Committee on Making Best Use of the Agent Orange Exposure Reconstruction Model's Books

The Utility of Proximity-Based Herbicide Exposure Assessment in Epidemiologic Studies of Vietnam Veterans

By: Institute of Medicine,Board on Military and Veterans Health,Committee on Making Best Use of the Agent Orange Exposure Reconstruction Model

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The Utility of Proximity-Based Herbicide Exposure Assessment in Epidemiologic Studies of Vietnam Veterans

By: Institute of Medicine,Board on Military and Veterans Health,Committee on Making Best Use of the Agent Orange Exposure Reconstruction Model

A fundamental challenge in past studies evaluating whether health problems experienced by Vietnam veterans might be linked to wartime use of Agent Orange or other herbicides has been a lack of information about the veterans' level of exposure to these herbicides. To address that problem, researchers developed a model to assess the opportunity for herbicide exposure among these veterans. The Utility of Proximity-Based Herbicide Exposure Assessment in Epidemiologic Studies of Vietnam Veterans presents the conclusions and recommendations of an Institute of Medicine committee (IOM) that was convened to provide guidance to the Department of Veterans Affairs (VA) about the best use of a model to characterize exposure to the troops based on their proximity to herbicide spraying in Vietnam. This book's assessment is guided by four primary considerations: to be clear about what the assessment model does and does not claim to do; to gain understanding of the strengths and limitations of data on herbicide spraying, troop locations, and health outcomes; to consider whether the model locates spraying and troops accurately to consider the potential contributions and pitfalls of using it in epidemiologic studies. Of particular interest in these deliberations were the degree to which exposure classification might be improved if the model were to be used, and the appropriate interpretation of the results of any such studies. In light of the questions that remain concerning herbicide exposure and health among Vietnam veterans and the array of evidence that has thus far been brought to bear on that issue, The Utility of Proximity-Based Herbicide Exposure Assessment in Epidemiologic Studies of Vietnam Veterans concludes that the application of this model offers a constructive approach to extending knowledge about the effects of herbicides on the health of these veterans and merits the initial steps recommended in our report.

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160

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National Academies Press

Published Date

ISBN 10

0309114497

ISBN 13

9780309114493

Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam

Interim Findings and Recommendations

By: Institute of Medicine,Board on Health Promotion and Disease Prevention,Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam

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Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam

Interim Findings and Recommendations

By: Institute of Medicine,Board on Health Promotion and Disease Prevention,Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam

From 1962 to 1971, US military forces sprayed more than 19 million gallons of herbicides over Vietnam to strip the thick jungle canopy that helped conceal opposition forces, to destroy crops that enemy forces might depend on, and to clear tall grass and bushes from around the perimeters of US base camps and outlying fire-support bases. Most large-scale spraying operations were conducted from airplanes and helicopters, but herbicides were also sprayed from boats and ground vehicles, and by soldiers wearing back-mounted equipment. After a scientific report concluded that a contaminant of one of the primary chemicals used in the herbicide called Agent Orange could cause birth defects in laboratory animals, US forces suspended use of the herbicide; they subsequently halted all herbicide spraying in Vietnam in 1971. At the request of the Veteran's Administration, the Institute of Medicine established a committee to oversee the development and evaluation of models of herbicide exposure for use in studies of Vietnam veterans. That committee would develop and disseminate a request for proposals (RFP) consistent with the recommendations; evaluate the proposals received in response to the RFP and select one or more academic or other nongovernmental research groups to develop the exposure reconstruction model; provide scientific and administrative oversight of the work of the researchers; and evaluate the models developed by the researchers in a report to VA, which would be published for a broader audience. Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam is the IOM's report that evaluates models of herbicide reconstruction to develop and test models of herbicide exposure for use in studies of Vietnam veterans.

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National Academies Press

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ISBN 10

0309089433

ISBN 13

9780309089432

Veterans and Agent Orange

Health Effects of Herbicides Used in Vietnam

By: Institute of Medicine,Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides

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Veterans and Agent Orange

Health Effects of Herbicides Used in Vietnam

By: Institute of Medicine,Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides

Have U.S. military personnel experienced health problems from being exposed to Agent Orange, its dioxin contaminants, and other herbicides used in Vietnam? This definitive volume summarizes the strength of the evidence associating exposure during Vietnam service with cancer and other health effects and presents conclusions from an expert panel. Veterans and Agent Orange provides a historical review of the issue, examines studies of populations, in addition to Vietnam veterans, environmentally and occupationally exposed to herbicides and dioxin, and discusses problems in study methodology. The core of the book presents: What is known about the toxicology of the herbicides used in greatest quantities in Vietnam. What is known about assessing exposure to herbicides and dioxin. What can be determined from the wide range of epidemiological studies conducted by different authorities. What is known about the relationship between exposure to herbicides and dioxin, and cancer, reproductive effects, neurobehavioral disorders, and other health effects. The book describes research areas of continuing concern and offers recommendations for further research on the health effects of Agent Orange exposure among Vietnam veterans. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans organizations, researchers, and health professionals.

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833

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National Academies Press

Published Date

ISBN 10

0309048877

ISBN 13

9780309048873

Veterans and Agent Orange

Herbicide/Dioxin Exposure and Type 2 Diabetes

By: Institute of Medicine,Division of Health Promotion and Disease Prevention,Committee to Review the Evidence Regarding the Link Between Exposure to Agent Orange and Diabetes

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Veterans and Agent Orange

Herbicide/Dioxin Exposure and Type 2 Diabetes

By: Institute of Medicine,Division of Health Promotion and Disease Prevention,Committee to Review the Evidence Regarding the Link Between Exposure to Agent Orange and Diabetes

In response to the concerns voiced by Vietnam veterans and their families, Congress called upon the National Academy of Sciences (NAS) to review the scientific evidence on the possible health effects of exposure to Agent Orange and other herbicides. This call resulted in the creation of the first NAS Institute of Medicine Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides in 1992. The committee published its initial findings in the 1994 report Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. This report is the result of a 1999 request from the Department of Veterans Affairs (DVA) under the aegis of the Veterans and Agent Orange research program. Specifically, DVA asked the committee to examine evidence regarding the association, if any, between Type 2 diabetes and exposure to dioxin and other chemical compounds in herbicides used in Vietnam. Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes reviews the scientific evidence regarding the association, if any, between Type 2 diabetes1 and exposure to dioxin2 and other chemical compounds in herbicides used in Vietnam. This report examines, to the extent that available data permitted meaningful determinations, (1) whether a statistical association with herbicide exposure exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiologic methods used to detect the association; (2) the increased risk of the disease among those exposed to herbicides during Vietnam service; and (3) whether there is a plausible biological mechanism or other evidence of a causal relationship between herbicide exposure and the disease.

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National Academies Press

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ISBN 10

0309171490

ISBN 13

9780309171496

Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft

By: Institute of Medicine,Board on the Health of Select Populations,Committee to Evaluate the Potential Exposure to Agent Orange/TCDD Residue and Level of Risk of Adverse Health Effects for Aircrew of Post-Vietnam C-123 Aircraft

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Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft

From 1972 to 1982, approximately 1,500-2,100 US Air Force Reserve personnel trained and worked on C-123 aircraft that had formerly been used to spray herbicides in Vietnam as part of Operation Ranch Hand. After becoming aware that some of the aircraft on which they had worked had previously served this purpose, some of these AF Reservists applied to the US Department of Veterans Affairs (VA) for compensatory coverage under the Agent Orange Act of 1991. The Act provides health care and disability coverage for health conditions that have been deemed presumptively service-related for herbicide exposure during the Vietnam War. The VA denied the applications on the basis that these veterans were ineligible because as non-Vietnam-era veterans or as Vietnam-era veterans without "boots on the ground" service in Vietnam, they were not covered. However, with the knowledge that some air and wipe samples taken between 1979 and 2009 from some of the C-123s used in Operation Ranch Hand showed the presence of agent orange residues, representatives of the C-123 Veterans Association began a concerted effort to reverse VA's position and obtain coverage. At the request of the VA, Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft evaluates whether or not service in these C-123s could have plausibly resulted in exposures detrimental to the health of these Air Force Reservists. The Institute of Medicine assembled an expert committee to address this question qualitatively, but in a scientific and evidence-based fashion. This report evaluates the reliability of the available information for establishing exposure and addresses and places in context whether any documented residues represent potentially harmful exposure by characterizing the amounts available and the degree to which absorption might be expected. Post-Vietnam Dioxin Exposure rejects the idea that the dioxin residues detected on interior surfaces of the C-123s were immobile and effectively inaccessible to the Reservists as a source of exposure. Accordingly, this report states with confidence that the Air Force Reservists were exposed when working in the Operation Ranch Hand C-123s and so experienced some increase in their risk of a variety of adverse responses.

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110

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National Academies Press

Published Date

ISBN 10

0309308933

ISBN 13

9780309308939

Veterans and Agent Orange

Update 11 (2018)

By: National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Population Health and Public Health Practice,Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eleventh Biennial Update)

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Veterans and Agent Orange

Update 11 (2018)

From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam. Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academies of Sciences, Engineering, and Medicine was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 11 (2018) examines peer-reviewed scientific reports concerning associations between various health outcomes and exposure to TCDD and other chemicals in the herbicides used in Vietnam that were published between September 30, 2014, and December 31, 2017, and integrates this information with the previously established evidence database.

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739

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National Academies Press

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ISBN 10

0309477166

ISBN 13

9780309477161

Blue Water Navy Vietnam Veterans and Agent Orange Exposure

By: Institute of Medicine,Board on the Health of Select Populations,Committee on Blue Water Navy Vietnam Veterans and Agent Orange Exposure

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Blue Water Navy Vietnam Veterans and Agent Orange Exposure

By: Institute of Medicine,Board on the Health of Select Populations,Committee on Blue Water Navy Vietnam Veterans and Agent Orange Exposure

Over 3 million U.S. military personnel were sent to Southeast Asia to fight in the Vietnam War. Since the end of the Vietnam War, veterans have reported numerous health effects. Herbicides used in Vietnam, in particular Agent Orange have been associated with a variety of cancers and other long term health problems from Parkinson's disease and type 2 diabetes to heart disease. Prior to 1997 laws safeguarded all service men and women deployed to Vietnam including members of the Blue Navy. Since then, the Department of Veteran Affairs (VA) has established that Vietnam veterans are automatically eligible for disability benefits should they develop any disease associated with Agent Orange exposure, however, veterans who served on deep sea vessels in Vietnam are not included. These "Blue Water Navy" veterans must prove they were exposed to Agent Orange before they can claim benefits. At the request of the VA, the Institute of Medicine (IOM) examined whether Blue Water Navy veterans had similar exposures to Agent Orange as other Vietnam veterans. Blue Water Navy Vietnam Veterans and Agent Orange Exposure comprehensively examines whether Vietnam veterans in the Blue Water Navy experienced exposures to herbicides and their contaminants by reviewing historical reports, relevant legislation, key personnel insights, and chemical analysis to resolve current debate on this issue.

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158

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National Academies Press

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ISBN 10

0309216214

ISBN 13

9780309216210

The Utility of Proximity-Based Herbicide Exposure Assessment in Epidemiologic Studies of Vietnam Veterans

By: Institute of Medicine,Board on Military and Veterans Health,Committee on Making Best Use of the Agent Orange Exposure Reconstruction Model

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The Utility of Proximity-Based Herbicide Exposure Assessment in Epidemiologic Studies of Vietnam Veterans

By: Institute of Medicine,Board on Military and Veterans Health,Committee on Making Best Use of the Agent Orange Exposure Reconstruction Model

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160

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National Academies Press

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ISBN 10

030917810X

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9780309178105

Review of the Department of Defense Biokinetic Modeling Approach in Support of Establishing an Airborne Lead Exposure Limit

By: National Academies of Sciences, Engineering, and Medicine,Division on Earth and Life Studies,Board on Environmental Studies and Toxicology,Committee to Review DoDâ¬"s Proposed Occupational Exposure Limits for Lead

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Review of the Department of Defense Biokinetic Modeling Approach in Support of Establishing an Airborne Lead Exposure Limit

Biokinetic modeling provides a mathematical technique for estimating absorption, distribution, metabolism, and excretion of chemicals, including particles and metals, in humans. Such models can be used to relate the amount of lead external exposure to the amount of lead found in the blood and other tissues at different points in time. At the request of the Department of Defense (DoD), Review of the Department of Defense Biokinetic Modeling Approach in Support of Establishing an Airborne Lead Exposure Limit evaluates whether the model used by DoD to derive airborne lead concentrations from blood lead levels is appropriate. This report also considers whether DoD's modifications to the model are appropriately justified, and whether the assumptions in and inputs to the model are reasonable.

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National Academies Press

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ISBN 10

0309671957

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9780309671958

Review of the Environmental Protection Agency's Draft IRIS Assessment of Formaldehyde

By: National Research Council,Division on Earth and Life Studies,Board on Environmental Studies and Toxicology,Committee to Review EPA's Draft IRIS Assessment of Formaldehyde

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Review of the Environmental Protection Agency's Draft IRIS Assessment of Formaldehyde

By: National Research Council,Division on Earth and Life Studies,Board on Environmental Studies and Toxicology,Committee to Review EPA's Draft IRIS Assessment of Formaldehyde

Formaldehyde is ubiquitous in indoor and outdoor air, and everyone is exposed to formaldehyde at some concentration daily. Formaldehyde is used to produce a wide array of products, particularly building materials; it is emitted from many sources, including power plants, cars, gas and wood stoves, and cigarettes; it is a natural product in come foods; and it is naturally present in the human body as a metabolic intermediate. Much research has been conducted on the health effects of exposure to formaldehyde, including effects on the upper airway, where formaldehyde is deposited when inhaled, and effects on tissues distant from the site of initial contact. The U.S. Environmental Protection Agency (EPA) released noncancer and cancer assessments of formaldehyde for its Intergated Risk Information System (IRIS) in 1990 and 1991, respectively. The agency began reassessing formaldehyde in 1998 and released a draft IRIS assessment in June 2010. Given the complexity of the issues and the knowledge that the assessment will be used as the basis of regulatory decisions, EPA asked the National Research Council (NRC) to conduct an independent scientific review of the draft IRIS assessment. In this report, the Committee to Review EPA's Draft IRIS Assessment of Formaldehyde first addresses some general issues associated with the draft IRIS assessment. The committee next focuses on questions concerning specific aspects of the draft assessment, including derivation of the reference concentrations and the cancer unit risk estimates for formaldehyde. The committee closes with recommendations for improving the IRIS assessment of formaldehyde and provides some general comments on the IRIS development process.

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