VA Secretary David Shulkin says he favors expanding Agent Orange-related care to new categories of veterans but certain factors stand in the way.
VA Secretary David Shulkin suggests he favors expansion of Agent Orange-related health care and disability compensation to new categories of ailing veterans but that factors like cost, medical science and politics still stand in the way.
Shulkin told the Senate Veterans Affairs Committee on Wednesday that he made recommendations to White House budget officials last year on whether to add up to four more conditions — bladder cancer, hypothyroidism, Parkinson-like tremors and hypertension (high blood pressure) — to the VA list of 14 illnesses presumably caused by exposure to herbicides used during the Vietnam War.
Shulkin didn’t say which of the four conditions, if any, he wants added to the presumptive list, if and when cleared by the White House.
At the same hearing, the VA chief was asked his position on Blue Water Navy veterans of the Vietnam War who also suffer from illnesses on the VA presumptive list but aren’t eligible to use it to facilitate claims for care and compensation.
They “have waited too long for this,” Shulkin agreed, but then suggested the solution for these veterans is blocked by medical evidence or swings on the will of the Congress.
Vietnam veterans who served even a day in country who have illnesses on the presumptive list can quality for VA medical care and disability compensation without having to show other evidence that their ailments are service connected.
Shulkin said VA “recently” received the last report of the National Academy of Medicine, which found a stronger scientific association than earlier studies between certain ailments and herbicide exposure. In fact, however, VA has had that report, "Veterans and Agent Orange: Update 2014," for two years.
It was written by a committee of medical experts who reviewed medical and scientific literature on select ailments and herbicide exposure published from Oct. 1, 2012, through Sept. 30, 2014. Released in March 2016, the report found evidence to support raising the strength of association between herbicide exposure and bladder cancer and hypothyroidism. The report upgrades the link from “inadequate or insufficient” evidence to “limited or suggestive” evidence of an association.
In years past, the VA decided that for some ailments, such as Parkinson’s and ischemic heart disease, “limited or suggestive evidence” was enough to add these illnesses to the Agent Orange presumptive list. For others, including hypertension, a more common disease of aging, VA deemed it wasn’t enough.
This last NAM report, however, looked again at cardiovascular conditions and herbicide exposure. It didn’t upgrade the link to heart ailments but it did affirm limited or suggestive evidence that hypertension is linked to herbicide exposure.
It also studied whether Parkinson’s-like symptoms should fall into the same limited or suggestive category as Parkinson’s disease itself. The 2016 report found “no rational basis” to continue to exclude Parkinson-like symptoms from the same risk category. Parkinson’s disease itself was added to presumptive list in 2010.
VA secretaries under both the Obama and Trump administration reacted more slowly on the last NAM perhaps, by law, they could. Congress in 2015 let a portion of the Agent Orange law expire, language that required the VA Secretary to decide on new presumptive conditions within 180 days of accepting a NAM report.
The impact was immediate. Though a senior VA official tasked with reviewing this last NAM report said then-VA Secretary Bob McDonald would make his decisions within three months, it didn’t happen. McDonald left it to his successor. Shulkin waited more months and, in July 2017, vowed to decide by Nov. 1. OMB blocked an announcement, however, presumably over projected costs.
Cost has been a factor, too, in Congress not passing legislation to extend VA benefits to Blue Water Navy veterans diagnosed with illnesses on the presumptive list. Budget analysts a few years ago estimated a cost of $1.1 billion over 10 years.
Also, NAM did conduct a review of medical and scientific evidence regarding Blue Water Veterans’ possible exposure to herbicides and concluded in a May 2011 report that "there was not enough information … to determine whether Blue Water Navy personnel were or were not exposed to Agent Orange."
Blue Water Veterans remain be ineligible to use the Agent Orange presumptive list. A lone exception is granted for veterans with non-Hodgkin's lymphoma. Vietnam veterans with this ailment may be granted service-connection without showing inland waterway service or that they set foot in country.
The current House version of the Blue Water Navy Vietnam Veterans Act, introduced in January 2017 by Rep. David Valado, R-Ga., has 327 co-sponsors. Yet prospects of passage remain dim. Valado reminded Shulkin at a mid-March hearing of the House Veterans Affairs Committee that, six months ago, Shulkin said he was seeking more recommendations from “subject matter experts” on the issue and would be ready to update Congress in the coming months.
“I am aligned with you that these veterans have waited too long,” Shulkin said, “and this is a responsibility that this country has. And, as our veterans get older, it’s unfair.…I believe it is imperative upon us to resolve this issue.
The Senate version of Blue Water legislation was introduced by Sen. Kirsten Gillibrand, D-N.Y., has 49 co-sponsors and, so far, equally dim prospects of passage.