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United States. Congress. House. Committee on Veter.

Viewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 online

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new population of female veterans. Physicians and
emergency department staff, in particular, will need to
be educated in gender specific health care. Special
programs for the homeless and victims of violence
should be established. Women live longer than men, are
more likely to be alone in later years and will require
home health care and nursing home facilities. Adult
Day Care facilities would help to address the needs of



51



the increasing nvimbers of both the elderly and the
homeless. This would also be a cost saving measure by
providing health promotion and health screening in the
Day Care that would help to prevent more costly
hospitalizations .

Above all, the veteran will need evidence that the
VA hospital will be a better, more comfortable, more
caring place to go than the private facility down the
block. That will mean renovation, additional nurses and
intensive campaigns to improve the attitudes of
physicians and staff toward their customers.

The Veterans Health Administration of the future
will be a national resource during national emergencies
for care, post-traumatic stress counseling and disaster
relief. And, at the same time, will continue to be the
potential source of wartime casualty care, essential to
the defense of our nation. The narrow perspective of
the VHA as just another provider in a community of
providers should not obscure the big picture of the VHA
as a national resource.

References

Becraft, C. (1991) . Woman In the U.S. armad Barvlcas:
The war in the Persian Oul£. Washington, DC:
Women's Research and Education Institute.

Gallup, J., Gores, F.A. & Bowman, K.M. (1994). Hospice
Care: Its time has come. VA Practitioner, 11(4),
54-57a) .

Headley, E.J., Fox, T. & Morrow, T.A. (1994). VA and
national health care reform. VA Practitioner,

11(4), 31-37.



52



Leda, C, Rosenheck, R. & Gallup, P. (1992). Mental
Illness among female veterans . Hospital emd
Community Psychiatry, 43(10), 1026-1028.

Mathews, J. (1992) . Female veterans seek answers:

Vietnam cancer risks in question. Journal of the
National Cancer Institute, 84(19), 1462-3.

Plichta, S. (1992). The effects of woman abuse on
health care utilization and health status: A
literature review. Women's Health, 2(3), 154-162.

Romeis, J.C, Gillespie, K.N. & Thorman, K.E. (1988).
Female veterans' use of health care services.
Medical Care, 26(6), 589-595.

Tierney, H. (Ed.). (1991). Women's studies

encyclopedia: Volxune X, Views from the sciences.
New York: Peter Bedrick Books.

Turpin, R.S., Darcy, L.A. , Weaver, F.M. & Kruse, K.
(1992) . Assessing health care delivery to male
versus female veterans. Women fc Health, 18(1),
81-95.

Utilization of American military women in Operation

Desert Shield and Desert Storm, Auoust 2, 1990 to
April 11, 1991. (1991) Washington, DC: Department
of Defense.



53




^^■■^Hrn For release :

B"l.lflHI May 4, 1994

175FifthAvetl808
New York.NY 10010
(212) 777-3470

Statement of Tod Ensign , Director of Citizen Soldier be-
fore the House Veterans Affairs Subcomniittee on Oversight
and Investigation, May 4, 1994, Washington, D.C.

Mr. Chairman, it's a privilege to testify before your sub-
committee today. Citizen Soldier was organized in the midst of
the Vietnam war to advocate for veterans. Unlike most veterans
groups at the time we opposed the Vietnam war and called for the
immediate withdrawl of our troops.

At the same time, we advocated for VA healthcare and disabili-
ty compensation for ailing veterans. For instance, we raised the
issue that large numbers of Vietnam vets were suffering from post-
traumatic stress disorder years before the VA finally established
special programs for these veterans.

I will use my few minutes today to highlight special problems
which continue to plague atomic veterans and Agent Orange vets
and to urge this committee to take corrective action. While
some progress has been made, much more must be done if these two
groups are going to receive the assistance they deserve.

Atomic veterans Since new disclosures were made about human
radiation experiments last November 1993, atomic vets have been
hopeful that long-classified reports and documents about their
exposure to radiation would finally see the light of day.

While the Department of Energy seems to be making an honest
effort to locate and release secret data on radiation experiments,
I don't believe that the Department of Defense nor the Department
of Veterans Affairs are making a comparable effort. For example,
a recent newsletter of the National Association of Atomic Veterans
contains a detailed account by a Navy officer who, along with
seven other "volunteers" witnessed the detonation of a 55 kilo-
ton bomb (three times the Hiroshima bomb) just a mile from ground
zero. My research has convinced me that there were many such
experiments using GIs as "volunteers" during America's 200+
atmospheric bomb tests. I urge this committee to take a strong
public position in support of releasing all data on these tests.

Although Congress adopted legislation to make it easier for
some of our 205,000 atomic veterans obtain disability awards,
the DVA's handling of their claims is a scandal. It has
approved 1,401 claims out of a total of 15,369 that were filed
by January 1994. One barrier many claimants face is obtaining

accurate information about the levels of radiation to which they
were exposed. The DVA relies heavily on dose-construction pre-
pared by Science Applications International, a private contractor.

I would urge this committee to conduct oversight hearings
on the activities of this contractor. Its work product bears
directly on the fact that fewer than one in ten atomic veterans
has been able to win a disability claim from the DVA. Inciden-
tally, SAI has been paid over $1.5 billion to date for these
radiation estimates; far in excess of what atomic vets
have received as compensation!

This committee would be performing a great public service by
probing that whole issue of radiation exposure records. I recall
a New York Times story (2/8/1982) which published an account of
a former Array medic. Van R. Brandon of Sacramento, CA that his
unit kept two sets of books on radiation readings during the
1956-57 tests. "One set was to show that no one received an



54



(elevated) exposure," Brandon stated. "The other set of books
showed... the actual reading. That set was brought in a locked
briefcase every morning," he recalled.

If the DVA is going to base its disability decisions in part
on veterans' radiation exposure, then this committee has a duty
to insure that that data is as accurate and complete as possible.

Finally, I urge this subcommittee to investigate the circum-
stances surrounding the appointment of Kenneth R. Feinberg, Esq.,
to the White House Advisory Committee on Human Radiation Experi-
ments. I believe that once you have examined Mr. Feinberg 's
history you will join Citizen Soldier and other veteran groups
in calling for his removal from this panel.

The only attorney on the committee, Feinberg is widely
reviled by Vietnam veterans for his role, as federal judge Jack
Weinstein's emissary, in pressuring an eleventh-hour settlement
of the Agent Orange class action lawsuit for $180 million in 1984.
Although he played no part in preparing the six year old litiga-
tion for trial, he received an enormous legal fee for his role
in securing a settlement.

Veterans are asking why the White House would chose Feinberg
to sit on a panel which will be asked to make important decisions
about which groups of radiation exposure victims should be con-
sidered for compensation. Given his history, there is a deep
suspicion that he has been placed on the panel so that, once
again, he can minimize the assistance provided to ailing veterans.

Feinberg is not an expert on radiation effects: he's an
expert at settling lawsuits for a penny on the dollar. It's
appointments like these that reinforce the cynicism and distrust
of so many of our military veterans!

Agent Orange As I noted, these vets were left with a pittance
when the class action suit against the manufacturers was settled
behind their backs in 1984. In February, the US Supreme Court
refused to hear an appeal of judge Weinstein's ruling that veterans
who developed injuries after 1984 cannot sue the manufacturers,
even in state courts. The attorney generals of all fifty states
filed an amicus brief in support of this appeal.

I believe that it's significant that only when a scientific
task force appointed by the National Academy of Science published
a major report last July 1993 finding "significant associations"
between Agent Orange exposure and certain cancers, did the DVA
finally agree to recognized several cancers as "service-connected."
While the maxim "better late than never" applies here, I would
urge this committee to closely monitor how the DVA actually
processes Agent Orange claims in the future.

In November, 1993, I attended the Second International
Symposium on the Human Health Effects of Herbicides in Hanoi,
Vietnam. The Vietnamese scientists who participated expressed a
strong desire to work cooperatively with American researchers
to study the long-term health effects of Agent Orange on citizens
of both countries. Now that President Clinton has ended the
economic embargo of Vietnam, I would urge you to take an active
part in encouraging and funding research that will benefit
veterans in both countries.

Independent scientists such as Drs. Jeanne and Steven Stellman,
who co-authored the American Legion Study, have continued to
urge Congress to support new studies which focus on the most
highly-exposed veterans. They also argue that the CDC's original
idea to organize veteran groupings by their level of exposure
is sound and deserves to be revived and implemented.

This panel has a special responsibility to serve as an advo-
cate for ailing veterans. The past seventeen years have taught
us that powerful interests are arrayed in defense of the status
quo. You must serve as the uncorruptible advocate for these
deserving men and women. Thank you.

Ensign, an attorney, is co-author of G.I. Guinea Pigs : How
the Pentagon Exposed Our Troops to Dangers More Deadly Than War
Playboy Press (1980) and author of Military Life : The Insider's
Guide , Arco/Simon & Schuster (1990) He has written on these
issues for numerous magazines and newspapers, including forth-
coming articles in Covert Action and The Progressive .



55



TESTIMONY OF



THE VIETNAM VETERANS HEALTH INITIATIVE COMMISSION
PRESENTED BY DWIGKT D. EDWARDS, EXECUTIVE DIRECTOR (WHIC)
MAT 4, 1994
US HOUSE Or REPRESENTATIVES
■ COMMITTEE ON VETERANS' AFFAIRS

I would like to make three recoounendations with the time I have
allotted. They are as follows: 1) Implement sensitivity
training for prospective residents and interns at VA facilities
prior to their being allowed to see patients. 2} Include
provision of medical exans at rural and urban vet center
locations. 3) Provide information to non-VA health care
professionals re: Desert Storm Illness.

The Vietnam Health Initiative Commission was created by Act 67
19S7 in the PA General Assembly. The Commission was established
as the result of the ongoing issues and concerns Pennsylvania
Vietnam veterans had relative to health risks associated with
their service. The Commission was mandated to 1) design and
implement an ongoing continuing education program for health
care professionals regarding the adverse health effects of
Vietnam service; 2) conduct outreach to bring Vietnam veterans
into treatment mainstream and 3) conduct research with regard to
the impact of the Vietnam War on PA veterans.

The Research Triangle study of 1988 indicated a majority of
Vietnam veterans had not sought treatment from VA for their
health concerns. The Triangle study also determined Vietnam
vets were seeking treatment from private or other public health
care facilities. The Commission, through hearings, determined
that physicians and other health care professionals had limited
knowledge of the psychological, physiological impact of the
Vietnam war on its veterans. The three aforementioned factors
led us to develop a two-phased educational effort.



56



The 1st phase was the development of a booklet entitled The
Vietnam Experience. This instrument serves as a guide for
diagnosis and treatment of diseases associated with Vietnam
service. The booklet also serves as a resource guide of US
Department of Veterans Affairs and other veterans' services in
the Commonwealth. This booklet has been disseminated to
physicians and other health care professionals in the
Commonwealth with the assistance of the PA Medical Society. The
booklet is nationally recognized and has been requested by
health care professionals and concerned others internationally.
A copy of the booklet is included.

The second phase of our effort was the implementation of a series
of seminars regarding the adverse health effects of Vietnam
service. These programs are presented regionally to health care
professionals throughout the Commonwealth. Eight of these
seminars will be conducted by June of 1994. The seminars, to
date, have been evaluated as excellent for content, and intent.

The seminars have also served to establish a dialogue between
veterans, health care professionals, and governmental agencies.
It was this dialogue which encouraged several health care
professionals to indicate they received part of their medical
training at VA facilities. They further stated they had little
concern for those they treated. These individuals indicated
their only concern was learning to properly provide mechanical
and other medical services such as injections, X.V.s, etc.
It is with great dismay, I report this, because these attitudes
may be persuasive in interns and residents. These Individuals
indicated their classmates felt the same way. Certainly our
veterans are worthy of more concern, support, and compassion
from those that provide medical services to them.

For some time Veterans have indicated to the Commission they felt
there was a lack of concern by those who provide treatment at
many VA medical centers. The aforementioned attitudes of the
medical students being trained at VA facilities may account for
some of that feedback. Most VA Medical facilities are located



57



near Univsrsities with Hadical Schools, and have agrseaents for
their students to rotate through VA facilities. A aajor affort
to sensitize these students to the patient population is
imperative for the VA to provide competitive and quality care.
The students must realize the patients they serve are those who
have defended their right/privilege to receive their education.
Outreach

WHIG has been involved with outreach efforts throughout the
Commonwealth. It has found the U.S. Department of Veterans
Affairs, Vet Center to be a very important arm in many of its
efforts. The Vet Center is the only VA facility operating
within the community without many bureaucratic trappings. It
is, for many veterans, the first contact they will have with the
V.A. The counseling/outreach services provided by these centers
are invaluable but limited. There are WW II and Korean War

veterans which suffer from Post Traumatic Stress Disorder who
would benefit from the counseling services offered by the Vet
Center. These veterans are currently ineligible to receive
these services. I support pending legislation and regulations
which will include these veterans for service provision.

I also support the concept of Vet Centers which will provide
certain basic medical services such as cardiovascular screening,
basic health exams, etc. Vietnam veterans are beginning to age
and bring to the centers medical as well as psychological
problems. The inclusion of War World II and Korean vets would
increase the numbers of veterans that would cone to centers
requiring of basic medical attention. These facilities should
not become full out patient centers, but outstatlon sites where
basic exams would be conducted. The provision of these
additional services would improve the image of the VA in the
community. These efforts would impact on certain hard-to-reach
populations, bringing them into the treatment mainstream and
raising their comfort level in utilizing the VA system.
Provision of these services at Vet Centers would benefit
veterans who reside in rural areas ailes away from the nearest



58



VA Medical Center and liait painful or unnecessary travel
for basic procedures.

Desert Storm

Our outreach and educational efforts have brought WHIG into
contacts with Desert Stora veterans and concerned physicians.
The contacts with Desert Storm veterans reoind me of earlier
experiences, both as a Vietnam Vet and with Vietnam vets,
regarding Agent Orange. They ask the questions about their
situation and get few substantive answers. They are discouraged
by the lack of progress being made by the government with
scientific investigation. They complain and feel the V.A. and
the government are in collusion to hide information concerning
their ailments. They are bombarded weekly with news stories
depicting birth defects, fatigue and other symptomatology with
no acceptable resolution. Many of these veterans are turning to
non-VA physicians in their community for assistance. These
physicians indicate a reluctance of the Desert Storm vet to use
the VA because of a lack of trust. During WHlC-conducted
educational programs, physicians have expressed concerns
regarding limited information on adverse health effects of
Desert Storm service. I believe an improved system for access
to the latest diagnostic and treatment information for these
veterans and physicians is essential. I believe programs like
this should be implemented and conducted in all states,
particularly those with large numbers of Desert Storm
participants. I recommend a publication similar to "The Vietnam
Experience" be developed to discuss the symptoms and treatments,
for disorders associated with Desert Storm. We must not repeat
the patterns of neglect that surrounded the Agent Orange Issue;
access to information is one way to prevent this recurring
experience.



59




The Vietnam
Experience:

An Overvieiv of the
Health Problems
Associated with
Vietnam Service



Robert P. Casey
Governor

Allan S. Noonan. MD. MPH
Secretary of Health



Agent Orange

Post-Tiaumatic Stress Disorder

Infectious Diseases Prevalent in Southeast Asia

Resources

Bibliography (By Subject)



60



ACKNOWLEDGEMENTS;

Produced for the Vietnam Veterans Health Initiative

Commission, Pennsylvania Department of Health by The

Educational and Scientific Trust of the Pennsylvania Medical

Society under contract number 57728.

A special thanks to those involved in the development of

this booklet.

Ronald A. Codario. MD

David A. Grady. PsyD

Maureen Hoepfer. MS

Sandra L. Ritchie, RN. MS

Dwight D. Edwards. MEd
This guide is not a standard of medical care. Its purpose is to
inform health care professionals about potential health
problems in Vietnam veterans resulting from service in
Southeast Asia. The booklet is a follow-up to TOXIC
HERBICIDE EXPOSURE (AGENT ORANGE): THE
PHYSICIAN'S RESOURCE wrhich was published by the
Pennsylvania Vietnam Herbicide Information Commission and
the Pennsylvania Department of Health in 1984.



Pennsylvania Vietnam Veterans Health Initiative

Commission
Pennsylvania Department of Health
P.O. Box 90, Room 1013
Harrisburg, PA 17108



Printing funded hv:




T^ietnam T/etezam of c/lmezica, One.
Pe»»i^cvama State GouhccC



61



The

Vietnam

Experience:

An Overview
of the Health
ProbJems
Associated
with Vietnam
Service



FOREWORD


2^1


INTRODUCTION


3^1


AGENT ORANGE:
An Overview


4^1


EVALUATION OF PATIENTS
EXPOSED TO DIOXIN


S^H


TREATMENT


5^1


CONTINUING RESEARCH


6^1


PSYCHOLOGICAL PROBLEMS


6^1


POST-TRAUMATIC STRESS
DISORDER


7^H


PTSD-PHYSICAL SYMPTOMS


8^1


DIFFERENTIAL DIAGNOSIS
AND COMORBIDITY


8^1


RELATED PSYCHOLOGICAL
DISORDERS


8^1


TREATMENT OF
WAR-RELATED
STRESS CONDITIONS


10^1


INFECTIOUS DISEASES
PREVALENT IN SOUTHEAST
ASIA


10^1


RESOURCES


12^1


END NOTES


IS^I


BIBLIOGRAPHY (By Subject)


16^1



62



FOREWORD



The Vietnam Veterans Health Initiative Commission was
estabhshed in 1987 by Act 67. It replaces the Vietnam Herbi-
cide Information Commission and was created to: (1) deter-
mine what medical, administrative, and social assistance is
needed for veterans who have suffered adverse health effects
from Vietnam service; (2) conduct an extensive outreach pro-
gram to coordinate and supplement the efforts of the Federal
Government, State Government Veterans Service Organiza-
tion and related agencies to inform veterans of all available
assistance; (3) assist in disseminating to veterans and their
dependents information regarding health studies being con-
ducted: (4) maintain a central data bank of scientific informa-
tion collected on the health effects of exposure to Vietnam
Herbicide: (5) establish a reporting process for veterans who
have indicated they have suffered adverse health effects as
the result of their service; and (6) establish a continuing edu-
cation program for all health professionals to provide state-of-
the-art knowledge about detection, diagnosis and treatment
of chronic symptoms associated with Vietnam service.

This booklet addresses the latter-most goal. It is a follow up
to "Toxic Herbicide Exposure (Agent Orange): The Physi-
cian's Resource" and includes information on additional
medical and psychological conditions related to Vietnam ser-
vice. The guide is being made available to health profession-
als throughout the Commonwealth. It is hoped that the health
care provider's ability to understand the problems confront-
ing Vietnam veterans will be enhanced by this initiative.

Many Vietnam veterans feel that traditional providers have
failed to serve them in a knowledgeable and sensitive man-
ner. They have shied away from those who provide treatment
for these and other reasons. A report soon to be released by
the Triangle Research Institute indicates a great percentage of
those veterans affected by the war have not sought treatment.
It is the hope of the Commission that this guide will, at least,
encourage the health care professional and the Vietnam vet-
eran to discuss health problems associated with Vietnam ser-
vice, and provide information concerning the availability and
location of appropriate supportive services.



63



INTRODUCTION



i:



I he Vietnam War exposed more than two million
Americans to a variety of physical and emotional
disturbances. This booklet is written to provide the
health care professional with a resource for treating Vietnam
veterans, but also contains valuable information for the vet-
eran and other interested laymen. It includes information on
chemical exposure, bacterial and parasitic infection, and the
psychological problems that a health care professional should
take into account when examining a patient who served in
Southeast Asia.

This booklet provides only an oven,'iew on the health prob-
lems of Vietnam veterans as they are currently understood. To
further assist the health care professional in evaluating the ^■^t.',^,^ ' -^

physical and mental conditions of a veteran with iden\^Sed.'^, K^'-j^yrr r'r '''- ■.
Vietnam service, a listing of resource centers and a selecfea-Cj'-.-; ''ix'^'-^" .C^''
bibliography of relevant articles has been included in this '^' q'^C'^'':~''-:'1
booklet. Further research and the referral of individuals to-v^-lf- ■J^\X'*^"'"'^v
qualified specialists or tliese identified resource centers is 9~,'r^A^C

recommended.




64



AGENT ORANGE:
An Overview



r\



TT ippn



w



i-K- t




Agent Orange is a mixture of two
herbicides — 2.4.5-T (trichloro-
phenoxyacetic acid) and 2.4-D (di-
chlorophenoxyacetic acid) and a con-
taminant, TCDD (tetrachlorodibenzo-
dioxin). The latter is the most toxic of
the 75 dioxin isomers and generally
referred to as "dioxin."'

Dioxin has been implicated as a
cause of birth defects, liver, lung and
pharyngeal carcinoma, impaired im
mune function, and gastrointestina
hemorrhage. In addition, the com
pound has been associated with thy
mic and testicular atrophy in labora
tory mammals and chromosoma
damage in bacteria and yeast.'

Humans exposed to dioxin in in-
dustrial accidents and spillage have


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Online LibraryUnited States. Congress. House. Committee on VeterViewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 → online text (page 7 of 23)