Provided below is an initial email exchange with the Institute of Medicine regarding the high number and high relative proportion of Blue Water Navy personnel showing symptoms of Agent Orange disease compared to other branches of U.S. Military as presented in the 2004 Agent Orange Update (a study done for the Department of Veterans Affairs.)

This clearly shows it was known by the DVA as early as 1990 (and probably before then) that Blue Water Navy personnel were in the highest resultant Agent Orange disease category, and yet the VA chose to discontinue medical disability compensation for Agent Orange exposure to this "highest risk level" group. This has unfortunately led to the belief that offshore personnel had no significant incidence of contamination by Agent Orange or other herbicides, which is patently false.

The U.S. research regarding Agent Orange studies has become even more important with the recent admission by the researchers who compiled the report that the "Ranch Hand Study" was flawed and contained falsified data. This acknowledgement has clouded all conclussions made by the VA for the purposes of medical compensation for Agent Orange diseases for all branches of military service.

Additional references from research papers is also provided.


From: John Paul Rossie [mailto:johnr@rossie.com]
Sent: Thursday, February 02, 2006 7:02 PM
To: IOMWWW
Subject: request for information clarification

Can you direct this query to the proper individual who will be able to provide an answer to the questions found below? Thank you for your assistance.

I am inquiring about information in the Veterans and Agent Orange: Update 2004

On page 308 there is information contained in Table 6-44 regarding BLUE-WATER NAVY veterans and the Estimated Relative Risk. Your table indicates a Relative Risk factor for this group as 2.2 (1.2-3.9) This appears to be a high Relative Risk factor compared to any other group listed on that page. Can you expand upon this information as to how to interpret this "high risk factor"? Can you provide information or links to information or documentation that would provide a more complete picture of the dioxin risk level for this specific group (Blue-Water Navy veterans)?

Thank you for any information you might be able to provide.
Respectfully,

-John Paul Rossie


Subject: RE: request for information clarification
Date: Thu, 9 Feb 2006 18:19:40 -0500
From: "Paxton, Mary"
To: John Rossie
Cc: "Cohen, Jennifer"


Dear Mr. Rossie,
The individual entry you mention in Table 6-44 of Veterans and Agent Orange: Update 2004 on non-Hodgkin's Lymphoma (NHL) is a piece of evidence that has been carried forward from IOM's first review of this material, as reported in Veterans and Agent Orange published in 1994. The estimated relative risk for blue-water Navy Vietnam veterans is from the "Selected Cancers Study" conducted by the Centers for Disease Control (CDC) and published in 1990. It is indeed among the highest risks listed for studies of veterans. The Veterans' Administration (VA) has recognized NHL as a compensable exposure-presumed service-related illness for Vietnam veterans since IOM's 1994 report, but, now that you bring this to my attention, I would wonder whether the "blue-water Navy" individuals comprising this statistic would themselves be considered eligible under the VA's condition that the Vietnam veteran must have served on land to be compensated for the conditions identified by IOM.

On page 542, the 1994 report comments on this subgroup of the 32 cases noted for the Navy overall (RR=1.9, 95% CI 1.1-1.32):

"No cases occurred among naval personnel stationed on river and near-shore ships, and only four among shore personnel.

No explanation is known for the high blue water Navy odds ratio (OR=2.2, CI 1.2-3.9) [for the other 28 cases].
The study's authors feel that it is unlikely to be the result of occupational exposures aboard ship."

I am not aware of any follow-up that has been conducted on this particular set of study subjects, but I am grateful to have had this example brought to my attention and I intend to look into it further. If you have additional information on Vietnam veterans who were members of the "blue-water Navy," it would be of interest to the committee currently forming to conduct Veterans and Agent Orange: Update 2006.

Mary Paxton

Mary Burr Paxton, PhD, DABT
Senior Program Officer
Population Health and Public Health Practice
Institute of Medicine
Keck 871, 500 Fifth St., NW
Washington, DC 20001
(202) 334-1731
fax: (202) 334-2939


FURTHER RESEARCH INFORMATION Includes

Blue Water Navy Facts

Here are some quotable FACTS. They are statistical, and might be said to be "taken out of context." But the source of each quote is also provided so the information can be verified and seen "in context" as required. I believe the statements speak for themselves. These are statements of facts by reputable research institutions, and to believe otherwise is blatantly ignoring the facts.

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Navy veterans had the highest rate of cancer, higher than expected by 22-26%... 1997 Mortality of Vietnam Veterans: The Veteran Cohort Study-- (Australian Study #1, Summary) [The five Veteran Cohort Studies can be found here. ]

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Specifically, Navy veterans had a higher than expected mortality from lung cancer (39%) and melanoma (56%), whereas mortality from non-Hodgkin’s lymphoma was 48% lower than expected. Also mortality from mesothelioma was higher than expected based on small numbers. (1997 Mortality of Vietnam Veterans: The Veteran Cohort Study -- Australian Study #2 Summary)

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National Service veterans experienced a 23% higher overall mortality than non-veterans, RR = 1.23 (95% CI 1.13, 1.34).( 1997 Mortality of Vietnam Veterans: The Veteran Cohort Study -- Australian Study #3 Summary)

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The estimated relative risk for blue-water Navy Vietnam veterans is from the "Selected Cancers Study" conducted by the Centers for Disease Control (CDC) and published in 1990. It is indeed among the highest risks listed for studies of veterans. http://www.ncbi.nlm.nih.gov/pubmed/2244764 On page 542, the 1994 report comments on this subgroup of the 32 cases noted for the Navy overall (RR=1.9, 95% CI 1.1-1.32): "No cases occurred among naval personnel stationed on river and near-shore ships, and only four among shore personnel. No explanation is known for the high blue water Navy odds ratio (OR=2.2, CI 1.2-3.9) [for the other 28 cases]. The study's authors feel that it is unlikely to be the result of occupational exposures aboard ship." ((This explanation could well be 'exposure to Agent Orange' through the ships fresh water supply.)).

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Only Navy veterans had a statistically significant increased risk of testicular cancer (odds ratio (OR) = 2.60; 95% confidence interval (CI), 1.08 to 6.24).(January, 1994, Annals of Epidemiology, "Risk of testicular cancer associated with surrogate measures of Agent Orange exposure among Vietnam veterans on the Agent Orange Registry".)

http://www.ncbi.nlm.nih.gov/pubmed/8205269 **************************

The highest elevation in mortality was among veterans of the Royal Australian Navy, rather than the land and air forces (Crane et al., 1997a). Dec. 2002, Examination of the Potential Exposure of Royal Australian Navy (RAN) Personnel to Polychlorinated Dibenzodioxins and Polychlorinated Dibenzofurans Via Drinking Water.

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http://archinte.ama-assn.org/cgi/gca?gca=150%2F12%2F2473&gca=150%2F12%2F2
As part of a series of investigations into the health of Vietnam veterans, we conducted a population-based, case-control study of non-Hodgkin's lymphoma between 1984 and 1988. All men born between 1929 and 1953 and diagnosed as having non-Hodgkin's lymphoma in an area covered by eight cancer registries were considered eligible. Control subjects were identified by random-digit dialing from these same regions and were frequency-matched to men with lymphoma by age. Analyses of 1157 men with pathologically confirmed lymphomas and 1776 control subjects showed that the risk of non-Hodgkin's lymphoma was approximately 50% higher among Vietnam veterans (odds ratio, 1.47; 95% confidence interval, 1.1 to 2.0) compared with men who did not serve in Vietnam. Vietnam veterans were also at higher risk relative to (1) men who had not served in the military, (2) other veterans, and (3) other veterans who served between 1964 and 1972. An analysis of the military histories of the 232 Vietnam veterans suggested that the relative risk (1) increased with length of service in Vietnam (P = .10), and (2) was higher among men in the sea-based Navy than among other veterans (P = .11). Little difference in risk, however, was noted according to dates of service, type of unit, military region, or any other characteristics that may have been associated with the use of Agent Orange. Although the cause remains uncertain, results of this study indicate that the risk of non-Hodgkin's lymphoma is higher among Vietnam veterans than among other men. The Association Of Selected Cancers With Service In The US Military In Vietnam. I. Non-Hodgkin's lymphoma. The Selected Cancers Cooperative Study Group - Center for Disease Control

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Of the three service branches, Navy veterans had the highest overall mortality (SMR=1.37; 95% CI, 1.23-1.52) and the only significantly elevated overall mortality. The SMR for Army veterans was 1.00 (95% CI, 0.99-1.05) and for Air Force veterans 1.12 (95% CI, 0.97-1.27). The SMR for deaths from neoplasms among Navy personnel was 1.58 (95% CI, 1.31-1.89). Navy veterans also had significantly increased mortality due to diseases the circulatory system (SMR=1.26; 95% CI, 1.04-1.52) and external causes (SMR=1.48; 95% CI, 1.15-1.86). (" Health effects of Vietnam service," ADF Health, Vol 4, Sept 2003)

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Summary from Vietnam Veterans Association of Australia

"Current issues involving the Association include the recently released results of the Vietnam Veterans’ Mortality Study, (commissioned by the Department of Veterans Affairs) and following through on the self-reported issues revealed in the long-delayed Vietnam Veterans’ Health Study, including spouses and children. The Mortality Study revealed that Vietnam veterans have a death rate 7% higher than the general male population, with deaths from cancer 21% higher, prostate cancer 53% higher, lung cancer 29%, ischaemic heart disease 10% and suicides 21% above the general male population."

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