Behind-the-scenes of the IOM panel that helped extend reservist medical benefits

By Brian Donohue  |  HSNewsBeat  |  Updated 9:30 AM, 07.28.2015

Posted in: Issues

In June, the U.S. Department of Veterans Affairs (VA) reversed a longstanding position and extended medical benefits to about 2,000 Air Force reservists who worked on C-123 aircraft that were returned to the United States after being used to spray Agent Orange defoliant in Vietnam.

The VA was acting on findings of an Institute of Medicine ad hoc panel, whose seven members included John Kissel, a University of Washington professor of environmental and occupational health sciences. In an interview, he gave context to the panel’s job, its process and findings, and his takeaway. This Q&A is excerpted from that conversation.

Q: What’s your background that led to your inclusion on the panel?
A: I do human exposure assessment in community and occupational environments.

Q: What was the panel’s task?
A: We were supposed to decide whether the Air Force reservists who flew and maintained the planes well after Vietnam could have gotten meaningful exposures to Agent Orange residues that would make them potentially eligible for compensation.

John Kissel
John Kissel is a professor of environmental and occupational health sciences.
Years ago Congress decided that, presumptively, all Vietnam veterans were exposed to Agent Orange and its contaminant, dioxin. The standing IOM committee on Agent Orange – another group, not our panel – has reviewed epidemiological records and created a list of health outcomes for which there is an accepted link between Agent Orange exposure and negative consequences. I think 18 or 19 diseases are on the list.

We were looking at a population of people who didn’t go to Vietnam but who may have had equal or higher exposures than some veterans who did. The non-Vietnam veterans were presumptively not covered.

Q: Was the panel going to stand entirely on science, either way, or were you looking for justification to cover the reservists?
A: Just the science. We weren’t unaware of the contention of the non-covered veterans that this was an equity issue, but we weren’t impaneled to deal with equity. We could have said, “It doesn’t seem fair to us, but we found no basis for your claims of exposure.”

Q: Were you lobbied?
A: We had one public hearing where people were able to offer their opinion. There were advocates for the reservists and on the other side there was the VA’s primary consultant as well as consultants paid by Dow and Monsanto, who made Agent Orange, to argue that the reservists’ claims didn’t hold up to scrutiny. We also received written comments on both sides of the issue.

Q: What did the science tell you?
A: We had a problem with lack of information. If you want to assess a person’s or a group’s exposure, you would like to have environmental data from the period of exposure, plus skin data, inhalation data, and urine data from the population. You’d also want to know the length of potential exposure – how many hours a day, how many years. At the individual level, we had little or none of that. What we had was residue numbers obtained from the planes a decade or more after the reservists served. Given that there was still residue in the planes 10 or more years after they had been active, we were confident that there was residue in the planes when the reservists were working.

Q: The dioxin residue was still there?
A: A lot of military aircraft get mothballed in the Arizona desert because things rust slowly. The planes’ doors and windows were sealed up. Dioxin biodegrades very slowly and, if there’s no sunlight, it can’t decompose through photolysis.

Air Force
Dioxin residue was found in aircraft used to spray Agent Orange defoliant in Vietnam.
Q: Your panel’s report didn’t actually recommend coverage for the reservists.
A: It wasn’t ours to decide whether to compensate the reservists. We were asked to answer whether meaningful exposures were plausible. We estimated that the reservists would have been “downhill” in a chemical sense from the surface residues, so exposures would be expected. We also determined that, given the paucity of information, we could not conclude that the reservists’ exposures would have been negligible. We decided that to go to just that far, and left it to the VA to make the final decision.

Q: What do you take from this experience?
A: It’s enjoyable to serve on a panel with bright people to chew on a real problem, and there’s satisfaction in writing a report that somebody read and that apparently made a difference. That doesn’t always happen.