More than four decades have passed since the U.S. involvement in the Vietnam War ended and the last American troops left the country. Yet, for veterans of the war -- and in some cases, their next of kin -- the impact of that service on their well-being is still being determined, particularly for those exposed to the herbicide Agent Orange.
Contaminated with the chemical dioxin, millions of gallons of Agent Orange were sprayed in South Vietnam during the war as part of a defoliation program to reduce tree cover for North Vietnamese and Viet Cong troops and kill crops that provided food for the opposition.
In the years following the war, exposure to Agent Orange has been found to be associated with a higher risk of developing many health conditions. And veterans groups say more still needs to be done to care for veterans exposed to the herbicide, as well as their family members. At present, the U.S. Department of Veterans Affairs recognizes certain cancers and other health problems among a list of "presumptive diseases" -- or conditions presumed to be associated with exposure to Agent Orange or other herbicides during military service. Those range from certain luekemias, Hodgkin's disease and prostate cancer to Parkinson's disease. As noted on its website, the VA also presumes certain birth defects in children of Vietnam and Korean War veterans are associated with their parents' service. That includes spina bifida, a birth defect that occurs when a baby's spine doesn't form properly and that has been linked to Agent Orange exposure. And scientists keep turning over more stones to unearth the long-term health impact.
Agent Orange and Hypertension
Most recently, the focus has turned to whether Agent Orange exposure may raise veterans' risk of developing another condition that -- like with diabetes -- is quite prevalent in older Americans: high blood pressure. To take a closer look, VA researchers published a study in November in the Journal of Occupational and Environmental Medicine evaluating relative hypertension risk for aging veterans who had served in Army Chemical Corps, including those who sprayed Agent Orange by hand and from helicopters. "What the findings showed was that the highest risk for reporting hypertension was among those who stated that they were sprayers and were in Vietnam," says Aaron Schneiderman, director of epidemiology in Post-Deployment Health Services at the Veterans Health Administration, which is part of the Department of Veterans Affairs. Of those studied, 81.7 percent of Vietnam sprayers had self-reported and physician-diagnosed hypertension. That compared with about 77.4 percent of sprayers who served outside of Vietnam, 72.2 percent who served in Vietnam but weren't sprayers and 64.6 percent of non-Vietnam non-sprayers.
"While the type of study conducted, a cross-sectional study, cannot be sure of cause, it does demonstrate an association between exposure to Agent Orange with its dioxin contamination and elevated blood pressure," says Dr. Arnold Schecter, a Vietnam-era veteran, dioxin scientist and adjunct professor at the University of Louisville Medical School and School of Public Health and Information Sciences in Kentucky. However, he adds: "Most Vietnam veterans are not believed to have much, if any, elevation of that dioxin from Agent Orange exposure based on this study and others."
Whether the VA will add hypertension to its list of conditions presumed to be associated with Agent Orange exposure remains to be seen. "We're looking at it very carefully right now," says Dr. Ralph Erickson, chief consultant of Post-Deployment Health Services at the Veterans Health Administration. "This is certainly a study that would add evidence in favor of looking more seriously at hypertension as perhaps one of those presumptions." That decision will ultimately be left to the new incoming administration under President-elect Donald Trump.
Accessing Needed Care
Veterans' advocates encourage veterans to file claims with the VA for so-called "service-connected" conditions, including those presumed to be associated with Agent Orange exposure, to receive compensation and ensure they're able to get medical treatment through the VA. "It's not for monetary benefits as much as it is access to the system," says Rick Weidman, executive director of government affairs for Vietnam Veterans of America, a group that advocates for all veterans and their families. Weidman says that given the hurdles many face in having claims processed in a timely fashion, veterans should get help from a service officer from a veterans group who can advocate on their behalf. VVA offers a self-help guide for veterans who've been exposed to Agent Orange and their families.
Mokie Porter, VVA's director of communications, urges those children and grandchildren of vets to educate their physicians. "Inform them of your parent or grandparent's military service and toxic exposures; request that this military health history be included in your medical records," he says. He recommends anyone who believes that his or her health has been impacted by a veteran parent or grandparent's military toxic exposure register with Birth Defect Research for Children. The nonprofit registry collects and provides information on birth defects to parents and expectant parents.
Weidman, a Vietnam vet, receives limited compensation for his diabetes, which is also on the VA's list of conditions presumed to associated with Agent Orange exposure; and he gets treatment through the VA for high blood pressure -- a condition for which he plans to file a claim for compensation. He recalls how research shed light on diabetes' association with Agent Orange. In some cases, veterans who were in great shape with no family history of diabetes ended up developing the disease, he says. So as not to confuse the issue regarding treatment, though, experts point out that standard advice to prevent and manage chronic health conditions still applies. Weidman is able to control his diabetes primarily through diet and medication.
Weidman criticizes the VA for not doing more to study potential health issues related to Agent Orange. "The VA has continually resisted doing this type of research," he says, adding that's kept more conditions from being added to the list of diseases presumed to be associated with Agent Orange -- a designation that's intended to expedite the processing of veterans' claims. "They don't want to pay, basically," Weidman says.
Erickson says the VA is actively studying Vietnam veterans exposed to Agent Orange to better understand the health issues they face and find ways to best address them. "We're not satisfied with the status quo," he says. The VA is seeking to reach veterans in-person and online to enroll for care and access benefits tied to exposure to Agent Orange or other herbicides during military service. He also recommends vets who feel their health may have been affected by exposure to Agent Orange join the VA's Agent Orange Registry, which includes undergoing a comprehensive health exam to determine if they have any long-term health problems that may be related to exposure to the herbicide during their military service. In addition, he adds that the VA's War Related Illness and Injury Study Center, which has locations in the District of Columbia; East Orange, New Jersey; and Palo Alto, California, caters directly to some of these special deployment-related and environmental-related health care issues, like those related to Agent Orange.
Even today, the complete picture of how Agent Orange exposure -- seemingly a lifetime and half a world away -- affects aging vets and their families hasn't come fully into focus. But by taking steps and getting support, including from veterans groups, experts say, veterans can receive the care they need and manage chronic conditions to optimize their health.
Michael Schroeder is a health editor at U.S. News. He covers a wide array of topics ranging from cancer to depression and prevention to overtreatment. He's been reporting on health since 2005. You can follow him on Twitter or email him at firstname.lastname@example.org.