Tag Archives: vietnam veterans

Abstract WP249: Risk for Ischemic and Hemorrhagic Stroke is Increased in Veterans Exposed to Agent Orange and Those With Myeloproliferative Neoplasms

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Natasha Mathur, Andrew Tiu, Zoe McKinnell, Puneet Gill, Martha Antonio, Shanshan Liu, Guoqing Diao, Ramesh Subrahmanyam, Craig M Kessler and Maneesh R Jain

Abstract

Agent Orange (AO) is a dioxin containing defoliant and carcinogen used in the Korean and Vietnam War. There is limited evidence of the association between AO exposure among Veterans and stroke. Stroke is not yet part of the list of presumptive conditions according to the Promise to Address Comprehensive Toxics (PACT) Act which provides Veterans and their survivors disability compensation for conditions arising from exposure to AO. Myeloproliferative Neoplasms (MPN) are uncommon etiologies of stroke but whether AO exposure increases incidence of stroke in MPN has not been described.

Utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database, a case-control study was performed from 1/1/2006 – 1/26/2023 on the Veterans from Illinois, the state most representative of the US population. ICD-9 and -10 codes identified Veterans with stroke and MPN. AO exposure was verified on the Veterans’ service duration and location. Qualitative data were compared by chi-square tests.

Among 586,555 Veterans from Illinois, there were 15,455 ischemic stroke (IS), 1,593 hemorrhagic stroke (HS), 2,752 MPN, and 59,393 with AO exposure. Among MPNs, there were 237 IS (41 with AO) and 26 HS (3 with AO). IS and HS were associated with AO exposure, OR 1.34 95% CI 1.28-1.41, p<0.0001, and OR 1.20 95% CI 1.03-1.39, p=0.02, respectively. MPN is associated with IS and HS, OR 3.52, 95% CI 3.08-4.03, and OR 3.54, 95% CI 2.4-5.23, both p<0.0001, respectively. There is no significant association with AO exposure among Veterans with MPN with stroke. Among non-MPN Veterans with AO exposure, there was an earlier median age of IS and HS, 67 vs. 70 and 67 vs. 71, both p<0.0001. There was no difference in median age of stroke among MPN Veterans with or without AO exposure. There were no differences with rates of hypertension, hyperlipidemia, diabetes, smoking, heart failure, and pulmonary hypertension among MPN Veterans with stroke with and without AO exposure.

In conclusion, there is an association of AO exposure with IS and HS with an earlier onset among those exposed. There is a strong association between MPN and stroke independent of AO exposure. The biologic plausibility of endothelial dysfunction and accelerated atherosclerosis from AO exposure warrants further investigation.

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Examples of Approved VA Benefits for Vietnam Veterans

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The Department of Veterans Affairs has a search site to look up specific benefit claim cases.  Below are of few examples of MPN-related claims granted (on appeal).

To search the entire VA claims database click here. -for best results be sure to fill in specific illness and search all possible years.

Myelofibrosis

Citation 18101521-Read full report here

FINDINGS OF FACT –

1. An unappealed claim for service connection for myelomonocytic leukemia was denied by the RO in an October 2011 rating decision. The Veteran was notified of the rating decision, but did not appeal.

2. Evidence received since the last final October 2011 rating decision is new and material, and relates to an unestablished fact necessary to substantiate the claim for service connection for myelofibrosis.

3. The Veteran has a current diagnosis of myelofibrosis.

4. The Veteran is presumed to have been exposed to herbicide agents, to include Agent Orange, in service based on his service in the Republic of Vietnam during the Vietnam Era.

5. The medical evidence of record establishes that the Veteran’s myelofibrosis is related to presumed herbicide agent exposure during service.

CONCLUSION OF LAW -New and material evidence has been received to reopen service connection for myelomonocytic leukemia, now claimed as myelofibrosis. The criteria to establish service connection for myelofibrosis are met.

REASONS AND BASES FOR FINDING AND CONCLUSION-(View full report by clicking on citation number above)… This language was included in the Finding…

A letter dated August 2014 from T.A., MD notes that the doctor provided care for the Veteran beginning in 2005 after he was diagnosed with leukemia. Doctor T.A. stated that he reviewed the Veteran’s military records and considered his exposure in Vietnam to Agent Orange. Citing reports by the Institute of Medicine and the Myeloproliferative Neoplasm Research Foundation, Doctor T.A. stated that Agent Orange is a known causative agent of the type of leukemia with which the Veteran was diagnosed. Considering the Veteran’s diagnosis, military and medical records, and the absence of a family history of bone marrow disease, Doctor T.A. opined that it is more likely than not that the Veteran’s leukemia is a direct result of his exposure to Agent Orange during service. 

Citation=0309503-Read full report here

FINDING OF FACT –  There is competent evidence attributing the diagnosis of primary myelofibrosis to the veteran’s service.

CONCLUSION OF LAW –  Primary myelofibrosis was incurred in service.

REASONS AND BASES FOR FINDING AND CONCLUSION-  Although the Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096, is applicable to the veteran’s claim, the Board finds that it is unnecessary to address its applicability in this case in view of the disposition reached herein. The veteran’s service records show that his occupational specialty was that of an aircraft engine mechanic during his military career. In 2000, the veteran was diagnosed with primary myelofibrosis. The veteran asserts that he developed this disease due to Agent Orange exposure while in Vietnam.

Citation 0731552-Read full report here

FINDINGS OF FACT:

1. The veteran served on active duty in the Republic of Vietnam during the Vietnam era.

2. He currently has myeloproliferative disorder with myelofibrosis; this condition was initially diagnosed many years after service.

3. Medical evidence is in relative equipoise as to whether the veteran’s myeloproliferative disorder with myelofibrosis was caused by exposure to Agent Orange in service.

 

Background/Analysis:

The veteran has submitted evidence which suggests an association between myeloproliferative disorder with myelofibrosis and exposure to chemicals, such as benzene. He submitted articles which discuss the use of Agent Orange during the Vietnam War. The articles indicate that Agent Orange was a 50-50 mix of two chemicals and that the combined product was mixed with kerosene or diesel fuel and dispersed by aircraft. Other articles note that benzene is a volatile aromatic hydrocarbon which causes various types of leukemia, lymphoma and blood diseases, including myelofibrosis. The greatest risk was to workers who use various petroleum solvents containing benzene such as painters, gasoline distribution workers, refinery workers, chemical workers, rubber workers, printers, newspaper pressworkers and shoe and leather workers. The veteran submitted additional articles regarding herbicide exposure, benzene exposure, dioxins and the health risks associated with exposure to small amounts of chemical benzene.

CONCLUSION OF LAW -Resolving all reasonable doubt in favor of the veteran, myeloproliferative disorder with myelofibrosis was incurred as the result of exposure to Agent Orange in service.

 

Essential Thrombocythemia

Citation 19144431 -Read full report here

FINDINGS OF FACT

1. Resolving reasonable doubt in his favor, the Veteran was exposed to Agent Orange during active service.

2. The Veteran’s thrombocythemia is associated with in-service Agent Orange exposure.

3. The Veteran’s venous stasis ulceration of the bilateral lower extremities is proximately due to his service-connected thrombocythemia

…The Veteran submitted two letters from his treating physicians linking his thrombocythemia to his Agent Orange exposure. An October 2010 letter from the Veteran’s oncologist, Dr. D.B., indicated that the Veteran was diagnosed with thrombocythemia and has been under his care since June 2009. Dr. D.B. wrote that the Veteran was exposed to Dioxin while in Vietnam. He indicated that the Veteran’s diagnosis of essential thrombocytosis was as likely as not related to Dioxin (Agent Orange). A January 2011 letter from Dr. N.B., a hemotologist, indicated that the Veteran was also under her care. Dr. N.B. wrote that the Veteran was exposed to dioxin on different occasions while serving in Vietnam. At the time, she indicated that she was not aware of any studies linking dioxin to essential thrombocythemia but felt that the Veteran’s condition may be as likely as not related to his dioxin exposure.

CONCLUSION OF LAW – Essential thrombocythemia, a form of leukemia, was incurred in active service.

 

Polycythemia Vera

Citation 1414817- Read full report here

FINDINGS OF FACT

1. The Veteran served in the Republic of Vietnam during the Vietnam era, and therefore he is presumed to have been exposed to herbicides.

2. The most probative evidence of record demonstrates that the Veteran’s polycythemia vera is etiologically related to his in-service herbicide exposure.

CONCLUSION OF LAW The criteria for service connection for polycythemia vera are met.

Please see language below in this case the “nexus” is specifically explained as contributing to the decision to grant benefits.

“Concerning Shedden element (3), a nexus between the Veteran’s in-service herbicide exposure and his current polycythemia vera, the Board notes that there are positive nexus opinions of record. An October 2009 treatment record by Dr. Green, D.O., indicated that it was notable that the Veteran had served in Vietnam and that it was entirely possible that he had been exposed to chemicals during his tour of duty which may have contributed to his myeloproliferative disorder (polycythemia vera is categorized as a myeloproliferative disorder). Also of record are several letters from Dr. Webb, M.D., the Veteran’s primary care physician. In the most recent letter, dated August 2012, Dr. Webb noted that the Veteran was previously evaluated by a hematologist who believed that chemical exposure during the Veteran’s tour in Vietnam, specifically Agent Orange, had contributed to his current medical condition. Dr. Webb went on to reason that given the lack of other possible etiologies for his condition and the mounting evidence that Agent Orange has been implicated in other cases of polycythemia, the Veteran’s exposure would make the most sense for a cause and effect relationship. Dr. Webb opined that, based on his review of the Veteran’s records, he concurred that the Veteran’s Vietnam exposure was at least as likely as not to be contributory to his current medical condition. In the absence of any contrary nexus evidence, the Board finds the private physicians’ opinions to be the most probative evidence concerning the etiology of the Veteran’s polycythemia vera. Accordingly, the Board finds Shedden element (3) has been satisfied.”