The T· etn Tete Agent range: The War Liuge

up this herbicide, 2,4-0 and 2,4,5-T were widely used in the United State~ by farmers and foresters to kill un­ wanted vegetation. In fact, you could buy them off the shelf of you r neigh­ borhood hardware store to ki II weeds in your lawn or garden. John C. Hansen The military began using several herbicides in Vietnam in early 1962. Mr. Hansen is a senior evaluator recently reassigned from the Federal Personnel and The herbicides were identified by code Compensation Division to the Veterans names which referred to the color of Administration audit site of the Human bands painted on the chemical con­ Resources Division where he is continuing tainers. Thus, they were given names his work on Agent Orange. He joined GAO like Agent Orange, Agent Blue, and In 1974 after receiving a B.S. degree in Agent White. These herbicides were finance and a M.B.A. from the University of applied by cargo planes, helicopters, Almost 1 years after the end of the Rhode Island. Mr. Hansen is a past member ° trucks, riverboats, and from back­ of GAO's Career Level Council and is a Vietnam War many veterans believe packs. About 90 percent of the Agent member of the American Society for Public they are still fighting the enemy in a life Orange used in Vietnam was for forest Administration. or death struggle. That enemy is not or jungle defoliation. Crop destruction the Viet Cong, but the toxic defol iant missions accounted for 8 percent of known as Agent Orange. the Agent Orange applied. The remain­ Si nce 1977, the emotionally charged ing 2 percent was used around base Agent Orange issue has grown into a perimeters, cache sites, waterways. national controversy. Thousands of and communication lines. Vietnam veterans claim that exposure By the late 1960's, Vietnamese to Agent Orange has made them sick newspapers and various scientists and deformed their children, and they began to attribute certain health prob·· are frustrated at the slow pace of lems found in the civilian Vietnamese Government efforts to find answers to population, such as birth defects, can­ their questions. cers, and skin problems, to herbicide There are many emotional issues in exposure. About the same time, the the public forum today which are National Institutes of Health reported rooted in debate over Government's that 2,4,5-T, one of the chemicals in responsibility to the public and its Agent Orange, could cause malforma­ influence on our lives. However none tions and stillbirths in mice. In April .is more fundamental than the 'ques­ 1970, DOD suspended all use of Agent tion: What does the Government owe Orange in Vietnam largely as a result veterans who have served the country of the Department of Agriculture'S res­ in battle? Vietnam veterans concerned triction of certain domestic uses of about Agent Orange believe the Gov­ 2,4,5-T because of its possible health ernment is not fulfilling its obligation hazards. These health hazards were on this complex issue. GAO has con­ attributed to the inevitable by-product tributed to the ongoing debate through of the manufacture of 2 4 5-T The by­ several reports. product is TCDD, a ~horthand for l\!hat Is Agcnt O.-augc'! 2,3, 7,8-tetrach lorodi benzoparad ioxin, simply called dioxin, which manY From 1965 to 1970, the Department scientists consider tile deadliest of all of Defense (DOD) sprayed almost 11 manmade poisons. m!llion gallons of Agent Orange over millions of acres of Vietnam to prevent the enemy from hiding in the jungle, thereby enhancing security and im­ proving observation, and to destroy the enemy's food supply. Since tile 1940's, the two chemicals which made 1 I

r. " tIe Vete.·:uls' Otdery \ :J.cgills

In late 1977, veterans began ap­ proach ing the Veterans Administra­ tion (VA) with various health problems they believed were related to herbicide exposure in Vietnam. Extensive media coverage of the purported adverse health effects of 2.4,5-T and its dioxin contaminant also raised concerns among many Vietnam veterans. Ill­ nesses which these veterans believed were caused by exposure to Agent Orange included skin conditions, can­ cer, birth defects in offspring, nervous disorders, numbness in extremities, I' miscarriages, reduced libido, impo­ tency, vision and/or hearing impair­ ment, and gastrointestinal tract dis­ turbances. In April 1978, the late Congressman Ralph H. Metcalfe expressed his con­ cern about possible long-range ad­ verse health effects of exposure to Agent Orange. He asked GAO to examine DOD's use of the herbicide in Vietnam and the VA's handling of herbicide-exposure disability claims 'submitted by Vietnam veterans. Air Force C-123B on a defoliation mission. (U .S. Air Force photo.)

. .~

Three Air Force C-123 "Ranch Hand" aircraft dispense defoliants over Vietnam jungles. (Photo by Sgt. W. A. Betts, U.S. Air Force photo,) (,1.0 [{':\1C\\, /Sprillg 19H I 30 l b e Vietnam Ve teran \'l'i, Agcllt (h'angc : 'Ibe WIll' 'Ib a ! Lingers

An interim report (CED-78-158, Aug 16, 1978) to Congressman Met­ calfe addressed the (1) extent of DOD's use of herbicides and other chemicals in South Vietnam, (2) num­ ber of military and civilian personnel exposed to these chemicals, and (3) DOD-funded studies of these chemi­ cals' effect on health, A second report, "Health Effects of Exposure to Herbi­ cide Orange in South Vietnam Should be Resolved" (CED-79-22, Apr 6, 1979), focused on VA's response to veterans' concerns on herbicide expo­ sure and health effects studies of dioxin and other chemicals used ill Vietnam In these early reports GAO con­ cluded that VA needed a better basis for evaluating the nature of veterans' concerns about the herbicide. GAO recommended that, in eval uati ng herbicide-related di sability compen­ sation claims, VA obtain all military records pertaining to a veteran's pos­ sible exposure to herbicides in Viet­ nam and that all veterans submitting such claims be encouraged to contact VA health care facilities. GAO also recommended that DOD study. with the assistance and guidance of an The use of defoliants in Vietnam deprived the enemy of jungle cover. (U.S. Air Force photo.! appropriate interagency group, tile

f ! .. :1 ":Ii :, ~I l .. ' " ';1 '; After defoliation, t his Viet Cong trench was discovered 22 miles outside of Saigon. Note cratevs from earlier 8 -52 bo mbing. ; (U,S. Air Force photo, ) l ( ~~J (.,\() l

fwalth risks involved by Its personnel Marine Corps un it records, it was Using average stren9th and turn­ I exposed to herbicides in Vietnam. obvious that they did not contain con­ over figures for the sample, GAO esti­ In response to those recommenda­ clusive proof of ground personnel mated that 21 8, 000 personnel were tions and the mounting public and reporting that they were sprayed by assigned to the 24 battalions in I Corps congressional concern, VA started a aircraft on Agent Orange missions. between '1966 and 1969. registry of all Vietnam veterans exam­ Thus, another approach to analyzing Ground troop locations were com­ ined at VA medical facilities for available data had to be developed to pared with Agent Orange missions, herbicide-related health problems. show whethel' ground tro ops were il1 taking into account the time and geo­ A!sO the Air Force initiated a health or near areas sprayed with Agent graphic proximity of battalion loca .. effe cts study of Air Force personnel Orange. An FPCD auditor who had tions to spraying sites. Various time involved in operation "Ranch Hand" been an Army helicopter pilot in Viet­ and distance combinations were ana­ WllO sprayed Agent Orange in Viet­ nam, a member of FPC D's systems lyzed because many variables affected nam. DOD believed these individuals analysis staff, and I formed a team to an individual's potential for exposure. had the greatest potential for exposure. focus on this difficult problem. Different estimates exist on the life of By the spring of 1979, veterans' com­ DOD had developed a computel' dioxin and the drift of Agent Orange plaints were flooding congressional data base on herbicide spraying mis­ from target areas. offices. Many complaints were from sions conducted between August 1965 The four time periods used were the gmund troops in Vietnam who be­ and February 1971. This data base day the mission was conducted (day 1) lieved they were sprayed and had included the date, number of planes, and within 7, '14, and 28 days after the dnmk from water contaminated with amount of herbicide sprayed, and the mission The 28th day was significant Agent Orange. They disagreed with location for approximately 86 percent because DOD had consistently stated DOD's contention that only "Ranch of all herbicide operations in South that ground troops' exposure to Agent Hand" personnel had been exposed. Vietnam What was missing was a data Orange was unlikely because they did In May 1979, Senator Charles Percy, base of troop locations and strengths not enter sprayed areas until 4 to 6 "cting on the growing complaints of which could be compared with the weeks afterwa rd. ground-troop exposure, requested spraying missions to estimate the The distance criteria used were .5, GAO to determine what precautions number and proximity of troops to the 1.5, and 2.5 kilometers, or about .3, .9, were taken to prevent ground troops areas sprayed with Agent Orange. and 1.6 miles from a sprayed area. (A and others from exposure and whether Unfortunately, Army troop records kilometer is 0.62 miles, almost 2/3 of a military units were in or near areas from the Vietnam conflict were neither mile) Distance from a sprayed area sprayed with Agent Orange. complete nor well organized because was important because the Agent of the Army's rapid pullout from Viet­ Orange sprayed from a plane often liT. 'ed lVilli li'ew nam Thus, a thorough reconstruction drifted beyond the target area. Drift of these rec ords was necessary to was affected by the altitude and speed ~»-tl·~~ntiolls determine the locations of Army per­ of the ai rcraft, the terrain of the area to At the time DOD started using her­ sonnel who made up the majority of be sprayed, and the climate. DOD bicides in Vietnam, they considered roughly 2.6 million peop le who served stud ies showed that drift was generally Agent Orange to be 'relatively non­ in Vietnam However, a revi ew of 31 less than 1 kilometer when the aircraft toxic to man or animals," As a result, quarterly operational reports from 13 sprayed Agent Orange at an altitude of few precautions were taken to prevent major Army corn bat Lin its located 150 feet an ai rspeed of 130 to 140 exposure Personnel handling the her­ throu9hou t Vietn am showed that 10 of knots, and windspeed of less than 10 bicide were merely instructed to use the 13 units reported using Agent knots. However, the National Academy safety equipment, such as gloves and Orange on base camp perimeters, of Sciences reported that drift had face shields, and were advised to roads or crops, or aircraft mi ss ions in caused widespread crop damage. In showe r and change cloth es if they areas of operation. Undoubtedly, Army fact, its study showed that crop dam­ came in contact with the herbicide. troops were close to areas sprayed age resulting from drift on missions Defe nse officials did not prescribe with Agent Orange. designated as defoliation was greater additional precautions because they Marine Corps unit records from than that caused by crop destruction believed exposure of gmund troops Vietnam proved more encouraging. missions. Herbicide mission com­ was unlikely since they did not enter Monthly Marine Corps battalion re­ manders confirmed that drift was a sprayed areas unti 14 to 6 weeks after a ports contained detailed information common problem and cou Id extend mission when defoliation was com­ on location, strength, and personnel from 1 to 2 kilometers. pleted and the herbicide had biode­ turnover necessal'y to deve lop a data Table 1 shows the estimated num ber gr'aded or photodegraded. However, base to compare wi th Agent Orange of marines assigned to Mal'ine Corps there was no evidence of any written spraying missions. A random sample infantry battalions in I Corps from regulation restricting troops fro m of monthly reports from the 24 Mal'irre January 1,1966, to December 31. recently sprayed ar-eas. infantry battalions stationed in the I 1969, within the various time and dis­ Corps, or nOl'th ern sectio n of South tance criteria from spraye d areas. Vietnam, between ,January 1966 and About 5.900 marines were assigned J ' 0 .v."tive , I ' December 1969 was used to compile to uni ts within 5 kilometers of areas J. Gl> IU-O.lC les '" the data base. During these 4 years, spl'ayed with Agent Orange on the , ~·dc. ...uc ,rho ~a.tfoJi 2.18 million gallons o f Agent Orange, same day Some of the units were iRxposed Of' about 20 percent of th e herbicide directly in the path of Agent Orange used in Vietnam. was spl'ayed in I spraying missions The number of After an initial review of Army and Corps. marines within .5 kilometers of sp rayed ( " I f) 1<'Tkw, ~ I' d ll t~ I !Ii-I I :J2 The Vietnam Ve teran vs. Agent Orange: The War lbat Lingers

each of the wide spectrum of health Table I effects alleged to have resulted from Estimated Number of Marines Near Areas Where Agent Orange Was Used these phenoxy acids or their dioxin contaminants. For years scientists have examined Within kilometers Within days of Esti mated no. the physiological effects of chemicals, spraying mission of marines of sprayed area including those in Agent Orange, on .5 1 5,90'0' animals. Most believe animal studies 7 7,600 are helpful in suggesting the potential 14 9,10'0 for toxic actions of chemicals in 28 16,10'0 humans. The Food and Drug Adminis­ tration and EPA make extensive use of 1.5 1 16,50'0' animal studies in assessing the risks of 7 21 ,50'0' chemicals on human health. 14 25,80'0' Animal studies of the effects of 2,4- 28 30',10'0' D, 2,4,5-T and TCDD (dioxin) have shown a variety of health problems. In . 17,40'0' 2.5 1 mice, rats, rabbits, and hamsters, small 7 23,90'0' doses of dioxin cause cancer, birth 14 29,90'0' defects, liver malfunctions, skin rashes, 28 . 39,40'0' immune system failure, and enzyme changes. However, many scientists and Gov­ areas before the 4-week reentry period Group has focused its attention on ernment officials believe that the only established by DOD was about 16,100. initiating and monitoring studies con­ way to reach definite conclusions Thus, DOD's contention that ground cerning whether exposure to dioxin about the effects of Agent Orange on troops did not enter sprayed areas or Agent Orange causes cancer or humans is through studies of exposed until 4 to 6 weeks afterward was inac­ birth defects in children and whether human populations. These types of curate, and the chances that ground exposure to Agent Orange has ad­ studies, known as epidemiology stud­ troops were exposed to Agent Orange versely affected the health of Vietnam ies, deal with the relationships of the were higher than DOD previously veterans. various factors which determine the acknowledged. Since ground troops About the same time the President frequency and distribution of illness were not included in the ongoing established the Work Group, the Con­ and diseases. Although epidemiology health effects studies, GAO recom­ gress mandated the VA to conduct an studies of Vietnam veterans exposed mended that the Congress determine epidemiology study of veterans who to Agent Orange are just getting the need for a study of the health were likely to have been exposed to underway, there are completed stud­ effects of Agent Orange on ground Agent Orange in Vietnam. GAO's ies of workers exposed to the chemi­ troops likely to have been exposed, method of determining the proximity cals in Agent Orange during their on the basis of its feasibility and value of troops to sprayed areas is being manufacture or use. However, results in resolving veterans' concerns over used by DOD to develop a population of these studies conflict. alleged health risks. for VA's study. VA is currently contract­ A study funded by the Monsanto ing for the design of this study. Company on the mortality rates of Gove...... e ut'lackle s workers exposed to TCDD in an acci­ Agent Orange Issue Conclusive ScientiGc dent at its Nitro, West Virginia plant in Evidence o f Uluuau 1949 showed that there were fewer Within one month after Senator deaths among exposed workers than Percy released GAO's report, "U.S. Health Effe cts in individuals of the same age and sex Ground Troops in South Vietnam Were Remains Elusive in the U.S. population. Also, worker In Areas Sprayed With Herbicide death rates from cancer were not Orange" (FPCD-80-23, Nov. 16, 1979), There is a growing frustration among increased. the President and the Congress took Vietnam veterans, Members of Con­ However, more recently several steps toward resolving concerns about gress, and Government officials about Eu ropean stud ies of rai I road workers the long-term health effects of expo­ the Agent Orange issue. Does expo­ exposed to constituents of Agent sure to Agent Orange. su re to Agent Orange's dioxin contam­ Orange show a correlation between The President appointed an Inter­ inant increase one's risk of cancer, exposure and an increased risk of agency Work Group to coordinate the birth defects in children, and other cancer. Also, Dr. Ton-That Tung, a Government's efforts to study the ailments? Even the experts have trou­ Vietnamese physician and scientist, effects of Agent Orange and other ble answering this question. The Pres­ has reported a higher incidence of liver herbicides. The Work Group consists ident's Work Group summarized their cancer among exposed Vietnamese of representatives of agencies already view on the status of scientific evalua­ populations, and a higher incidence of involved in this issue- DOD, VA, the tion of Agent Orange in an August 1, abortions and birth defects among Environmental Protection Agency 1980, report. The report stated' exposed women. Unfortunately, the (EPA), the Department of Agriculture, Current scientific knowledge does validity of this data cannot be con­ and the Department of Health and not permit unequivocal judgments firmed due to lack of access to Human Services (HHS) The Work as to the health risk associated with Vietnam . 33 GAO Review/Spring 1981 GAO Review, .- .' or' .

The Vietnwn Veteran vs. Agent Orange: The War 1bat Lingers

7J of health suIted from heir dioxin

1 examined chemicals, )range, on !lal studies Ie potential ~ micals in 9 Adminis­ lsive use of the risks of 1. SOUTH VIEifNAM ects of 2,4- Dxin) have DEfOLIATION MISSIONS ·oblems.ln sters, small ncer, birth .kin rashes, -HERBICIDE ORANGE USAGE ld enzyme

sand Gov­ lat the only onclusions Orange on of exposed e types of )Iogy stud­ hips of the ermine the 1 of illness idemiology lS exposed Jst getting deted stud­ the chemi­ uring their ,ver, results

Monsanto ty rates of , in an acci­ nia plant in oNere fewer )rkers than tge and sex Iso, worker were not

tly several ad workers of Agent >n between ,ed risk of lat Tung, a d scientist, ence of liver Vietnamese ncidenceof !cts among mately, the lot be con- access to

'Spring 1981 '. GAO Review/Spring 1981 3 4 DIe Vietnam Veteran V!;. Agent Omll~e: ' nlt~ War 'I1mt Lingers

Although most attention has been believes that, while the results of sev­ tions of the House Interstate and focused on Agent Orange, some eral studies of workers exposed in Foreign Commerce Committee on scientists now believe that it may be industrial accidents will soon be avail­ September 25,1980, VA Administrator, only one of a variety of potentially able, it may be 2 or 3 years before the Max Cleland, reaffirmed the agency's toxic chemicals to which American preliminary results are in on studies of policy on the Agent Orange con­ servicemen were exposed. In its April Vietnam veterans. This conclusion is troversy: 1979 report, GAO acknowledged that hardly comforting to the large number I cannot state in strong enough other chemicals used in Vietnam may of Vietnam veterans concerned about terms that in the interim, it has been pose health problems. While the toxic their health. and will continue to be the stated potential of some of these substances policy of the Veterans,Administra­ is known, no studies have been done Veterdus'lake tion that no eligible veteran will be of the synergistic or combined effects Chenaieal Corupruaies denied medical care and treatment of the so-called "toxicological cock­ by the VA because the answers are tail" which existed in Vietnam. Some of to COID1- not in. Our goal remains to provide these chemicals were In January 1979, a class action suit compassionate and understanding • Cacodylic acid: An arsenic-based was filed in Federal District Court in service. This is a responsibility th at component of Agent Blue used on New York on behalf of veterans and we take very seriously. base camp perimeters is under re­ their families who suffer health prob­ newed EPA investigation because of lems they attribute to Agent Orange VA has participated in several activi­ its potential for causing cancer. exposure. The veterans in the suit are ties on the Agent Orange issue. I n Apri l • 2,4-0: A herbicide used in Agent asking that a trust fund be created to 1978, VA established an advisory Orange and Agent White has been reimburse the Government for the committee to exchange information linked by some animal tests to cancer compensation and care of all veterans on Agent Orange and its potential and reproductive disorders. EPA has and their children injured by dioxin. health effects, and to advise VA on requested more tests on its effects. The fund, which could reach billions future courses of action. This advisol'y The National Park Service recently of dollars, would be administered committee, composed of representa­ suspended the use of 2,4-0 in all by the court and financed by the chem­ tives of various Government agencies, national parks until more is known ical companies who manufactured veterans' organizations and academia, about its human health risks. Agen.t Orange. The five chemical com­ is still active. • DO T: A pesticide used for mos­ panies named as defendants are the VA has also participated in the quito control was banned by EPA in Dow Chemical Company, the Mon­ efforts of the President's Work Group 1972 for most domestic uses. santo Company, the Thompson Hay­ to cool'dinate Federal research efforts • Chlordane. A pesticide used for ward Chemical Company, Hercules, and other activities regarding the pos­ termite control was banned for most Inc., and the Diamond Shamrock sible health effects of herbicides such domestic uses by EPA in 1975 after Corporation. as Agent Orange. being found to cause cancer in test In what has been called the largest The focal point of VA's effort to animals. product liability suit in history, the assist veterans is the Agent Orange • Dapsone: An experimental anti­ veterans claim that the chemical com­ registry initiated in 1978. The purpose malarial drug given to many combat panies knew that Agent Orange was of the registry is to identify veterans troops to ward off a resistant strain of highly dangerous, but failed to warn who are concerned about possible malaria. Studies show this drug to be a either DOD or servicemen who might health effects resulting from exposure potential carcinogen in male labora­ be exposed. The defendants have to Agent Orange, and to gather base­ tory rats. denied all liability, claiming that the line medical information oil indi vidual herbicides they sold to the military veterans who might later develop Recognizing veterans' health prob­ posed no danger to human health. illnesses whicll could be related to lems may be related to exposure to a Recenlly, the manufacturer's asked herbicide exposure. This information variety of chemicals, including Agent that the U.S. Government be named as is obtained from a questionnaire and Orange, the President's Work Group a defendant, because any harm caused medical history, a physical examina­ recommended that scientific studies by Agent Orange was due to the mili­ tion, and a set of basic laboratory tests. focus on whether service in Vietnam, tary's misuse of an otherwise safe While the registry was not intended to rather than solely Agent Orange expo­ product. serve as a research study, it should sure, may have caused Vietnam vet­ Although a three-Judge panel of the give scientists some idea about the erans to suffer certain health prob­ Circuit Court of Appeals dismissed symptoms Vietnam veterans are ek lems. The Senate Veterans Affairs this suit in November 1980 on proce­ periencing. Committee endorsed this recommen­ dural gmunds, the veterans are likely Howeve r, tile registry has been the dation and urged VA to broaden the to appeal this decision, extending this target of a growing number of veteran planned epidemiology study to con­ case for many years. complaints that VA is not keeping their sider sel'vice in Vietnam as the causal pledge to provide tllorough medical factor of veterans' illnesses. VA will care and treatment until scientifiC explore this possibility in planning the 1111at Is VA Doing Jut· answers are available. Many veterans study design. SciclliUie At.~WCI~ allege that they have to wa it montlls for When will we be able to draw con­ examinations, that they are treated clusions about the effects of Agent IJCCOIliC ,.i\,,'aihlhlc"l with contempt by VA physicians and Ol'ange and other chemicals on ve t­ In test imony before the Subcom­ staff, that the examinations al'e not el'3ns' health? The Work Group mittee on Oversight and In ves ti ga- th orough. that the pllysicialls fail to :l. ( .. \() Iic,·j C\\.'S ,lJillg I !/:-ll The Vietnam Vetemn vs. Agent Orange: The War lbat Lingers

provide adequate treatment and fol- 10wuP of diagnosed symptoms, that medical records are falsified, and that VA just does not care about them. Veterans are also critical of VA for denying most disability compensation claims related to Agent Orange. VA has denied most claims because it believes there is insufficient evidence that the claimed disabilities were in­ curred during the veterans' service as a result of exposure to Agent Orange. This situation is likely to continue until more scientific evidence on the long­ term effects of herbicide exposure on veterans becomes available. A final criticism of VA is that it has failed to undertake an outreach pro­ gram to inform veterans of the poten­ tial hazards of herbicide exposure and the availability of a physical exam and treatment at VA medical facilities. Once again Members of Congress have requested GAO to continue its work on the Agent Orange controversy and review complaints about VA's response to concerned veterans. The Soeiall»oliey Deeision It is now 3 years since the Agent Orange controversy began, and many believe answers are still years away There is a growing realization that it may not be possible to determine how much Agent Orange or other toxic chemicals a veteran was exposed to in Vietnam, and there may never be con­ clusive scientific evidence on th e long­ term effects of exposure on human health Ultimately, this complex and con­ trove rsial matter is I ikely to become a social policy issue that only the Con­ gress and the President can resolve. This decision will require judgments on several key factors. What consti­ tutes fair treatment of veterans while scientific data is being gathered? How much evidence is necessary to prove or disapprove adverse health effects and a veteran's right to disability com­ pensation? Who bears the burden of proof of adverse health effects as a result of Agent Orange exposure- the veteran or Government? And finally, What must the Government do to uphold the immortal words of Abra­ ham Lincoln which serve as VA's motto-"To care for him who shall have borne the battle and for his widow and his orphan"?

(;',\0 Rc\iew/Spring 19tH 36