Trib feature on Agent Orange

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For those who have not followed this series, it is a must read. There are so many things that the general public should know and understand in order to see the world around them.

 

http://www.chicagotribune.com/health/agent...0,1766354.story

 

Part 1 of a Tribune investigation finds that U.S. officials have neglected a lasting problem even as the health fallout has spread. Complete coverage >>

 

In central Indiana, two sisters struggle through another day, afflicted by a painful condition in which their brains are wedged against their spinal cords. They are in their 30s, but their bodies are slowly shutting down.

 

Thousands of miles away, amid the rice paddies of Vietnam, a father holds down his 19-year-old daughter as she writhes in pain from a seizure brought on by fluid in her skull, which has been drained four times in the past four years.

 

"The doctors said that they were sorry, but they could not cure her," the father says. "They told me I should take her home and that she would pass away very soon."

 

These women come from different cultures, from nations separated by more than 8,300 miles. Their fathers fought on opposite sides of the Vietnam War, but they are linked by the stubborn legacy of Agent Orange and other defoliants sprayed by the U.S. military decades ago.

 

Contaminated with dioxin, a chemical now considered the most toxic ever created by man, the defoliants are linked to a higher risk of multiple cancers, birth defects and other conditions that are contributing to a dramatic increase in financial compensation for U.S. veterans and their families.

 

Service-related disability payments to Vietnam veterans have surged 60 percent since 2003, reaching $13.7 billion last year, and now account for more than half of such payments the U.S. Department of Veterans Affairs provides to veterans of all wars. The average compensation payment for Vietnam vets is 41 percent higher than that for World War II veterans and 35 percent higher than for those who served in Korea. Those disability checks do not include the billions spent on health care for Vietnam veterans.

 

The price tag is only expected to escalate as scientists learn more about the effects of dioxin, as veterans are stricken late in life and as the children of veterans discover they are sick. In September, three more diseases were added to the list of illnesses for which the VA provides compensation -- an expansion the agency estimates will affect roughly 200,000 veterans and cost billions of dollars annually.

 

Meanwhile, untold numbers of Vietnamese -- including many who weren't even alive during the war -- also suffer from maladies associated with the defoliants. Tens of thousands more are at risk today from dioxin that remains in the environment at dozens of former U.S. military bases.

 

Yet in the 30 years since Agent Orange was recognized publicly as a potential health threat, the federal government has established a record of neglect.

 

U.S. veterans seeking compensation for their illnesses face delays and a maddening bureaucracy. Adding to their frustration, the federal government never has gotten to the bottom of Agent Orange's full impact, failing to follow through on requests for large-scale studies on how defoliants may have affected veterans' health.

 

In Vietnam, children sing songs of the devastation caused by Agent Orange and government officials wonder how the U.S. can avoid fully addressing the health and environmental havoc wreaked by the chemicals, even as the two nations foster stronger trade and military ties.

 

Since the countries normalized relations in 1995, Congress has allocated just $6 million for herbicide-related issues in Vietnam, even though Vietnamese officials say addressing them will take tens of millions. The Ford Foundation, a philanthropic organization that has made Agent Orange a focus, has provided $11.7 million.

 

With assistance from the Fund for Investigative Journalism, the Tribune spent a month traveling to eight provinces throughout Vietnam, conducting nearly two dozen interviews with civilians and former soldiers who say they were exposed to the defoliants.

 

The newspaper used a database of every spraying mission, mapping software and a GPS device to help corroborate their stories. And in the U.S., the paper researched thousands of pages of government documents and traveled to the homes of veterans to gauge the impact and measure the cost in both dollars and human misery.

 

Some scientists remain skeptical that Agent Orange and other defoliants directly cause diseases. But with hundreds of independent studies completed in the years since the war ended, there is strong evidence that people exposed to the herbicides have a higher risk of contracting illnesses such as soft tissue sarcoma and non- Hodgkin's lymphoma. The number of medical conditions linked to the defoliants continues to grow.

 

The lingering controversy over the herbicides on both sides of the Pacific Ocean provides a sobering reminder of the often unforeseen consequences of war at a time when the country is fighting protracted conflicts in Iraq and Afghanistan.

 

"We do not know the answer to the question: What happened to Vietnam veterans?" said Jeanne Stellman, an epidemiologist who has spent decades studying Agent Orange for the American Legion and the National Academy of Sciences. "The government doesn't want to study this because of international liability and issues surrounding chemical warfare. And they're going to win because they're bigger and everybody's getting old and there are new wars to worry about."

 

A deadly defense

 

The U.S. military began spraying herbicides in South Vietnam in 1961, as the Cold War raged and America seemed beset on all sides by the threat of communism. Vietnam, a sliver of a country hugging the South China Sea, was split in half, with communists controlling the north. Led by nationalist leader Ho Chi Minh, the communists sought to reunite the country by toppling the U.S.-backed Republic of Vietnam in the south.

 

The greatest asset of the armies fighting the U.S. may have been the landscape of South Vietnam. Triple-canopy jungles cascading down mountainsides, patchworks of rice paddies and dense forests covered a battlefield where the line between enemy and civilian was often blurred.

 

The verdure allowed North Vietnamese forces to harass, resupply and melt back into the thick vegetation while surviving on food grown by local supporters.

 

The U.S. countered with chemical defoliants aimed at destroying the natural fortresses protecting the enemy. Over 10 years, U.S. and South Vietnamese forces released nearly 20 million gallons of herbicides in Southeast Asia, enough to blanket Lake Michigan four times. The vast majority of the missions took place in South Vietnam, but border areas in Cambodia and Laos were also sprayed.

 

Though Agent Orange was the most widely used herbicide, there were actually a half-dozen "agents," including White, Blue, Purple, Pink and Green. About 65 percent of them were contaminated with TCDD, a highly toxic form of dioxin, while more than 1 million gallons of Agent Blue contained arsenic.

 

The U.S. military stopped using Agent Orange in 1970 after a study for the National Institutes of Health showed that a chemical found in some of the compounds caused birth defects in laboratory animals. Soon after, the U.S. surgeon general halted the domestic use of that chemical, a dioxin-tainted compound known as 2,4,5-T.

 

Some limited spraying continued in Vietnam for another year, but only with agents that did not contain dioxin. The herbicide program, known as Operation Ranch Hand, stopped in 1971, four years before the war officially ended.

 

'We're a mess'

 

Nearly four decades later, on a quiet street in Brownsburg, Ind., Carrie Price-Nix and Amanda Price Palmer have resigned themselves to a life of prolonged fatigue and permanent disability. They've had 41 surgeries between them in the past 20 years, including five brain operations, two spinal cord surgeries and one hysterectomy.

 

Their father, Stephen Price, was an Air Force mechanic who served at the U.S. air base in Da Nang in 1967. Even today, the site is contaminated with levels of TCDD that are as much as 365 times higher than what the World Health Organization deems safe.

 

Price died in April 2008 after fighting leukemia, diabetes and chloracne, all of which are associated with the herbicides used in Vietnam. He began receiving full disability compensation from the VA in 2005, after waiting two years for his claim to be approved.

 

His daughters both have Chiari malformation, a structural defect in the base of the brain associated with spina bifida, which the VA recognizes as a defoliant-related birth defect in the offspring of male veterans.

 

Price filed a claim with the VA for Price-Nix in July 2002. Three and a half years later, she was approved for partial compensation. By that time, her bladder had shut down, and her father was dying.

 

Palmer, who has similar health problems, has spent six years seeking compensation from the VA. "They're waiting for you to die," her sister said. Last week, the agency denied Palmer's claim, ruling her illness is not related to spina bifida.

 

The deterioration of Palmer's abdominal muscles forces her to remove her feces manually. Price-Nix has a pacemaker-like device to regulate her bowels and must catheterize herself daily.

 

"We're a mess," Palmer said jokingly. Then the sisters began weeping as they pondered the reality that there is no recovery from their conditions.

 

See video of the sisters discussing their family's health issues

 

Far away from Brownsburg, in central Vietnam's Quang Binh province, Do Thi Hang, 19, suffers from symptoms similar to the sisters'. She has regular seizures caused by the fluid that accumulates in her brain. She can't walk and has trouble controlling her bowels.

 

Her parents have never been given a specific diagnosis because of Vietnam's underdeveloped health care system, but Hang's ailments mirror those of people suffering from spina bifida.

 

As a soldier fighting the U.S., Hang's father, Do Duc Diu, 58, was stationed for four years at an abandoned U.S. air base called A So, located in a valley where parts of the Ho Chi Minh Trail wound along the Laotian border. U.S. and South Vietnamese forces sprayed more than 400,000 gallons of herbicides in the Aluoi Valley, formerly known as A Shau.

 

New studies show that areas where the U.S. military stored chemicals on the A So air base are still contaminated with dangerously high levels of TCDD.

 

Since the war ended, Diu and his wife, Pham Thi Nuc, have had 15 children. Twelve died before the age of 3, all from illnesses similar to Hang's, Diu said. Their small graves sit atop a sandy hill behind Diu's home where he goes nearly every day to burn incense.

 

"I can say that I have no future, no happiness," he said.

 

See video of Diu's family at home in Vietnam

 

Invisible wounds

 

The compensation U.S. veterans now receive for herbicide-related illnesses was gained only after a long, hard-fought battle in which the lines between science and politics were often blurred.

 

Part of the problem was that veterans were returning home with invisible wounds. Their fight to receive recognition and compensation for their war-related illnesses, including post-traumatic stress disorder, opened the door for veterans of all wars.

 

"The better care that troops get now is owed to their Vietnam brothers," Stellman said.

 

New scientific studies, dogged investigations into political interference in government-sponsored studies and a $180 million settlement in a veterans' class action suit against chemical companies paved the way for the Agent Orange Act of 1991.

 

Among other provisions, the legislation created a list of "presumptive illnesses" for which Vietnam veterans could be compensated. It directed the National Academy of Sciences to review studies on the chemicals found in the herbicides and, every two years, recommend additions to the list. Diseases or birth defects are recommended if exposure to defoliants is more likely than not to increase a person's risk.

 

Since then, the VA has added 15 diseases as well as 17 birth defects in the children of female veterans.

 

But veterans groups say as many as a dozen more illnesses could be associated with the herbicides, as could numerous birth defects in the offspring of male vets.

 

One reason for the slow pace in adding diseases is that the VA relies on outside research on workplace exposure and industrial accidents instead of conducting a broader epidemiological study on veterans, which Congress first asked for in 1979. For years the agency said it could not study the impact of the herbicides on veterans because it had no way of measuring their exposure.

 

But that excuse is no longer valid, according to Stellman, professor emeritus at Columbia University's school of public health.

 

With her husband, Steven, an epidemiology professor, she compiled a comprehensive database on spraying missions and used it to develop an exposure model that has twice been blessed by the Institute of Medicine, an independent panel of medical experts whose recommendations on health policy help guide the VA's decision-making.

 

The VA said in 2003 it would take the model under advisement. The agency is still evaluating it.

 

"I'm surprised that it hasn't been pursued more energetically," said Dr. David Savitz, a physician at Mount Sinai School of Medicine in New York City who chaired the institute's review panel.

 

In September, the VA announced a broad, three-year study on Vietnam veterans' health, but it won't look specifically at defoliants like Agent Orange. Coming more than three decades after the war ended, the plan has many veterans believing the government is simply waiting for them to disappear.

 

"The mantra of the VA is delay, delay, delay until they all die," charged Paul Sutton, a Vietnam veteran and former chairman of Vietnam Veterans of America.

 

Retired Army Gen. Eric Shinseki, now the secretary of veterans affairs, has acknowledged the adversarial relationship between the VA and former soldiers. A Vietnam veteran who was wounded in combat, Shinseki has vowed to be more of an advocate for those who serve the country.

 

Members of Congress say much of the foot-dragging on studying Agent Orange is tied to the bottom line.

 

"I don't think they really want to know the answer," said Rep. Bob Filner, D-Calif., chairman of the House Veterans Affairs Committee. "The (financial costs) would be so high that they'd scare the hell out of everybody."

 

Jason Grotto reported from Vietnam; Tim Jones reported from Indiana.

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Part 2 of a Tribune investigation finds that for many U.S. veterans, the bureaucratic fight to be compensated for health problems linked to Agent Orange amounts to a new and unexpected war, long after the shooting ended overseas. Complete coverage >>

 

Jack Cooley delivered his final argument in a long, distinguished legal career from a hospital bed.

 

Four months before succumbing to multiple myeloma, the Chicago-area Vietnam veteran and federal magistrate judge wrote a 140-page claim for justice and filed it with the U.S. Department of Veterans Affairs. Cooley's message to the government was personal and direct: Agent Orange is killing me, and you need to take responsibility.

 

Cooley didn't know it last spring, but when the former Army artillery captain filed his disability claim, he was just entering a maddening bureaucratic maze many veterans know well. The VA would kick back Cooley's claim after a month, saying he lacked the required proof he'd served in Vietnam.

 

Cooley could have spent months navigating this convoluted path. But with Cooley's life fading, his family reached out to an old friend, a member of his West Point class of 1965. It was former Army Chief of Staff Eric Shinseki, recently appointed secretary of the Department of Veterans Affairs.

 

In short order the obstacles to Cooley's claim disappeared. The VA delivered three monthly disability checks for $2,700 before Cooley died July 21, at 65, in Evanston.

 

"This was insult to injury," said his daughter Christina. "If Gen. Shinseki was not ... a family friend and a West Point classmate, we would have never seen a dime. It makes me think about everybody else out there struggling without resources."

 

The Vietnam War ended almost 35 years ago, but for many veterans, battles with cancer, diabetes, Parkinson's disease and other maladies associated with defoliants used in the war are only now beginning. Until 2007, Jack Cooley had been in good health.

 

For many veterans, this is the unexpected new war, long after the old one ended.

 

The government has been slow to recognize the connection between wartime service and debilitating diseases that strike Vietnam veterans decades later. Even when they suffer from conditions officially linked to Agent Orange, veterans can wait years for their requests for disability compensation to run through the VA system.

 

Jack Cooley's death from multiple myeloma, a form of blood cancer associated with exposure to Agent Orange, opens a window into the clogged workings of the VA, the final arbiter on war-related disability claims.

 

"The truth is, veterans who went to Vietnam returned much sicker than their (civilian) peers. Something happened over there. Why arm wrestle over it?" said Linda Schwartz, commissioner of veterans affairs in Connecticut and the author of early studies on the health of female veterans.

 

The VA declined requests to interview Shinseki, who has said he wants to change the culture at the agency and make it more of an advocate for those who serve the country.

 

As long-dormant effects of Agent Orange begin to surface in many Vietnam War veterans, the backlog of disability claims has been growing fast, despite the VA's adding more than 3,000 employees to handle the traffic jam.

 

"They're overwhelmed," said Joe Moore, a former VA attorney who now represents veterans in cases against the agency. "They simply can't do the decision-making fast enough."

 

In response to a December 2008 lawsuit filed in U.S. District Court in Washington seeking to force the VA to decide claims in 90 days, the government acknowledged that "certain diseases for Vietnam-era veterans" are contributing to the backup.

 

The lawsuit, filed by the Vietnam Veterans of America and Veterans of Modern Warfare, argues that "thousands of veterans die each year" before the VA acts on their disability claims. The lawsuit alleges the VA takes at least six months to consider an initial request, and appeals can drag on for years.

 

"In the face of such delays, many veterans simply give up, choosing to accept less than they deserve rather than to endure years of delay and frustration," it said.

 

Or they just die early. According to data from the VA, 58 percent of the 490,135 Vietnam veterans who died from 2000 to 2007 were younger than 60.

 

For Vietnam veterans, the ongoing drama over Agent Orange can be broken into three acts. In the first, soldiers are totally unaware of the dangers posed by dioxin-laced defoliants sprayed in Vietnam. With the second comes outrage at the belated discovery of harm. And the third act is frustration with the bureaucracy set up to help veterans.

 

James Sprandel, a retired truck driver for the Chicago Department of Streets and Sanitation, has lived through all three.

 

Sprandel left South Vietnam almost 41 years ago, relieved to have survived his one-year tour as a combat medic at Tan An Airfield, about 20 miles south of Saigon. Today Sprandel, 64, uses a wheelchair because of diabetes and neuropathy, a nerve disorder that has drained the strength from his legs. The VA took 14 months to approve his disability claim.

 

Although he has little desire to revisit the war, Sprandel said he clearly recalls being assured that nothing was wrong with the water from rivers and streams around the air base. "There was a huge tank for bathing. ... We bathed in it, we drank it. They told us it was potable water," Sprandel said.

 

Never informed of the health risks, soldiers commonly reused Agent Orange barrels as barbecue pits, toilets and holding tanks for shower water. Studies show that as much as five gallons of residue often remained in 55-gallon barrels.

 

Not long after the war, it appeared the government would respond to the emerging realization that veterans faced a health threat from their exposure. Upon learning about Agent Orange's risks, Congress ordered a full epidemiological study in 1979 with the intent of determining and monitoring the health impact of exposure to the defoliants.

 

But the government balked at the directive and has yet to carry it out.

 

Early studies on women who served in Vietnam suggested a higher risk of several types of cancer, as well as reproductive problems and birth defects in their children. But, as with male veterans, extensive studies still have not been completed.

 

Meanwhile, veterans joined a massive class-action lawsuit against Dow Chemical Co., Monsanto and other chemical companies that produced herbicides used in Vietnam. The case was settled out of court in 1984 for $180 million. The most common payment, distributed from 1988 to 1997, was for mental disorders -- which, ironically, research has never linked to Agent Orange.

 

Out-of-court settlements often suggest closure of a dispute, but the controversy has only grown in the last 25 years. At the time of the agreement scientists did not fully understand the long-term effects of dioxin, especially its connection to cancer and other slow-developing diseases, gradually documented in small studies.

 

In 1998, attorneys filed a new lawsuit against chemical companies that manufactured defoliants, contending that the settlement money had dried up by the time thousands of veterans developed illnesses linked to the defoliants. The 2nd U.S. Circuit Court of Appeals rejected the argument, and the Supreme Court declined to hear the case in March.

 

The most comprehensive study on the defoliants' health effects was conducted by the Air Force, which over 27 years took biological samples from and tracked the health of a small number of soldiers who personally handled and sprayed the chemicals during the war.

 

The Operation Ranch Hand study, named for the defoliation effort, has long been criticized for underestimating the impact of the chemicals. More recently, new information has emerged showing that some herbicides used in the war contained even more dioxin than was once thought.

 

Scientists who worked on the study say re-examining the rich data in this light could bring crucial new insights. "I believe the whole thing needs to be reconsidered," said Joel Michalek, an epidemiologist at the University of Texas Health Science Center at San Antonio.

 

Last year, Congress directed the VA to provide funding to do just that. So far the money has not been made available.

 

A war on 2 fronts

 

Mary Ann Dove's husband, a Vietnam veteran and former Marine, was diagnosed in 1989 with the same disease that killed Cooley, multiple myeloma, which the VA did not link to Agent Orange until five years later.

 

In fact, the Vietnam War had been over for 16 years before the VA acknowledged that Agent Orange exposure was associated with a higher risk of any postwar illnesses. The first three to be recognized, in 1991, were soft tissue sarcoma, non- Hodgkin's lymphoma and chloracne, a skin disorder that chemical companies had linked to dioxin decades earlier.

 

From 1991 to 1997, the VA accepted evidence that 10 diseases, including several cancers and neuropathy, were linked to Agent Orange. In the next six years, two diseases were added to its list.

 

Dove, a retired Army nurse who also served in Vietnam, recalls her husband saying early on: "You can fight the disease or you can fight the government -- you can't do both." He chose to fight the disease, which killed him within six years.

 

The government "is clueless about what it did in Vietnam and the damage that was done," Dove said.

 

The sheer number of claims contributes to the delays. According to annual reports from the VA, the number of Vietnam veterans receiving disability benefits grew 20 percent from 2003 to 2008 to 1,015,410.

 

At the same time, the number of veterans receiving aid after fighting in the Persian Gulf, Afghanistan and Iraq jumped 88 percent, to 897,000.

 

"There's a lot of pressure to decide the cases from Iraq and Afghanistan quickly. What seems to be getting lost is those cases in the middle, where the veteran has already been denied and is now appealing," said Barton Stichman, joint executive director of the National Veterans Legal Service Program, a Washington-based advocacy group for veterans.

 

Stichman said the VA is generally tightfisted and "with Agent Orange, they are skeptical adjudicators."

 

Shinseki, a veteran wounded in Vietnam, proposed new rules in October for adding diseases to the expanding list of illnesses presumed to have been caused by the defoliant. The rules will undergo a period of public comment. He says he also wants to speed up the claims process.

 

"Since my confirmation as secretary, I've often asked why, 40 years after Agent Orange was last used in Vietnam, we're still trying to determine the health consequences to our veterans who served in the combat theater," Shinseki said in a statement at the time. "Veterans who endure a host of health problems deserve timely decisions."

 

Paul Sutton, the former chairman of Vietnam Veterans of America, called the announcement too little, too late.

 

"At this stage, about a million-and-a-half of us are already gone," Sutton said.

 

Feeling 'betrayed'

 

Jack Cooley never expected to fight his government. He attended a military high school in St. Louis and, at West Point, developed a deep respect for Civil War Gen. Ulysses Grant. "Jack is not the type to 'take things by storm,' " his classmates said of him in the 1965 West Point yearbook, the Howitzer.

 

One July day in 1968, Cooley flew by helicopter to Quang Tri province's Landing Zone Jane, which he described in a letter to his wife, Maria, as "God-forsaken."

 

Cooley was traveling the area as an artillery officer based at Camp Carroll. In all, 168,000 gallons of Agent Orange and other defoliants were dumped on the province in the year he spent there, according to a Tribune analysis of spraying data.

 

"This is one of the better places to be at the present time," Cooley assured his mother in a tape recording he mailed home in early 1968.

 

After leaving the Army, Cooley would earn a law degree from the University of Notre Dame, clerk for a federal judge in Chicago and be appointed a federal magistrate. He earned a reputation as a skilled mediator who could bring people together. He wrote textbooks on problem-solving and taught at Northwestern and Loyola universities.

 

When he was diagnosed with multiple myeloma, Cooley quickly made the connection to Agent Orange.

 

"I then (in the summer of 2007) put 2 and 2 together and realized that I had been exposed to massive amounts of toxic chemicals in the air observer assignment and other job assignments I had while in Vietnam," Cooley wrote in his claim to the VA for disability compensation.

 

The Cooleys started work on his claim to the VA while he was in intensive care in an Evanston hospital, having earlier undergone a stem cell transplant that failed to stop the spread of the disease.

 

Christina Cooley said her father "felt very betrayed" by the government's failure to disclose the dangers of Agent Orange to the men and women serving in Vietnam.

 

"He strongly believed the government is there to watch out for us," she said.

 

At Cooley's memorial service in September, friends from the West Point class of '65 attended, including Shinseki. At the end of the service, a short prayer was recited for "families who have lost a member to Agent Orange."

 

Two weeks later a packet from the federal government was dropped in Cooley's mailbox in Evanston. Inside were documents requested nearly four months earlier, verifying that Cooley had served in the Vietnam War.

 

Tribune reporter Jason Grotto contributed to this story.

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DONG NAI PROVINCE, Vietnam - Part 3 of a Tribune investigation finds that the role of defoliants in Vietnam's high rate of birth defects remains a contentious question decades after U.S. spraying missions ended. Complete coverage >>

 

The sun beats down on Dao Thi Kieu's straw hat as she hunches over thin strands of bright green rice plants, pulling them from beds submerged in muddy water and replanting them elsewhere.

 

These are the same paddies Kieu tended as a teenager during the Vietnam War, and she still remembers the planes that came in the mornings to spray Agent Orange and other defoliants while she worked.

 

"I was about 16 when I saw the planes flying overhead, and I saw the spraying until I was married," said Kieu, 58. "It smelled like ripe guava. No trees could survive. It made my clothes wet."

 

Her vivid memories are supported by data from spraying missions analyzed by the Tribune, which show at least seven sorties that dispensed nearly 13,000 gallons of defoliants passed over Kieu's fields.

 

Since then, the story of Kieu's life can be told with simple, heartbreaking math. She had eight children. Seven of them were born with severe deformities. Of those, five died before age 8. She also lost her husband, who served in the U.S.-backed South Vietnamese army, to cancers associated with herbicide exposure.

 

Decades after the Vietnam War ended, the most contentious question surrounding the use of defoliants by the U.S. military is the impact on the health of untold numbers of Vietnamese.

 

At the heart of the controversy is the suspected link between the herbicides and birth defects in Vietnam, where more than 5 out of every 100 children are born with some form of physical or mental abnormality, a fourfold increase since the start of the war, according to Vietnamese scientists.

 

The U.S. government spent $13.7 billion last year on disability payments for more than 1 million Vietnam veterans, many of whom were exposed to herbicides. Millions more have been spent compensating veterans' families whose children were born with birth defects. But U.S. officials bristle at acknowledging connections between the defoliants and illnesses in Vietnam.

 

Since the countries normalized relations in 1995, Congress has allocated at least $125 million to fight HIV/AIDS in Vietnam, whose infection rate ranks 67th worldwide. About $46 million has been provided to help Vietnamese who lost limbs from unexploded bombs dropped by the United States.

 

Yet, since the war ended 35 years ago, Congress has set aside just $6 million to assist Vietnam with herbicide-related issues, despite evidence that large numbers of civilians in the south -- people in whose name the war was fought -- were exposed to defoliants that have since been outlawed in the U.S.

 

Private philanthropies -- including the Ford Foundation, the Gates Foundation and Atlantic Philanthropies -- have provided nearly three times more money than the U.S. to help the Vietnamese overcome health and environmental damage brought on by the herbicides.

 

During the war, U.S. officials assured the Republic of Vietnam that the defoliants were harmless. The South Vietnamese government, in turn, sought to convince its citizens that the chemicals were safe. Vietnamese soldiers went so far as to douse themselves in the chemicals and even drink them with water, according to documents from the National Archives.

 

"Civil servants and cadres explain to the people there the harmlessness of the defoliation by spraying defoliant on the body and water and drinking it before the people," said an October 1963 report from the South Vietnamese government.

 

Like U.S. soldiers, Vietnamese citizens used empty herbicide barrels for showers and barbecues. Believing the chemicals were harmless, South Vietnamese soldiers often sold empty barrels containing as much as five gallons of herbicide residue to civilians in such places as Da Nang and Bien Hoa, government records state.

 

But many of the compounds weren't safe. They were contaminated with the most toxic man-made chemical known, the dioxin TCDD. The contaminant was an unintended byproduct of the manufacturing process used by U.S. chemical companies to produce an ingredient found in Agents Orange, Purple, Green and Pink -- compounds that made up more than 65 percent of the nearly 20 million gallons of herbicides released in Vietnam.

 

Scientists have tied dioxin to more than a dozen illnesses, including cancer, Parkinson's disease and crippling congenital disorders.

 

"I never met a hormone system that dioxin didn't like to disrupt," said Dr. Linda Birnbaum, director of the National Institute of Environmental Health Sciences and a leading dioxin expert. "It has widespread effects in nearly every vertebrate species at nearly every stage of development."

 

Early warnings

 

As a young obstetrician during the war, Dr. Nguyen Thi Ngoc Phuong brought hundreds of healthy babies into the world in Tu Du Hospital, home to Vietnam's largest maternity ward, in Saigon, now Ho Chi Minh City.

 

Then, in 1968, two years after U.S. forces expanded the use of herbicides by millions of gallons, Phuong said she delivered a baby born without a brain or a spinal cord.

 

In the next few months, she said, she delivered dozens of infants with equally severe deformities, three or four a week -- babies born with organs on the outside, with no arms, no legs, no eyes.

 

"It was very horrible for me and my colleagues," she said, her voice cracking as she wiped away tears. "The first case happened on my duty. I didn't show the mother because I was afraid she would go into shock. But the father and other family members demanded to see, and it was horrible."

 

Finally, she went to friends who wrote for one of the Saigon newspapers. Stories of birth defects linked to the U.S. war in Vietnam soon began to emerge, sparking a bitter controversy that continues today.

 

The U.S. military ended the herbicide program, known as Operation Ranch Hand, in 1971 after a study for the National Institutes of Health found that a chemical in some of the compounds caused birth defects in laboratory animals. Soon after, the U.S. surgeon general halted the domestic use of the chemical, known as 2,4,5-T. Later it became widely known that 2,4,5-T was contaminated with a highly dangerous form of dioxin, TCDD.

 

A diabolical toxin that attaches itself to the fat cells of humans and animals, TCDD can remain in the body for decades. Scientists think that once present, it binds with cell proteins known as Ah receptors, which can then trigger a series of molecular events that affect cellular growth, potentially leading to cancer and other illnesses. Researchers also hypothesize that dioxin's impact on the receptors can alter the regulation of genes, leading to changes in a person's DNA.

 

Multiple genetic and environmental factors can affect a person's reaction to TCDD, and scientists say health effects depend on genetic predisposition, the manner and amount of exposure and other factors that researchers haven't fully figured out.

 

In the case of birth defects, dozens of experiments show that laboratory animals exposed to TCDD have higher rates of birth defects, with dose and timing affecting risk. In humans, scientists have found some correlations between exposure and defects but have yet to prove a cause-and-effect relationship. Animal research suggests that the chemical can affect reproduction by corrupting sperm and interfering with hormones that regulate the development of fetuses.

 

The U.S. Department of Veterans Affairs in 2003 began providing disability compensation to the children of female Vietnam veterans if they suffer from any of 18 birth defects -- including the first deformity Phuong encountered four decades ago, known as anencephaly.

 

Male veterans' children are compensated for one defect: spina bifida, a condition in which some vertebrae in the spine are not fully formed, leading to a host of difficulties including paralysis, fluid in the brain, bowel control problems and learning disabilities.

 

Figuring out how and why children are born with birth defects remains painfully complicated. There can be multiple factors at play, many of which are never known, making the job of isolating one culprit difficult, if not impossible.

 

What is becoming clear, however, is that people -- especially women -- who are exposed to even trace amounts of TCDD, which scientists measure in parts per trillion, have a higher risk of bearing children with birth defects.

 

Conflicting views

 

The controversy over Agent Orange's impact in Vietnam stands at the crossroads of science and politics, a messy affair rife with hard feelings and stubborn assumptions on both sides.

 

Birth defects are the most emotionally charged part of the disagreement, with some Vietnamese claiming nearly every child born with a deformity is a victim of Agent Orange, while U.S. officials demand definitive proof that defoliants are to blame for any birth defect.

 

"The Vietnamese authorities, particularly at the local level, tend to lump all of these birth defects together and talk about them being related to Agent Orange," said Michael Marine, the U.S. ambassador to Vietnam from 2004 to 2007. "At the same time, I didn't think the U.S. side was tackling this with enough vigor. It was politically toxic to deal with."

 

As evidence of the large-scale impact of the herbicides, the Vietnamese point to a study by Columbia University professor emeritus Jeanne Stellman, published in the peer-reviewed journal Nature, that estimated 2.1 million to 4.8 million Vietnamese civilians were exposed to the chemicals during the war.

 

Still, some U.S. officials view accusations that the defoliants caused widespread birth defects in Vietnam as a centrally controlled propaganda campaign founded on scant scientific evidence.

 

"We believe the (Vietnamese government) will never permit research that in any way might discredit its two-decade long propaganda campaign, i.e., Agent Orange/dioxin is to blame for a huge range of serious health problems -- especially birth defects and mental retardation," said a 2003 memo from the U.S. Embassy in Hanoi.

 

U.S. officials point to a host of other possible reasons for the high rate of congenital deformities, including malnutrition, a lack of iodine in the diet of pregnant mothers, even alcoholism.

 

Much of the contentious political rancor is captured inside Tu Du Hospital, which cares for dozens of children with some of the most severe deformities. Many were abandoned at birth and spend their days studying and playing while undergoing physical therapy and other treatments to overcome their disabilities.

 

The hospital and the children treated there have become symbols of Agent Orange's lingering impact, even though in many cases little is known about whether and how their parents may have been exposed.

 

In 1968, Phuong and her colleagues began collecting dozens of fetuses and deformed babies who did not survive, storing them at Tu Du in large jars filled with formaldehyde. Foreign news reports about the herbicides often feature images of the jars, again despite a lack of hard evidence about what caused the deformities.

 

As the Tribune conducted interviews overseas, it was clear that some Vietnamese citizens are quick to blame the defoliants for health problems even when documenting exposure is difficult or the facts make direct exposure impossible. Some who said they were exposed didn't join the military until long after the spraying missions had ceased; others operated in areas where little or no spraying took place.

 

Still, the Tribune saw many children at Tu Du and elsewhere in Vietnam who suffer from birth defects and illnesses that science has linked to dioxin exposure. In many cases, data on wartime spraying missions supports their parents' stories of exposure to herbicides.

 

Parents' burdens

 

Tram Thi Shu has a 6-year-old son, Ho Cong Duc, who looks more like he's 6 months old. His blue veins are visible beneath his translucent skin. The boy is thin and pale; his breathing is raspy and labored. Shu believes his illnesses, as well as her daughter's seizures, are due to her exposure to defoliants.

 

"I remember seeing the plane fly over the back of my head," said Shu, 43, who grew up in Quang Nam province. "After it left, all of the leaves from the trees fell down. We were wet because of the spray. I don't remember exactly how many times it happened, but my mother said it was at least three times."

 

Data from spraying missions in Quang Nam show nearly 24,000 gallons of Agent Orange and 21,000 gallons of Agent Blue -- which contained arsenic -- were sprayed within two miles of Shu's village.

 

"I am very worried for my son," Shu said. "If I can live longer than him, it will be OK. But if I pass away, I don't know who will take care of him."

 

And then there's Dao Thi Kieu, who has lost a husband as well as five children.

 

Her husband, Lam Ba Trung, served in the U.S.-backed South Vietnamese army along the 17th Parallel in Quang Tri province, where U.S. and South Vietnamese forces sprayed more than 700,000 gallons of herbicides to destroy enemy crops and defoliate dense jungles.

 

He died in 2004 at 60 after a seven-year battle with lung and throat cancer, illnesses the Institute of Medicine and the U.S. Department of Veterans Affairs link to defoliants used during the war.

 

Like many Vietnamese citizens, Kieu and her husband spent years blaming themselves for their children's suffering.

 

"We thought that maybe we had done something bad in a past life," she said, her voice beginning to break. "That's why my husband became a vegetarian."

 

Almost every day, Kieu rises at 3 a.m. to care for her two surviving disabled daughters, Lam Kim Lien, 39, and Lam Ngoc Huong, 35.

 

Without the benefit of physical therapy, neither is able to walk, talk or even hold a spoon. Their misshapen, skeletal bodies and cropped hair make them look much younger, while their gaunt, expressionless faces reflect lives spent on a small wooden bed covered with a straw mat.

 

The couple's only healthy child, Lam Ngoc Nhan, 20, was born after Kieu and Trung waited 10 years to try again, an important detail considering dioxin levels are cut in half in human beings after about 7 1/2 years; the chemical also passes out of the body as mothers breast feed.

 

Kieu tends her rice paddies until dusk and then returns home to bathe and feed Lien and Huong. A diminutive woman with an iron resolve, Kieu is well-respected in her village for struggling through hardships, giving her a sense of pride amid all the pain.

 

But her strength melts away as she speaks about the difficulties she faces and her hopes for the future.

 

"I don't know what to say. To find justice?" she said, tears streaming from her dark eyes. "I lost five children and a husband. I have two children with disabilities. There are days when I come back from work, and I am so tired I cannot lift up my children."

[Y2HH]

My father was exposed to AO many times while he was in Vietnam, though, while he suffers from hypertension/high blood pressure/etc, he refuses to look into the matter in terms of treatment/compensation...he says he's fine and doesn't blame the government for these types of things.

 

That said, this shows you how awesome the VA is while they have thousands upon thousands of denied, pending/delayed or otherwise ignored/backlogged claims in relation to AO.