothers had been complaining about the suffering caused by the defoliation campaign for many years, but their complaints had been dismissed by American officials as enemy propaganda. Defoliation, according to Pentagon and government spokesmen, was taking place in only in areas “remote” from population centers, and neither American soldiers nor Vietnamese peasants were being exposed to
the deadly rain for herbicides.

  However, in Chemical and Biological Warfare, Seymour M. Hersh writes: “A 1967 Japanese study of US anti-crop defoliation methods, prepared by Yoichi Fukushima, head of the Agronomy section of the Japan Science Council, claimed that US anti-crop attacks have ruined more than 3.8 million acres of arable land in South Vietnam and resulted in the deaths of nearly i,000 peasants and more than 13,000 livestock. Fukushima said one village was attacked more than thirty times by C-123 crop dusters spraying agents more caustic then the arsenic-laden cacodylic acid.”11

  It is not clear whether a Japanese study of US anti-crop and defoliation methods would qualify as “independent” verification of what Dr. Handler had called “secondhand” reports; however, Dr. Handler did inform Congress that the NAS Committee “did not study or review the effects of herbicides on US military personnel who served in South Vietnam, nor had any reason to do so been called to our attention.”

  In the process of reading and rereading transcripts of testimony by Veterans Administration and Department of Defense officials before congressional committees and subcommittees, one begins to feel the presence of a bureaucratic Dr. Jekyll and Mr. Hyde. At the hearings Dr. Jekyll is the epitome of bureaucratic finesse, his statements sensible, reassuring, supportive of veterans, and often promising. On May 6, 1981, for example, Dr. William J. Jacoby Jr., deputy chief medical director, Department of Medicine and Surgery, Veterans Administration, told a congressional hearing: “Mr. Chairman, I wish to state at the very outset that from the time this issue first began to emerge, the VA has taken a leading role in the government’s efforts to keep abreast of the problem. It is largely because of this visible, and therefore perhaps vulnerable, position that the VA has at times come under heavy criticism. I would submit, however, that despite perceptions to the contrary, this agency has remained faithful to its primary mission as the true advocate of the veteran. Within the body of law that governs its operations, the VA has made every effort and has embarked on a series of bold initiatives in an attempt to respond to the many and varied concerns of our Vietnam veteran beneficiaries as they related to the issue of Agent Orange.

  “Further, we are firmly committed to the policy that all veterans reporting for examination and participation in our Agent Orange Registry will be treated with dignity and respect to which they are entitled. Every effort is made to ensure that from the time the veteran first enters a VA facility, to the conclusion of the physical examination, the experience is one which responds to medical or other needs in a compassionate manner.”12

  As ludicrous as Dr. Jacoby’s testimony must sound to many veterans, it is conceivable that the VA’s Washington headquarters issued orders to treat Vietnam veterans with “dignity” and “compassion,” and the regional staff were simply choosing to disobey. Might it have been possible that Dr. Jekyll just did not know what Mr. Hyde was doing outside congressional hearing rooms and the VA’s bureaucratic fortress?

  But this theory is easily disproven by the administrator’s many policy statements—which, if followed by regional hospitals, would contravene any public declaration of his agency’s good intentions. Why would the regional staff bother to find out anything about the effects of Agent Orange on human health if Washington’s policy was to dismiss such complaints as unfounded? And how, after receiving the memo cited earlier, could anyone expect doctors and administrators to treat veterans with dignity and respect? One does not advise health personnel to consider their patients’ complaints as groundless and then expect those same doctors, nurses, and physician’s assistants to behave compassionately.

  One of the most absurd arguments the VA uses to rationalize its behavior on the Agent Orange issue is that it has been unable to locate a “study population” that could provide “scientific verification” of veterans’ claims. The fact that a “study population” has been filing for disability, demanding medical care, lobbying the government, testifying at hearings, forming organizations and coalitions, and all too frequently, dying from cancer, seems to have escaped the VA. Had the agency really been interested in locating a “study population,” it might have held public hearings similar to those sponsored by the New York State Temporary Commission on Dioxin Exposure. At these hearings VA officials would hear grunts testify that they entered spray zones not six weeks after a defoliation mission, but on the very day of the spraying; that while guarding a base camp perimeter or on patrol they were soaked in herbicides jettisoned from C-123; and that since their return home they had been beset by a host of debilitating ailments. And the VA’s “no health effects” nonsense would be challenged by the sight of men who, when asked to give their ages, appear ten, fifteen, even twenty years older. These prematurely aged men tell a story that the VA has not wanted to hear. For example, one former combat infantryman told New York’s commission about assaulting a hill just seventy-two hours after it had been sprayed: “In October of 1968,” he testified, “we saw helicopters spraying intermittently in the valley in front of us. There were hills among us. Three days later we assaulted the hill before an artillery barrage hit it, and they napalmed it also. We assaulted the hill, and that night we slept on the ground, ponchos just covering us. At the time we saw the spraying, we thought it was nerve gas. We had no idea it was Agent Orange. No one had told us. That same night we also had to fight on that hill.

  “In December 1968 a hill, a ridge, was sprayed by helicopters. Again, we thought it was nerve gas. And Phantom jets strafed the hill with napalm, causing gas and a lot of smoke. I’m told now—I didn’t understand it then—that this causes more dioxin to be present.

  “I sweat all the time, my hands and feet. My joints are always sore. I have chronic diarrhea. In general, I consider myself a physical wreck. And I am thirty-three years old. I feel like I am sixty years old.”13

  Had they been willing to listen, VA officials would have heard a former aircraft crew chief announce: “I am compelled to testify because I probably won’t be alive for the next meeting of the Commission.

  “I was exposed approximately twenty to thirty times of flying through the mists… There was heavy defoliation in that area for a whole month. We were getting mists practically every day, coming into the compound. I had no health problems prior to my service time, and I was healthy up until six years after I left the army. In 1975 I suddenly became ill, and I went to see doctors. I had $12,000 in medical expenses. I spent all my savings…

  “No diagnosis was ever reached. I was forced to go to the VA for help. I stayed in the VA hospital for two and a half months. The doctors told me it was my gall bladder and I should have an operation.

  “I went through an exploratory laparotomy, in which they removed my gall bladder, they removed part of my spleen, and they also removed my appendix.

  “They had told me that if I underwent this operation, I would be okay. After the operation I was sicker than before, and the doctor, my surgeon, came and told me after the operation that my liver didn’t look so good. He couldn’t tell me at that time what it was.

  “When a biopsy came back, it came back as nonspecific hepatitis. I asked the doctor what that meant. He told me, that means you have a liver disease, that nobody knows what it is.

  “Between 1975 and the present time I have been over three and a half years in the VA hospital in Brooklyn. I get terrible pains in my right-hand side. I have lost over fifty pounds. I get nausea, vomiting; I can’t keep anything down.

  “In 1978 I also developed chronic idiocrasy and pancreatitis. I am getting worse and worse, and the VA cannot figure out what to do.

  “Now they tell me I have priority treatment. Priority treatment doesn’t mean anything to me because medical science doesn’t even know how to deal with my illness, an illness that’s never been seen before. But it’s not so unusual to me because all the years that I spent in the hospital, there have been other Vietnam veterans who have liver diseases that are also undiagnosable. They are unable to come here today because they are too
sick to even get out of bed.

  “So I think that we need medical help, but I would also like to stress the fact that these poisons that were dealt out in Vietnam, they have created diseases that medical science cannot even deal with today. There is no treatment for me. There is medicine that can only relieve my pain and try to help my symptoms, but there is no treatment that is going to help me get well. I am going to continue to deteriorate until I die.”14

  And the Veterans Administration or congressional committees would have heard Vietnam veterans and their wives testify that their treatment at VA hospitals had been anything but dignified and compassionate. They would have heard that following cursory physicals, which veterans had been led to believe were “comprehensive Agent Orange examinations,” they had waited weeks, even months, for the “results,” only to be informed the problem was “all in their head” and to be given a public relations packet that, said one veteran, “told you Agent Orange had saved your life so don’t worry about it.” VA officials would have heard a veteran testify that, unable to treat a fungus-like growth on his scrotum with over-the-counter remedies, he had visited the VA clinic, where a doctor ordered him to “drop his pants” and, without administering even a local anesthetic and using an unsterilized scalpel, proceeded to remove the fungus “as though he were scaling a fish.” The VA hierarchy would have heard, as I did at New York State’s public hearing on dioxin exposure, seemingly endless stories of abuse, neglect, incompetence, arrogance, faulty diagnosis, altered records, and ordinary stupidity.

  But perhaps the most disturbing thing these officials would have heard was that as the number of Vietnam veterans applying for disability increased, regional VA hospitals frequently resorted to a strategy perfected by totalitarian governments to silence dissidents. The dissident, in this case, is a veteran asking to be examined for bladder or liver cancer, who instead is given a psychiatric examination. Dissent is the desire to be seen as a rational human being with a genuine, urgent medical problem, rather than as a traumatized guerrilla fighter whose problem is postwar confusion. Had the VA been willing to listen, its medical staff would have heard veterans expressing their outrage at being treated as children, neurotics, and con artists.