Service Related Diseases, Illnesses, and Conditions

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1. Service Related Diseases, Illnesses, and Conditions Military History Toolkit Produced by the Veterans Advisory Council A Taskforce of the National Hospice and Palliative Care Organization Welcome to the Military History Toolkit. This slide presentation is one of three slide sets contained in the Military History Toolkit. Others include: Homeless Veterans at Life’s End and Veterans’ Benefits. This slide set provides an overview of the various military eras along with service related diseases, illnesses and conditions that may impact on veterans at the end-of-life, from both clinical and benefits perspectives. The content will increase understanding of the importance and implications of asking veterans about their military background. NOTE TO PRESENTERS: For more comprehensive information about the VA, visit the VA website at www.va.gov and check out the resources listed on the last slide of this slide set. DISCLAIMER: Although the information contained in this slide set presents an overview of service-related diseases, illnesses and conditions, it is not intended to provide interpretation of VA policy. Presenters should tailor the content to meet the needs of the target audience by working collaboratively with those who have relevant skills and background such as qualified healthcare professionals, VA staff and other providers of care and services for veterans. Welcome to the Military History Toolkit. This slide presentation is one of three slide sets contained in the Military History Toolkit. Others include: Homeless Veterans at Life’s End and Veterans’ Benefits. This slide set provides an overview of the various military eras along with service related diseases, illnesses and conditions that may impact on veterans at the end-of-life, from both clinical and benefits perspectives. The content will increase understanding of the importance and implications of asking veterans about their military background. NOTE TO PRESENTERS: For more comprehensive information about the VA, visit the VA website at www.va.gov and check out the resources listed on the last slide of this slide set. DISCLAIMER: Although the information contained in this slide set presents an overview of service-related diseases, illnesses and conditions, it is not intended to provide interpretation of VA policy. Presenters should tailor the content to meet the needs of the target audience by working collaboratively with those who have relevant skills and background such as qualified healthcare professionals, VA staff and other providers of care and services for veterans.

2. Military History Checklist In which war era or period of service did you serve? Often in the VA or military system, a soldier’s dates of service are spoken of in terms of the conflict in which the veteran served. As with branch of service, each era of service has its own unique culture, which can dramatically influence the outcome of a soldier’s experience. For example, WWII combat veterans are more likely to have had areas of safe haven than Vietnam veterans, who were often in immediate physical danger and resulted in a higher incidence of stress-related disorders. Korean veterans were often told not to discuss their military service and are sometimes overlooked in the discussion regarding the needs of veterans. A significant number of Korean veterans were POWs held by the Chinese, and subjected to torture and other mistreatment.   Overall how do you view your experience in the military? Veterans often take great pride in their service, seeing it as a period of time when they did something meaningful to make a difference in the world despite the fact that they may well have been imprisoned, tortured, wounded, exposed to atrocities, or had other traumatic experiences. Not all veterans see their service as a positive experience, and some do not see their sacrifice as having made any difference, which has resulting complications. There may be extensive existential questions, and providing opportunities during follow-up visits for team members to explore these has a great deal of value. Understanding how veterans view their service, whether it is positive or negative, has implications for how they view their disease, especially if it is related to their service.   Would you like your hospice staff/volunteer to have military experience, if available? The common military culture of veterans, which is often able to span eras and theaters of service despite the previously mentioned differences, can be a powerful force at end of life. Having a volunteer or staff member who is a part of the military culture can provide support in a way not otherwise available, and may provide an outlet for the stories and experiences that have never been communicated to family or others in the veteran’s life. Also, volunteer opportunities for veterans are often a path to healing war related trauma for the volunteer. Be aware that veteran volunteers may need additional support when caring for a fellow veteran, as their own trauma may also be re-triggered. Your local VA hospital, VetCenter, County Veterans Service Office, or a Veterans Service Organizations can be good sources of information and support for community hospices that are developing veteran volunteer programs. In which war era or period of service did you serve? Often in the VA or military system, a soldier’s dates of service are spoken of in terms of the conflict in which the veteran served. As with branch of service, each era of service has its own unique culture, which can dramatically influence the outcome of a soldier’s experience. For example, WWII combat veterans are more likely to have had areas of safe haven than Vietnam veterans, who were often in immediate physical danger and resulted in a higher incidence of stress-related disorders. Korean veterans were often told not to discuss their military service and are sometimes overlooked in the discussion regarding the needs of veterans. A significant number of Korean veterans were POWs held by the Chinese, and subjected to torture and other mistreatment.   Overall how do you view your experience in the military? Veterans often take great pride in their service, seeing it as a period of time when they did something meaningful to make a difference in the world despite the fact that they may well have been imprisoned, tortured, wounded, exposed to atrocities, or had other traumatic experiences. Not all veterans see their service as a positive experience, and some do not see their sacrifice as having made any difference, which has resulting complications. There may be extensive existential questions, and providing opportunities during follow-up visits for team members to explore these has a great deal of value. Understanding how veterans view their service, whether it is positive or negative, has implications for how they view their disease, especially if it is related to their service.   Would you like your hospice staff/volunteer to have military experience, if available? The common military culture of veterans, which is often able to span eras and theaters of service despite the previously mentioned differences, can be a powerful force at end of life. Having a volunteer or staff member who is a part of the military culture can provide support in a way not otherwise available, and may provide an outlet for the stories and experiences that have never been communicated to family or others in the veteran’s life. Also, volunteer opportunities for veterans are often a path to healing war related trauma for the volunteer. Be aware that veteran volunteers may need additional support when caring for a fellow veteran, as their own trauma may also be re-triggered. Your local VA hospital, VetCenter, County Veterans Service Office, or a Veterans Service Organizations can be good sources of information and support for community hospices that are developing veteran volunteer programs.

3. Veteran Population 23.8 million living veterans 7.5% women 37 million dependents (spouses and dependent children) of living veterans and survivors of deceased veterans Together, they represent 20% of the US population

4. Veteran Population Most veterans living today served during times of war Vietnam Era veteran – 7.9 million, representing the largest segment of the veteran population

5. Veteran Population Median age of all living veterans in 2007: 61 for men 47 for women Median ages by period of service: Gulf War, 37 years old Vietnam War, 60 years old Korean War, 76 years old WW II, 84 years old

6. Veteran Population Sixty percent (60%) of the nation’s veterans live in urban areas States with the largest veteran population are CA, FL, TX, PA, NY and OH, respectively 6 states account for 36% of total veteran population

7. Service Connected Disability VA pays disability compensation to veterans with injuries or illnesses incurred during, or aggravated by, their military service VA must determine that the disability is “service-connected” A Veterans Services Representative is available at VA medical centers and regional offices to explain and assist veterans who need help in applying for disability benefits Basis for VA Disability Ratings: VA disability compensation stems from an official finding that links an illness or disability with the period of a veteran's military service, whether war-related or in peacetime. VA usually does not need to find the exact cause of the illness. The dollar amount of compensation is determined by regulations that give a rating for each illness or injury on a scale of 0 to 100 based on the severity of the medical problem. The philosophy of the compensation program is that these ratings are intended to reflect a loss of earnings capacity. A veteran with a slight scar that does not interfere with work might be rated at 0 percent while brain cancer would be rated at 100 percent. That percentage is used to determine amounts of tax-free disability compensation that are paid in 10 percent increments and adjusted annually for inflation. The year 2008 range is $117 per month for a 10 percent rating to $2,527 monthly for a 100 percent disability. Payments are increased for dependents and for veterans with multiple illnesses officially connected with service. A veteran whose condition worsens may see his rating increased after periodic reexamination, or he may drop off the rolls altogether if cured of an illness. (www.vba.va.gov/bln/21/rates/comp01.htm#BM01) Reference: www1.va.gov/agentorange/page.cfm?pg=11 See the slide set on Benefits in the Military History Toolkit for a more in depth presentation about veterans’ benefits, what veterans need to do to apply for them and resources available to help with the application process. Basis for VA Disability Ratings: VA disability compensation stems from an official finding that links an illness or disability with the period of a veteran's military service, whether war-related or in peacetime. VA usually does not need to find the exact cause of the illness. The dollar amount of compensation is determined by regulations that give a rating for each illness or injury on a scale of 0 to 100 based on the severity of the medical problem. The philosophy of the compensation program is that these ratings are intended to reflect a loss of earnings capacity. A veteran with a slight scar that does not interfere with work might be rated at 0 percent while brain cancer would be rated at 100 percent. That percentage is used to determine amounts of tax-free disability compensation that are paid in 10 percent increments and adjusted annually for inflation. The year 2008 range is $117 per month for a 10 percent rating to $2,527 monthly for a 100 percent disability. Payments are increased for dependents and for veterans with multiple illnesses officially connected with service. A veteran whose condition worsens may see his rating increased after periodic reexamination, or he may drop off the rolls altogether if cured of an illness. (www.vba.va.gov/bln/21/rates/comp01.htm#BM01) Reference: www1.va.gov/agentorange/page.cfm?pg=11 See the slide set on Benefits in the Military History Toolkit for a more in depth presentation about veterans’ benefits, what veterans need to do to apply for them and resources available to help with the application process.

8. “Tell me about your military experience…” When and where did you serve? What did you do while you were in the service? Why ask these questions? . . . .Because it may influence both health and quality of life… Veterans often take great pride in their service, seeing it as a period of time when they did something meaningful to make a difference in the world despite the fact that they may well have been imprisoned, tortured, wounded, exposed to atrocities, or had other traumatic experiences. Not all veterans see their service as a positive one or do not see their sacrifice has having made any difference, and this has resulting complications. There may be extensive existential questions, and providing opportunities during follow-up visits for team members to explore these has a great deal of value. Understanding how veterans view their service, whether it is positive or negative, has implications for how they view their disease, especially if it is related to their service.Veterans often take great pride in their service, seeing it as a period of time when they did something meaningful to make a difference in the world despite the fact that they may well have been imprisoned, tortured, wounded, exposed to atrocities, or had other traumatic experiences. Not all veterans see their service as a positive one or do not see their sacrifice has having made any difference, and this has resulting complications. There may be extensive existential questions, and providing opportunities during follow-up visits for team members to explore these has a great deal of value. Understanding how veterans view their service, whether it is positive or negative, has implications for how they view their disease, especially if it is related to their service.

9. World War II “World War II (1939-1945) killed more people, destroyed more property, disrupted more lives, and probably had more far reaching effects than any other war in history.” WORLD BOOK ENCYCLOPEDIA WWII veterans today are all over 70 years old and subject to all the diseases of aging: cardiovascular diseases, cancer, dementias of the Alzheimer's type, etc. However, In the early 1940's, they were among the nation's fittest and participated in modern warfare that coincided with major advances in modern medicine. The advent of antibiotics began with the use of sulfonamides in the mid-1930's, hence the troops had the benefits of sulfa and penicillin to treat both disease and wound infections. They also benefited from the availability of blood transfusions, aeromedical evacuation, better burn management, synthetic antimalarials and DDT, and a wide range of preventive measures including immunizations against yellow fever, cholera, plague, influenza, typhus, typhoid and tetanus. The result was an up to then extraordinary 4% died-of-wounds rate for British and American troops, (this rate was later reduced to 2.5% in Vietnam) and death rates from disease markedly below the killed-in-action rate. Reference: www.va.gov/oaa/pocketcard/worldwar_summary.asp WWII veterans today are all over 70 years old and subject to all the diseases of aging: cardiovascular diseases, cancer, dementias of the Alzheimer's type, etc. However, In the early 1940's, they were among the nation's fittest and participated in modern warfare that coincided with major advances in modern medicine. The advent of antibiotics began with the use of sulfonamides in the mid-1930's, hence the troops had the benefits of sulfa and penicillin to treat both disease and wound infections. They also benefited from the availability of blood transfusions, aeromedical evacuation, better burn management, synthetic antimalarials and DDT, and a wide range of preventive measures including immunizations against yellow fever, cholera, plague, influenza, typhus, typhoid and tetanus. The result was an up to then extraordinary 4% died-of-wounds rate for British and American troops, (this rate was later reduced to 2.5% in Vietnam) and death rates from disease markedly below the killed-in-action rate. Reference: www.va.gov/oaa/pocketcard/worldwar_summary.asp

10. World War II December 7, 1941 – December 31, 1946 Total who served in all Armed Forces: 16,112,566 Battle Deaths: 291,557 Wounded: 671,846 Medals of Honor: 433 In what theatre of operations did the veteran serve? Pacific? Asia? Europe? World War II-Asiatic-Pacific Theater 1941-1946: the war in the Pacific was essentially a maritime war. The European Theatre of Operations (ETO) was an area of heavy fighting across Europe, during World War II, from Nazi Germany's invasion of Poland on September 1, 1939 until the end of the war with the German unconditional surrender on May 8, 1945 (V-E Day). The Allied forces fought the Axis powers in three sub-theatres: the Eastern Front, the Western Front, and the Mediterranean Theatre. (http://en.wikipedia.org/wiki/European_Theatre_of_World_War_II) Reference for statistics: www.va.gov/oaa/pocketcard/worldwar_summary.asp World War II-Asiatic-Pacific Theater 1941-1946: the war in the Pacific was essentially a maritime war. The European Theatre of Operations (ETO) was an area of heavy fighting across Europe, during World War II, from Nazi Germany's invasion of Poland on September 1, 1939 until the end of the war with the German unconditional surrender on May 8, 1945 (V-E Day). The Allied forces fought the Axis powers in three sub-theatres: the Eastern Front, the Western Front, and the Mediterranean Theatre. (http://en.wikipedia.org/wiki/European_Theatre_of_World_War_II) Reference for statistics: www.va.gov/oaa/pocketcard/worldwar_summary.asp

11. World War II Fighting occurred on the continents of Europe, Asia, and Africa and in the Atlantic and Pacific Oceans Service was carried out under severe winter conditions, in the harshest of deserts, and in the hottest, most humid, tropical climates Joining up, or being drafted, meant that you were in the military for the duration The U.S. entered the war in December 1941 following the attack on Pearl Harbor. Before it was over, Americans had fought on the continents of Europe, Asia, and Africa and in the Atlantic and Pacific Oceans. At various times, their service was carried out under severe winter conditions, in the harshest of deserts, and in the hottest, most humid tropical climes. Those who joined up or were drafted were in the military for the duration, however long that might be. The war in Europe ended on May 8, 1945, when the Germans surrendered at Reims in France. The war continued in the Pacific for three more months. However, following the dropping of the first atomic (U-235) bomb on Hiroshima on August 6 and a larger (plutonium) bomb on Nagasaki two days later, the Japanese surrender aboard the USS Missouri in Tokyo harbor on September 2, 1945. Reference: www.va.gov/oaa/pocketcard/worldwar_summary.asp The U.S. entered the war in December 1941 following the attack on Pearl Harbor. Before it was over, Americans had fought on the continents of Europe, Asia, and Africa and in the Atlantic and Pacific Oceans. At various times, their service was carried out under severe winter conditions, in the harshest of deserts, and in the hottest, most humid tropical climes. Those who joined up or were drafted were in the military for the duration, however long that might be. The war in Europe ended on May 8, 1945, when the Germans surrendered at Reims in France. The war continued in the Pacific for three more months. However, following the dropping of the first atomic (U-235) bomb on Hiroshima on August 6 and a larger (plutonium) bomb on Nagasaki two days later, the Japanese surrender aboard the USS Missouri in Tokyo harbor on September 2, 1945. Reference: www.va.gov/oaa/pocketcard/worldwar_summary.asp

12. Flag pole at Hickam AFB, Hawaii on Dec 7th 1941… …and today in 2007 The 7 December 1941 Japanese raid on Pearl Harbor was one of the great defining moments in history. A single carefully-planned and well-executed stroke removed the United States Navy's battleship force as a possible threat to the Japanese Empire's southward expansion. America, unprepared and now considerably weakened, was abruptly brought into the Second World War as a full combatant. Reference: www.history.navy.mil/photos/events/wwii-pac/pearlhbr/pearlhbr.htm Image (left): http://www.presidentialtimeline.org/html/images/objects/0163_lg.jpg Image (right): http://www.afa138.org/Images/Legacy_Pathway/Legacy_Pathway.jpg The 7 December 1941 Japanese raid on Pearl Harbor was one of the great defining moments in history. A single carefully-planned and well-executed stroke removed the United States Navy's battleship force as a possible threat to the Japanese Empire's southward expansion. America, unprepared and now considerably weakened, was abruptly brought into the Second World War as a full combatant. Reference: www.history.navy.mil/photos/events/wwii-pac/pearlhbr/pearlhbr.htm Image (left): http://www.presidentialtimeline.org/html/images/objects/0163_lg.jpg

13. World War II Unique Health Risks Infectious Diseases Wounds Frostbite / Cold Injury Mustard Gas Testing Exposure to nuclear weapons Nuclear Cleanup Morbidity from such diseases as tuberculosis (anti-tuberculous agents did not begin to appear until 1949), rheumatic fever, hepatitis, and tropical diseases was high, however, and the prime reason for residual disability and time lost from duty. World War II veterans also were the first to serve in the nuclear age and American POWs were employed in the clean up of Hiroshima and Nagasaki, thus becoming the first "atomic vets." Over 350,000 women served with a peak strength of 271,000 representing 2% of the personnel in uniform, compared to the approximately 15% now in the military. Women, mostly nurses, were taken prisoners of war by the Japanese when Bataan and Corregidor fell and were interned in the Philippines for four years. Following the war, there was a swift collapse of the alliance against Hitler with a failure to agree on peace terms, the partition of Germany and the beginning of the Cold War which was to last until 1991. Reference: www.va.gov/oaa/pocketcard/worldwar_summary.asp Morbidity from such diseases as tuberculosis (anti-tuberculous agents did not begin to appear until 1949), rheumatic fever, hepatitis, and tropical diseases was high, however, and the prime reason for residual disability and time lost from duty. World War II veterans also were the first to serve in the nuclear age and American POWs were employed in the clean up of Hiroshima and Nagasaki, thus becoming the first "atomic vets." Over 350,000 women served with a peak strength of 271,000 representing 2% of the personnel in uniform, compared to the approximately 15% now in the military. Women, mostly nurses, were taken prisoners of war by the Japanese when Bataan and Corregidor fell and were interned in the Philippines for four years. Following the war, there was a swift collapse of the alliance against Hitler with a failure to agree on peace terms, the partition of Germany and the beginning of the Cold War which was to last until 1991. Reference: www.va.gov/oaa/pocketcard/worldwar_summary.asp

14. Cold War “Atomic Veterans” Cold War refers to the period of tension between the US and its allies and the Soviet bloc from the end of WW II in 1945 until the collapse of the Soviet Union in the 1990s Major fear of the Cold War was nuclear war with associated health concerns about exposure to ionizing radiation The Cold War generally refers to the period of tension between the U.S. and its allies and the Soviet bloc from the end of World War II in 1945 until the collapse of the Soviet Union in the 1990s. A major fear of the Cold War was nuclear war with associated health concerns about exposure to ionizing radiation. By law the Defense Special Weapons Agency (DSWA) is responsible for determining radiation dose estimates for these groups, sometimes referred to as "atomic veterans". The average exposure for these veterans as estimated by the DSWA is relatively low, with less than 1% exceeding the current annual occupational limit of 5 rem (although many veterans question the accuracy of these official doses). Generally, no dose of radiation is considered to be safe from the risk for neoplastic transformation. On the other hand, a minimum or threshold dose of radiation generally is felt to be necessary for clinically significant nonneoplastic tissue or organ damage. Reference: www.va.gov/oaa/pocketcard/coldwar_summary.asp The Cold War generally refers to the period of tension between the U.S. and its allies and the Soviet bloc from the end of World War II in 1945 until the collapse of the Soviet Union in the 1990s. A major fear of the Cold War was nuclear war with associated health concerns about exposure to ionizing radiation. By law the Defense Special Weapons Agency (DSWA) is responsible for determining radiation dose estimates for these groups, sometimes referred to as "atomic veterans". The average exposure for these veterans as estimated by the DSWA is relatively low, with less than 1% exceeding the current annual occupational limit of 5 rem (although many veterans question the accuracy of these official doses). Generally, no dose of radiation is considered to be safe from the risk for neoplastic transformation. On the other hand, a minimum or threshold dose of radiation generally is felt to be necessary for clinically significant nonneoplastic tissue or organ damage. Reference: www.va.gov/oaa/pocketcard/coldwar_summary.asp

15. Cold War “Atomic Veterans” Approximately 200,000 US Service personnel performed occupation duties in Hiroshima and Nagasaki following the atomic bombing of Japan Similar numbers of service members participated in atmospheric nuclear weapons testing from 1945 to 1962

16. Nuclear testing at Bikini Atoll Bikini Atoll is one of the 29 atolls and five islands that compose the Marshall Islands. These atolls of the Marshalls are scattered over 357,000 square miles of a lonely part of the world located north of the equator in the Pacific Ocean. They help define a geographic area referred to as Micronesia. Reference: www.bikiniatoll.com/ Image: http://www.amphilsoc.org/library/exhibits/treasures/images/abomb2sm.jpg Nuclear testing at Bikini Atoll Bikini Atoll is one of the 29 atolls and five islands that compose the Marshall Islands. These atolls of the Marshalls are scattered over 357,000 square miles of a lonely part of the world located north of the equator in the Pacific Ocean. They help define a geographic area referred to as Micronesia. Reference: www.bikiniatoll.com/ Image: http://www.amphilsoc.org/library/exhibits/treasures/images/abomb2sm.jpg

17. Nuclear testing at Bikini Atoll Operation Crossroads was an atmospheric nuclear weapon test series conducted in the summer of 1946. The series consisted of two detonations, each with a yield of 23 kilotons: 1. ABLE detonated at an altitude of 520 feet (158 meters) on 1 July 2. BAKER detonated 90 feet (27 meters) underwater on 25 July. It was the first nuclear test held in the Marshall Islands. The series was to study the effects of nuclear weapons on ships, equipment, and material. A fleet of more than 90 vessels was assembled in Bikini Lagoon as a target. This target fleet consisted of older U.S. capital ships, three captured German and Japanese ships, surplus U.S. cruisers, destroyers and submarines, and a large number of auxiliary and amphibious vessels. Military equipment was arrayed on some of the ships as well as amphibious craft that were berthed on Bikini Island. Technical experiments were also conducted to study nuclear weapon explosion phenomena. The support fleet of more than 150 ships provided quarters, experimental stations, and workshops for most of the 42,000 men (more than 37,000 of whom were Navy personnel) of Joint Task Force 1 (JTF 1), the organization that conducted the tests. Additional personnel were located on nearby atolls such as Eniwetok and Kwajalein. The islands of the Bikini Atoll were used primarily as recreation and instrumentation sites. Reference: www.history.navy.mil/faqs/faq76-1.htm Image: http://en.wikipedia.org/wiki/Image:Atombombentest_Crossroads-Baker.jpg Nuclear testing at Bikini Atoll Operation Crossroads was an atmospheric nuclear weapon test series conducted in the summer of 1946. The series consisted of two detonations, each with a yield of 23 kilotons: 1. ABLE detonated at an altitude of 520 feet (158 meters) on 1 July 2. BAKER detonated 90 feet (27 meters) underwater on 25 July. It was the first nuclear test held in the Marshall Islands. The series was to study the effects of nuclear weapons on ships, equipment, and material. A fleet of more than 90 vessels was assembled in Bikini Lagoon as a target. This target fleet consisted of older U.S. capital ships, three captured German and Japanese ships, surplus U.S. cruisers, destroyers and submarines, and a large number of auxiliary and amphibious vessels. Military equipment was arrayed on some of the ships as well as amphibious craft that were berthed on Bikini Island. Technical experiments were also conducted to study nuclear weapon explosion phenomena. The support fleet of more than 150 ships provided quarters, experimental stations, and workshops for most of the 42,000 men (more than 37,000 of whom were Navy personnel) of Joint Task Force 1 (JTF 1), the organization that conducted the tests. Additional personnel were located on nearby atolls such as Eniwetok and Kwajalein. The islands of the Bikini Atoll were used primarily as recreation and instrumentation sites. Reference: www.history.navy.mil/faqs/faq76-1.htm Image: http://en.wikipedia.org/wiki/Image:Atombombentest_Crossroads-Baker.jpg

18. Cold War “Atomic Veterans” Exposure to radiation has been associated with a number of disorders including leukemia, various cancers, and cataracts Unique Health Risks Nuclear Testing Nuclear Cleanup Largely as a result of epidemiological studies of Japanese atomic bomb survivors, exposure to radiation has been associated with a number of disorders including leukemia, various cancers, and cataracts Information for veterans, their families and others about VA health care programs related to ionizing radiation issues. Ionizing Radiation Information: Depleted Uranium & Health Pocket Guide For Clinicians (May 2007) Ionizing Radiation Newsletter Sept 2006 Ionizing Radiation Newsletter 2006 Ionizing Radiation Handbook 2006 Ionizing Radiation Newsletter 2005 Ionizing Radiation Poster 2004 Ionizing Radiation Briefs 2004 Ionizing Radiation Newsletter 2004 Ionizing Radiation Fact Sheet 2003 VA Radiation Program Information Ionizing Radiation Newsletter February 2004 www.va.gov/VHI To download these documents go to: www1.va.gov/irad/ Largely as a result of epidemiological studies of Japanese atomic bomb survivors, exposure to radiation has been associated with a number of disorders including leukemia, various cancers, and cataracts Information for veterans, their families and others about VA health care programs related to ionizing radiation issues. Ionizing Radiation Information: Depleted Uranium & Health Pocket Guide For Clinicians (May 2007) Ionizing Radiation Newsletter Sept 2006 Ionizing Radiation Newsletter 2006 Ionizing Radiation Handbook 2006 Ionizing Radiation Newsletter 2005 Ionizing Radiation Poster 2004 Ionizing Radiation Briefs 2004 Ionizing Radiation Newsletter 2004 Ionizing Radiation Fact Sheet 2003 VA Radiation Program Information Ionizing Radiation Newsletter February 2004 www.va.gov/VHI To download these documents go to: www1.va.gov/irad/

19. Cold War “Atomic Veterans” Every VA medical facility has a registry physician for Agent Orange, Gulf War, and Ionizing Radiation - a resource for additional information Atomic veterans are eligible to participate in the VA's Ionizing Radiation Program. This includes the opportunity to have an Ionizing Radiation Registry Examination performed and special eligibility for treatment of conditions that the VA recognizes as potentially radiogenic by statute or regulation whether or not they have had a radiation compensation claim approved. For further information about VA examination and treatment of atomic veterans or other veterans exposed to ionizing radiation in service, please contact the Office of Public Health and Environmental Hazards (13), VA Central Office, telephone 202-273-8575, fax 202-273-9080. Veterans' questions regarding radiation compensation claims should be addressed to the appropriate VA Regional Office, telephone 800-827-1000. Reference: www.va.gov/oaa/pocketcard/coldwar_summary.asp Atomic veterans are eligible to participate in the VA's Ionizing Radiation Program. This includes the opportunity to have an Ionizing Radiation Registry Examination performed and special eligibility for treatment of conditions that the VA recognizes as potentially radiogenic by statute or regulation whether or not they have had a radiation compensation claim approved. For further information about VA examination and treatment of atomic veterans or other veterans exposed to ionizing radiation in service, please contact the Office of Public Health and Environmental Hazards (13), VA Central Office, telephone 202-273-8575, fax 202-273-9080. Veterans' questions regarding radiation compensation claims should be addressed to the appropriate VA Regional Office, telephone 800-827-1000. Reference: www.va.gov/oaa/pocketcard/coldwar_summary.asp

20. Korean War Korean War pitted the United States, South Korea and their UN allies against North Korea and the Chinese Communists On June 25, 1950 North Korea's invasion of South Korea brought about a United Nations' "police action" against the aggressors, which immediately produced heavy military and naval involvement by the United States. While there were no illusions that the task would be easy, nobody expected that this violent conflict would continue for more than three years. On July 27, 1953 negotiations concluded and fighting ended. However, the Cold War, considerably warmed up by the Korean experience, would maintain its costly existence for nearly four more decades. Reference: www.history.navy.mil/photos/events/kowar/kowar.htm On June 25, 1950 North Korea's invasion of South Korea brought about a United Nations' "police action" against the aggressors, which immediately produced heavy military and naval involvement by the United States. While there were no illusions that the task would be easy, nobody expected that this violent conflict would continue for more than three years. On July 27, 1953 negotiations concluded and fighting ended. However, the Cold War, considerably warmed up by the Korean experience, would maintain its costly existence for nearly four more decades. Reference: www.history.navy.mil/photos/events/kowar/kowar.htm

21. Korean War June 25, 1950 – July 27, 1953 Total who served in all Armed Forces: 5,720,000 Battle Deaths: 33,741 Wounded: 103,284 Medals of Honor: 131 Unique Health Risks -- Cold Injury -- Exposure to nuclear weapons -- Lasting Effects -- Chemical warfare experiments Reference: http://www.va.gov/oaa/pocketcard/korea_summary.asp Reference: http://www.va.gov/oaa/pocketcard/korea_summary.asp

22. Korean War Cold injuries, including frostbite and immersion (trench) foot, constituted a major medical problem for US Service personnel Cold accounted for 16% of Army non-battle injuries requiring admission Over 5000 US casualties of cold injury required evacuation from Korea during the winter of 1950-1951 Cold injuries including frostbite and immersion (trench) foot constituted a major medical problem for U.S. service personnel during the Korean War. Veterans of the Battle of the Chosin Reservoir are recognized as having suffered especially high rates of severe cold injuries. Cold accounted for 16% of Army non-battle injuries requiring admission and over 5000 U.S. casualties of cold injury required evacuation from Korea during the winter of 1950-1951. In many instances U.S. Service members did not seek or were unable to obtain medical care after cold injuries because of battlefield conditions. Documentation of such injuries may never have been made in their service medical records or may no longer be available. Reference: www.va.gov/oaa/pocketcard/korea_summary.asp Cold injuries including frostbite and immersion (trench) foot constituted a major medical problem for U.S. service personnel during the Korean War. Veterans of the Battle of the Chosin Reservoir are recognized as having suffered especially high rates of severe cold injuries. Cold accounted for 16% of Army non-battle injuries requiring admission and over 5000 U.S. casualties of cold injury required evacuation from Korea during the winter of 1950-1951. In many instances U.S. Service members did not seek or were unable to obtain medical care after cold injuries because of battlefield conditions. Documentation of such injuries may never have been made in their service medical records or may no longer be available. Reference: www.va.gov/oaa/pocketcard/korea_summary.asp

23. These cold-related problems may worsen as veterans grow older and develop complicating conditions such as diabetes and peripheral vascular disease, which place them at higher risk for late amputations Korean War Cold Injury: The Office of Public Health and Environmental Hazards develops and reviews policies and procedures relating to examination and treatment of cold-injured veterans. VA is committed to providing thorough examinations and high quality medical care to veterans with long-term and late sequelae of cold injuries. Forms VA Form 10-0376: Compensation and Pension Examination for Cold Injury Protocol Examination #1730 Worksheet, April 1998 (See Attachment A to IL 10-98-008) VA Form 10-0374: Protocol Examination History for Cold Injuries April 1998 (See Attachment B to IL 10-98-008) Reference: http://www.vethealth.cio.med.va.gov/ColdInjury.htm Image (left): http://z.about.com/d/history1900s/1/7/f/B/1/korean67.gif Image (right): http://www.mccoy.army.mil/vtriad_online/11242000/images/low_crawl_obstacle_winter_300_x.jpg Cold Injury: The Office of Public Health and Environmental Hazards develops and reviews policies and procedures relating to examination and treatment of cold-injured veterans. VA is committed to providing thorough examinations and high quality medical care to veterans with long-term and late sequelae of cold injuries. Forms VA Form 10-0376: Compensation and Pension Examination for Cold Injury Protocol Examination #1730 Worksheet, April 1998 (See Attachment A to IL 10-98-008) VA Form 10-0374: Protocol Examination History for Cold Injuries April 1998 (See Attachment B to IL 10-98-008) Reference: http://www.vethealth.cio.med.va.gov/ColdInjury.htm Image (left): http://z.about.com/d/history1900s/1/7/f/B/1/korean67.gif Image (right): http://www.mccoy.army.mil/vtriad_online/11242000/images/low_crawl_obstacle_winter_300_x.jpg

24. Korean War Many veterans who have experienced cold injuries will be living with long-term and delayed sequelae which include: peripheral neuropathy skin cancer in frostbite scars (heels, earlobes) arthritis in involved areas chronic tinea pedis fallen arches and stiff toes nocturnal pain cold sensation It is important for healthcare providers examining and caring for veterans who have experienced cold injuries to be familiar with the recognized long-term and delayed sequelae. These include peripheral neuropathy, skin cancer in frostbite scars (including in such locations as the heels and earlobes), arthritis in involved areas, chronic tinea pedis, fallen arches and stiff toes, nocturnal pain, and cold sensitization. These cold-related problems may worsen as veterans grow older and develop complicating conditions such as diabetes and peripheral vascular disease, which place them at higher risk for late amputations. Healthcare providers are encouraged to utilize the following sources of additional information on examination and treatment of cold-injured veterans: Questions relating to examination and treatment of cold-injured veterans may be referred to the Office of Public Health and Environmental Hazards (13), VA Central Office, telephone 202-273-8452, fax 202-273-9080. Veterans' questions regarding cold injury compensation claims should be addressed to the appropriate VA Regional Office, telephone 800-827-1000. Reference: www.va.gov/oaa/pocketcard/korea_summary.asp It is important for healthcare providers examining and caring for veterans who have experienced cold injuries to be familiar with the recognized long-term and delayed sequelae. These include peripheral neuropathy, skin cancer in frostbite scars (including in such locations as the heels and earlobes), arthritis in involved areas, chronic tinea pedis, fallen arches and stiff toes, nocturnal pain, and cold sensitization. These cold-related problems may worsen as veterans grow older and develop complicating conditions such as diabetes and peripheral vascular disease, which place them at higher risk for late amputations. Healthcare providers are encouraged to utilize the following sources of additional information on examination and treatment of cold-injured veterans: Questions relating to examination and treatment of cold-injured veterans may be referred to the Office of Public Health and Environmental Hazards (13), VA Central Office, telephone 202-273-8452, fax 202-273-9080. Veterans' questions regarding cold injury compensation claims should be addressed to the appropriate VA Regional Office, telephone 800-827-1000. Reference: www.va.gov/oaa/pocketcard/korea_summary.asp

25. The Vietnam War Wall of Honor: Their names are engraved on the black granite of the Vietnam Veterans Memorial in Washington, D.C. as well as on the hearts of those who love them. They are the 58,226 Americans who paid the supreme sacrifice in the service of their country in Southeast Asia. Go to http://www.vietnamwar.com/ and zoom in to interactively explore the “Vietnam Veterans Memorial Wall” and see the names of those who gave their lives in defense of the United States of America. Reference: http://www.vietnamwar.com/ Image: http://moreramblings.files.wordpress.com/2007/11/vietnam-war-memorial-wall.jpg?w=515&h=386 Wall of Honor: Their names are engraved on the black granite of the Vietnam Veterans Memorial in Washington, D.C. as well as on the hearts of those who love them. They are the 58,226 Americans who paid the supreme sacrifice in the service of their country in Southeast Asia. Go to http://www.vietnamwar.com/ and zoom in to interactively explore the “Vietnam Veterans Memorial Wall” and see the names of those who gave their lives in defense of the United States of America. Reference: http://www.vietnamwar.com/ Image: http://moreramblings.files.wordpress.com/2007/11/vietnam-war-memorial-wall.jpg?w=515&h=386

26. Vietnam War “No event in American history is more misunderstood than the Vietnam War. It was misreported then, and it is misremembered now.” - RICHARD M. NIXON, 1985 The Vietnam War was the longest and most unpopular war in which Americans ever fought. Direct American involvement began in 1957 with the arrival of the first advisors. The first combat troops arrived in 1965 and we fought the war until the cease-fire of January 1973. For many of the more than two million American veterans of the war, the wounds of Vietnam will never heal. The financial cost to the United States comes to something over $150 billion dollars. Reference: http://www.vietnamwar.com/ The Vietnam War was the longest and most unpopular war in which Americans ever fought. Direct American involvement began in 1957 with the arrival of the first advisors. The first combat troops arrived in 1965 and we fought the war until the cease-fire of January 1973. For many of the more than two million American veterans of the war, the wounds of Vietnam will never heal. The financial cost to the United States comes to something over $150 billion dollars. Reference: http://www.vietnamwar.com/

27. Vietnam Vietnam veterans now 50 to 75 yrs old By 2014, 60% of veterans over the age of 65 will be Vietnam veterans Will we be ready to care for them? Mental Health Issues: PTSD, Depression Substance Abuse Hepatitis C Agent Orange Growing list of service connected illnesses

28. Vietnam War August 4, 1964 – January 27, 1975 Statistics Total who served in all Armed Forces: 8,744,000 Deployed to Southeast Asia: 3,403,000 Battle Deaths: 47,424 Other deaths (In Theatre): 10,785 Wounded: 153,303 Medals of Honor: 238 Unique Health Risks: Length and Time of Service Exposure to Agent Orange Infectious Diseases America's involvement in Vietnam lasted from 1957 until 1975. (Official dates are 8/5/64 to 5/7/75 and 2/28/61 for veterans who served “in country” (in Vietnam) before 8/5/64). In 1954, the French were defeated and the former colony of French Indochina was divided into Communist North Vietnam and (non-Communist) South Vietnam. In 1957, the Vietcong began a rebellion against the South Vietnam government of President Diem, whom the US supported with equipment and advisors. In 1963, the government was overthrown, Diem was killed, and a new government was formed. In August of 1964, Congress passed the Tonkin Gulf Resolution giving the President the power to take "all necessary measures" to "prevent further (Communist) aggression." Between 1965 and 1969, US troop strength rose from 60,000 to over 543,000 in country. Despite the US's superior firepower against the guerilla forces of the enemy, the two sides fought to a highly destructive draw. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp America's involvement in Vietnam lasted from 1957 until 1975. (Official dates are 8/5/64 to 5/7/75 and 2/28/61 for veterans who served “in country” (in Vietnam) before 8/5/64). In 1954, the French were defeated and the former colony of French Indochina was divided into Communist North Vietnam and (non-Communist) South Vietnam. In 1957, the Vietcong began a rebellion against the South Vietnam government of President Diem, whom the US supported with equipment and advisors. In 1963, the government was overthrown, Diem was killed, and a new government was formed. In August of 1964, Congress passed the Tonkin Gulf Resolution giving the President the power to take "all necessary measures" to "prevent further (Communist) aggression." Between 1965 and 1969, US troop strength rose from 60,000 to over 543,000 in country. Despite the US's superior firepower against the guerilla forces of the enemy, the two sides fought to a highly destructive draw. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp

29. Those who have fought for freedom, and have lost it, know a sadness and sense a loss beyond bearing. Approximately 2,700,000 American men and women served in Vietnam. It was the first war in which the US failed to meet its objectives. It was also the first time America failed to welcome its veterans back as heroes. Many veterans were attacked personally by their fellow countrymen, who opposed the war. This situation magnified the stress associated with their combat experiences. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp Image: http://www.vietnamwar.com/memorywall.jpgApproximately 2,700,000 American men and women served in Vietnam. It was the first war in which the US failed to meet its objectives. It was also the first time America failed to welcome its veterans back as heroes. Many veterans were attacked personally by their fellow countrymen, who opposed the war. This situation magnified the stress associated with their combat experiences. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp Image: http://www.vietnamwar.com/memorywall.jpg

30. Vietnam War Lack of unit cohesiveness Many veterans were sent to Vietnam as individuals Left when their year’s tour was completed Often traveled alone to and from Vietnam by air An active combatant one day A veteran returning to a hostile civilian environment the next Also contributing to the stress many veterans experienced was the lack of unit cohesiveness as many were sent to Vietnam as individuals and left when their year's tour was completed. They often traveled alone to and from Vietnam by air, being an active combatant one day and a veteran returning to a hostile civilian environment the next. They reported being spat upon as they disembarked at the airport and being uncomfortable wearing their uniform in public. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp Also contributing to the stress many veterans experienced was the lack of unit cohesiveness as many were sent to Vietnam as individuals and left when their year's tour was completed. They often traveled alone to and from Vietnam by air, being an active combatant one day and a veteran returning to a hostile civilian environment the next. They reported being spat upon as they disembarked at the airport and being uncomfortable wearing their uniform in public. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp

31. Vietnam War Environmental hazards Pesticide herbicide spraying Tropical country High temperatures High humidity Monsoon climate (unable to get dry for days) Few opportunities for bathing Poor skin hygiene Bacterial and fungal infections Skin disease In addition to the risks inherent to combat, troops experience many environmental hazards. Pesticide and herbicide spraying was commonplace. In addition, Vietnam is a tropical country with high temperatures, high humidity and a monsoon climate. Many troops were unable to get dry for days, opportunities for bathing were infrequent, and skin hygiene was poor. Bacterial and fungal infections of the feet were a major cause of temporary disability. Skin disease was a leading cause of outpatient visits and hospitalization. Throughout the war, disease accounted for 70.6% of all admissions with the remaining approximately equally divided between battle casualties (15.6%) and nonbattle injury (13.8%). The good survival rates seen were attributed to rapid evacuation, the ready availability of whole blood and well-established semi-permanent hospitals. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp Image (top): http://www.bhopal.net/opinions/spray-orange.jpg Image (bottom): http://teachnet.ie/stonge/images/marines%20in%20the%20jungle%20in%201968.jpg In addition to the risks inherent to combat, troops experience many environmental hazards. Pesticide and herbicide spraying was commonplace. In addition, Vietnam is a tropical country with high temperatures, high humidity and a monsoon climate. Many troops were unable to get dry for days, opportunities for bathing were infrequent, and skin hygiene was poor. Bacterial and fungal infections of the feet were a major cause of temporary disability. Skin disease was a leading cause of outpatient visits and hospitalization. Throughout the war, disease accounted for 70.6% of all admissions with the remaining approximately equally divided between battle casualties (15.6%) and nonbattle injury (13.8%). The good survival rates seen were attributed to rapid evacuation, the ready availability of whole blood and well-established semi-permanent hospitals. Reference: www.va.gov/oaa/pocketcard/vietnam_summary.asp Image (top): http://www.bhopal.net/opinions/spray-orange.jpg Image (bottom): http://teachnet.ie/stonge/images/marines%20in%20the%20jungle%20in%201968.jpg

32. Agent Orange The name “Agent Orange” came from the orange stripe on the 55-gallon drums in which the herbicide was stored. Approximately 20 million gallons of herbicides were used in Vietnam between 1962 and 1971 to remove unwanted plant life and leaves which otherwise provided cover for enemy forces during the Vietnam Conflict. Shortly following their military service in Vietnam, some veterans reported a variety of health problems and concerns which some of them attributed to exposure to Agent Orange or other herbicides. The Department of Veterans Affairs has developed a comprehensive program to respond to these medical problems and concerns. The principal elements of this program include quality health care services, disability compensation for veterans with service-connected illnesses, scientific research and outreach and education. Reference: http://www1.va.gov/agentorange/ Image: http://images.google.com/imgres?imgurl=http://cdn8.wn.com/o25/ar/i/f7/04c15f2a83b44f.jpg&imgrefurl=http://archive.wn.com/2005/03/05/1400/p/03/973be548b083c0.html&h=480&w=640&sz=35&hl=en&start=92&um=1&tbnid=FXMaXcIF43wvVM:&tbnh=103&tbnw=137&prev=/images%3Fq%3Dagent%2Borange,%2Bvietnam%26start%3D90%26ndsp%3D18%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:*:IE-SearchBox%26rlz%3D1I7GWYE%26sa%3DN http://cdn3.wn.com/o25/ar/i/31/e9ab4978f6c185.jpgThe name “Agent Orange” came from the orange stripe on the 55-gallon drums in which the herbicide was stored. Approximately 20 million gallons of herbicides were used in Vietnam between 1962 and 1971 to remove unwanted plant life and leaves which otherwise provided cover for enemy forces during the Vietnam Conflict. Shortly following their military service in Vietnam, some veterans reported a variety of health problems and concerns which some of them attributed to exposure to Agent Orange or other herbicides. The Department of Veterans Affairs has developed a comprehensive program to respond to these medical problems and concerns. The principal elements of this program include quality health care services, disability compensation for veterans with service-connected illnesses, scientific research and outreach and education. Reference: http://www1.va.gov/agentorange/ Image: http://images.google.com/imgres?imgurl=http://cdn8.wn.com/o25/ar/i/f7/04c15f2a83b44f.jpg&imgrefurl=http://archive.wn.com/2005/03/05/1400/p/03/973be548b083c0.html&h=480&w=640&sz=35&hl=en&start=92&um=1&tbnid=FXMaXcIF43wvVM:&tbnh=103&tbnw=137&prev=/images%3Fq%3Dagent%2Borange,%2Bvietnam%26start%3D90%26ndsp%3D18%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:*:IE-SearchBox%26rlz%3D1I7GWYE%26sa%3DN http://cdn3.wn.com/o25/ar/i/31/e9ab4978f6c185.jpg

33. Agent Orange Herbicide used to kill unwanted plants and to remove leaves from trees that otherwise provided cover for the enemy Used to protect US troops No special Agent Orange (AO) tests are available – no way to show that AO or other herbicides caused individual medical problems VA makes a presumption of AO exposure for Vietnam veterans See a comprehensive list of Agent Orange Briefs at www1.va.gov/agentorange/page.cfm?pg=2 AGENT ORANGE BRIEFS (FACT SHEETS) Introduction: Introduction to Fact Sheet Series Agent Orange - General Information Agent Orange Class Action Lawsuit Addendum to Agent Orange Brief (A2) Agent Orange Registry Agent Orange - Health Care Eligibility Agent Orange and VA Disability Compensation VA Information Resources on Agent Orange and Related Matters Agent Orange - The Problem Encountered in Research Agent Orange and Vietnam Related Research - VA Efforts Agent Orange and Vietnam Related Research - Non-VA Efforts Birth Defects Chloracne Non-Hodgkin's Lymphoma Soft Tissue Sarcomas Peripheral Neuropathy Hodgkin's Disease Porphyria Cutanea Tarda Multiple Myeloma Respiratory Cancers Prostate Cancer Spina Bifida Diabetes Chronic and Lymphocytic LeukemiaSee a comprehensive list of Agent Orange Briefs at www1.va.gov/agentorange/page.cfm?pg=2 AGENT ORANGE BRIEFS (FACT SHEETS) Introduction: Introduction to Fact Sheet Series Agent Orange - General Information Agent Orange Class Action Lawsuit Addendum to Agent Orange Brief (A2) Agent Orange Registry Agent Orange - Health Care Eligibility Agent Orange and VA Disability Compensation VA Information Resources on Agent Orange and Related Matters Agent Orange - The Problem Encountered in Research Agent Orange and Vietnam Related Research - VA Efforts Agent Orange and Vietnam Related Research - Non-VA Efforts Birth Defects Chloracne Non-Hodgkin's Lymphoma Soft Tissue Sarcomas Peripheral Neuropathy Hodgkin's Disease Porphyria Cutanea Tarda Multiple Myeloma Respiratory Cancers Prostate Cancer Spina Bifida Diabetes Chronic and Lymphocytic Leukemia

34. Agent Orange Under Section 102, Public Law 104-262, the Veterans’ Health Care Eligibility Reform Act of 1996, VA shall furnish hospital care, medical services and may furnish nursing home care to veterans exposed to herbicides in Vietnam Veterans do not have to prove that Agent Orange caused their medical problems to be eligible for compensation. Rather, VA must determine that the disability is “service connected.” The following articles can be downloaded from: www1.va.gov/agentorange Agent Orange Poster - May 2004 IOM Identifies Link with Chronic Lymphocytic Leukemia, Principi Extends Benefits Agent Orange General Information Brochure - July 2003 Agent Orange Information Bulletin 10-49 - March 2004 (Espanol) Veterans Benefits for those exposed to Agent Orange Agent Orange Handbook 1302.1 – 2006 Veterans Health Initiative (VHI) Agent Orange DoD Report on Herbicides Used Outside of Vietnam (VA encourages any veteran with in-country Vietnam service and diagnosed diabetes mellitus to contact his or her local VA office for information and assistance on applying for benefits. The veteran also may apply on-line.) http://vabenefits.vba.va.gov/vonapp Image: http://pzzzz.tripod.com/nam_P/1M_bunkers.gif http://images.google.com/imgres?imgurl=http://pzzzz.tripod.com/nam_P/1M_bunkers.gif&imgrefurl=http://pzzzz.tripod.com/fortunateson.html&h=438&w=431&sz=147&hl=en&start=28&um=1&tbnid=zvRuF1Kh2VcqFM:&tbnh=127&tbnw=125&prev=/images%3Fq%3Dvietnam%2Bwar%2Bimages%26start%3D18%26ndsp%3D18%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:*:IE-SearchBox%26rlz%3D1I7GWYE%26sa%3DN Veterans do not have to prove that Agent Orange caused their medical problems to be eligible for compensation. Rather, VA must determine that the disability is “service connected.” The following articles can be downloaded from: www1.va.gov/agentorange Agent Orange Poster - May 2004 IOM Identifies Link with Chronic Lymphocytic Leukemia, Principi Extends Benefits Agent Orange General Information Brochure - July 2003 Agent Orange Information Bulletin 10-49 - March 2004 (Espanol) Veterans Benefits for those exposed to Agent Orange Agent Orange Handbook 1302.1 – 2006 Veterans Health Initiative (VHI) Agent Orange DoD Report on Herbicides Used Outside of Vietnam (VA encourages any veteran with in-country Vietnam service and diagnosed diabetes mellitus to contact his or her local VA office for information and assistance on applying for benefits. The veteran also may apply on-line.) http://vabenefits.vba.va.gov/vonapp Image: http://pzzzz.tripod.com/nam_P/1M_bunkers.gif http://images.google.com/imgres?imgurl=http://pzzzz.tripod.com/nam_P/1M_bunkers.gif&imgrefurl=http://pzzzz.tripod.com/fortunateson.html&h=438&w=431&sz=147&hl=en&start=28&um=1&tbnid=zvRuF1Kh2VcqFM:&tbnh=127&tbnw=125&prev=/images%3Fq%3Dvietnam%2Bwar%2Bimages%26start%3D18%26ndsp%3D18%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:*:IE-SearchBox%26rlz%3D1I7GWYE%26sa%3DN

35. Agent Orange Malignant Diseases  Lung cancer Prostate cancer Hodgkin's and Non-Hodgkin’s Lymphoma    Sarcomas    Multiple Myeloma  Chronic Lymphocytic Leukemia Non-malignant Diseases Birth Defects: Spina Bifida  Diabetes Peripheral Neuropathy The VA has recognized a number of diseases as being associated with (but not necessarily caused by) Agent Orange exposure: Sufficient Evidence of an Association with Agent Orange Chronic lymphocytic leukemia (CLL) Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma) Non-Hodgkin’s lymphoma Hodgkin’s disease Chloracne (or other acne form disease consistent with chloracne – must occur within one year of exposure to AO) Limited or Suggestive Evidence of an Association with Agent Orange Respiratory Cancers (lung/bronchus, larynx, or trachea) Prostate Cancer Multiple Myeloma Acute and subacute or early-onset transient peripheral neuropathy (appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset) Porphyria cutanea tarda (within one year of exposure to AO) Type 2 Diabetes Mellitus Spina bifida in offspring of exposed individuals Reference: www1.va.gov/agentorange   The VA has recognized a number of diseases as being associated with (but not necessarily caused by) Agent Orange exposure: Sufficient Evidence of an Association with Agent Orange Chronic lymphocytic leukemia (CLL) Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma) Non-Hodgkin’s lymphoma Hodgkin’s disease Chloracne (or other acne form disease consistent with chloracne – must occur within one year of exposure to AO) Limited or Suggestive Evidence of an Association with Agent Orange Respiratory Cancers (lung/bronchus, larynx, or trachea) Prostate Cancer Multiple Myeloma Acute and subacute or early-onset transient peripheral neuropathy (appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset) Porphyria cutanea tarda (within one year of exposure to AO) Type 2 Diabetes Mellitus Spina bifida in offspring of exposed individuals Reference: www1.va.gov/agentorange  

36. Hepatitis C Virus (HCV) HCV is the most common infection carried by blood in the United States. 63% of enrolled veterans testing positive for HCV are Vietnam Era veterans Average age: 49 years old 96% male 4% female It is VHA policy that each VA Medical Center Director must designate a Hepatitis C Lead Clinician to be the principal point-of-contact for all clinical hepatitis C program information and reporting between the facility, the Clinical Public Health Program office, and other facility program offices. Hepatitis C virus (HCV) infection is a major public health problem in the United States (U.S.) because of its potential to lead to cirrhosis, hepatocellular carcinoma, and other life-threatening conditions. Chronic hepatitis C affects approximately 1.3 percent of the general U.S. population. The Centers for Disease Control and Prevention (CDC) estimate that over 3 million Americans are chronically infected with HCV. The prevalence rate is 5.4 percent among a patient population of veterans who use VHA for their health care. The seroprevalence rate in veterans who used VHA for their health care was three times that of the general U.S. population; the majority of these veterans have chronic infection. One-fourth of veterans with HCV infection are also infected with human immunodeficiency virus (HIV), not only putting them at risk for the acquired immunodeficiency syndrome (AIDS), but also increasing their risk of developing life-threatening complications from HCV infection. The VHA Hepatitis C Program has used a comprehensive approach emphasizing clinical care and prevention through testing, counseling, research, and education. References: Veterans Health Administration Directive 2007-022 (July 23, 2007); Statement of Gary A. Roselle, M. D., Program Director for Infectious Diseases, Veterans Health Administration, Department of Veterans Affairs, Before the Subcommittee on Benefits Committee on Veterans' Affairs U.S. House of Representatives, April 13, 2000 (www.va.gov/OCA/testimony/hvac/13ap00GR.asp) It is VHA policy that each VA Medical Center Director must designate a Hepatitis C Lead Clinician to be the principal point-of-contact for all clinical hepatitis C program information and reporting between the facility, the Clinical Public Health Program office, and other facility program offices. Hepatitis C virus (HCV) infection is a major public health problem in the United States (U.S.) because of its potential to lead to cirrhosis, hepatocellular carcinoma, and other life-threatening conditions. Chronic hepatitis C affects approximately 1.3 percent of the general U.S. population. The Centers for Disease Control and Prevention (CDC) estimate that over 3 million Americans are chronically infected with HCV. The prevalence rate is 5.4 percent among a patient population of veterans who use VHA for their health care. The seroprevalence rate in veterans who used VHA for their health care was three times that of the general U.S. population; the majority of these veterans have chronic infection. One-fourth of veterans with HCV infection are also infected with human immunodeficiency virus (HIV), not only putting them at risk for the acquired immunodeficiency syndrome (AIDS), but also increasing their risk of developing life-threatening complications from HCV infection. The VHA Hepatitis C Program has used a comprehensive approach emphasizing clinical care and prevention through testing, counseling, research, and education. References: Veterans Health Administration Directive 2007-022 (July 23, 2007); Statement of Gary A. Roselle, M. D., Program Director for Infectious Diseases, Veterans Health Administration, Department of Veterans Affairs, Before the Subcommittee on Benefits Committee on Veterans' Affairs U.S. House of Representatives, April 13, 2000 (www.va.gov/OCA/testimony/hvac/13ap00GR.asp)

37. Gulf War The 1991 Gulf War was considered a brief and successful military operation with few injuries and deaths of U.S. troops. The war began in August 1990, and the last U.S. ground troops returned home by June 1991. Although most Gulf War veterans resumed their normal activities, many soon began reporting a variety of unexplained health problems that they attributed to their participation in the Gulf War, including chronic fatigue, muscle and joint pain, loss of concentration, forgetfulness, headache, and rash. Reference: Institute of Medicine - http://veterans.iom.edu/conflict.asp?id=6043 Image: http://www.als-mda.org/publications/als/images/als11_7_desert_soldier.jpg The 1991 Gulf War was considered a brief and successful military operation with few injuries and deaths of U.S. troops. The war began in August 1990, and the last U.S. ground troops returned home by June 1991. Although most Gulf War veterans resumed their normal activities, many soon began reporting a variety of unexplained health problems that they attributed to their participation in the Gulf War, including chronic fatigue, muscle and joint pain, loss of concentration, forgetfulness, headache, and rash. Reference: Institute of Medicine - http://veterans.iom.edu/conflict.asp?id=6043 Image: http://www.als-mda.org/publications/als/images/als11_7_desert_soldier.jpg

38. Gulf War It’s important to understand that there were, and continue to be: Many concerns about the association between the illnesses and symptoms veterans report and: their exposure to toxic agents their exposure to environmental and wartime hazards the preventive medicines and vaccines they received In 1998, in response to the growing concerns of the ill Gulf War veterans, Congress passed two laws: PL 105-277, the Persian Gulf War Veterans Act, and PL 105-368, the Veterans Programs Enhancement Act. Those laws directed the secretary of veterans affairs to enter into a contract with the National Academy of Sciences (NAS) to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines associated with Gulf War service and to consider the NAS conclusions when making decisions about compensation. Those studies were assigned to the Institute of Medicine (IOM). Reference: http://www1.va.gov/environagents/docs/IOM_Summary_Lit_Review_Vol_4.pdf In 1998, in response to the growing concerns of the ill Gulf War veterans, Congress passed two laws: PL 105-277, the Persian Gulf War Veterans Act, and PL 105-368, the Veterans Programs Enhancement Act. Those laws directed the secretary of veterans affairs to enter into a contract with the National Academy of Sciences (NAS) to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines associated with Gulf War service and to consider the NAS conclusions when making decisions about compensation. Those studies were assigned to the Institute of Medicine (IOM). Reference: http://www1.va.gov/environagents/docs/IOM_Summary_Lit_Review_Vol_4.pdf

39. Gulf War Outcomes Based Primarily on Symptoms or Self-Reports No unique syndrome, unique illness, or unique symptom complex in deployed Gulf War veterans Multi-symptom-based medical conditions reported to occur more frequently among deployed Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity Deployment places veterans at increased risk for symptoms of psychiatric illnesses, particularly post traumatic stress disorder (PTSD), anxiety, depression and substance abuse Gulf War and Health VOLUME 4 HEALTH EFFECTS OF SERVING IN THE GULF WAR Committee on Gulf War and Health: A Review of the Medical Literature Relative to the Gulf War Veterans’ Health Board on Population Health and Public Health Practice INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES The charge to this IOM committee was to review, evaluate, and summarize peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans. The study was to help to inform the VA of illnesses among Gulf War veterans that might not be immediately evident. Reference: http://www1.va.gov/environagents/docs/IOM_Summary_Lit_Review_Vol_4.pdf Gulf War and Health VOLUME 4 HEALTH EFFECTS OF SERVING IN THE GULF WAR Committee on Gulf War and Health: A Review of the Medical Literature Relative to the Gulf War Veterans’ Health Board on Population Health and Public Health Practice INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES The charge to this IOM committee was to review, evaluate, and summarize peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans. The study was to help to inform the VA of illnesses among Gulf War veterans that might not be immediately evident. Reference: http://www1.va.gov/environagents/docs/IOM_Summary_Lit_Review_Vol_4.pdf

40. Gulf War Studies of returning Gulf War veterans with at least one commonly reported symptom (fatigue, memory loss, confusion, inability to concentrate, mood swings, somnolence, gastrointestinal distress, muscle and joint pain or skin or mucous-membrane complaints) demonstrated poorer performance on cognitive tests than by returning Gulf War veterans who did not report such symptoms. Image: http://www.f16viper.org/CaptMikeDonnelly.jpgImage: http://www.f16viper.org/CaptMikeDonnelly.jpg

41. Gulf War Among studies that examined pulmonary outcomes in associations with specific exposures in the Gulf War Theater, exacerbation of asthma associated with oil-well fire smoke has been indicated. Image (top): http://media.portland.indymedia.org/images/2004/11/304516.jpg Image (bottom): http://msnbcmedia4.msn.com/j/msnbc/Components/Photos/060912/060912_gulfwarone_hmed.hmedium.jpgImage (top): http://media.portland.indymedia.org/images/2004/11/304516.jpg Image (bottom): http://msnbcmedia4.msn.com/j/msnbc/Components/Photos/060912/060912_gulfwarone_hmed.hmedium.jpg

42. Gulf War On December 10, 2001, Veterans' Affairs Secretary, Anthony Principi, announced that a recently completed Veterans’ Affairs study revealed that Persian Gulf War veterans are more than twice as likely as other veterans to develop ALS.  Image (left): http://images.usatoday.com/news/_photos/2003/09/22-als-inside.jpg Image (right): http://documents.clubexpress.com/clubs/619358/photos/thumbnail/49138846.jpgImage (left): http://images.usatoday.com/news/_photos/2003/09/22-als-inside.jpg Image (right): http://documents.clubexpress.com/clubs/619358/photos/thumbnail/49138846.jpg

43. Gulf War Unique Health Risks: Exposure to smoke Chemical or Biological Agents Reference: http://www.va.gov/oaa/pocketcard/ Image: http://msnbcmedia3.msn.com/j/msnbc/Components/Photos/061110/061110_gulfwar_hmed1p.hmedium.jpgReference: http://www.va.gov/oaa/pocketcard/ Image: http://msnbcmedia3.msn.com/j/msnbc/Components/Photos/061110/061110_gulfwar_hmed1p.hmedium.jpg

44. Gulf War Unique Health Risks Immunizations Infections Depleted Uranium (DU) Reference: http://www.va.gov/oaa/pocketcard/ Image (left): http://www.pbs.org/newshour/extra/images/july-dec02/army_cap.jpg, posted 12/13/02 Image (right): http://www.freecomputerdesktopwallpaper.com/new_wallpaper/B1_bomber_USAF_miliatry_aviation_freecomputerdesktopwallpaper_p.jpgReference: http://www.va.gov/oaa/pocketcard/ Image (left): http://www.pbs.org/newshour/extra/images/july-dec02/army_cap.jpg, posted 12/13/02 Image (right): http://www.freecomputerdesktopwallpaper.com/new_wallpaper/B1_bomber_USAF_miliatry_aviation_freecomputerdesktopwallpaper_p.jpg

45. Operation Enduring Freedom/ Operation Iraqi Freedom (OEF/OIF) Following the September 11, 2001, terrorist attacks on the World Trade Center and the Pentagon, the United States responded by deploying military personnel in Southwest Asia. By January 2002, more than 30,000 active duty were involved. Additional reserve personnel continue to be called to duty. Currently, as part of OEF, U.S. troops are on the ground in Afghanistan, Pakistan, and neighboring countries of the former Soviet Union. Reference: “Enduring Freedom Veterans: Information for Veterans Who Served in Afghanistan and For Their Families”, Veterans Health Administration, December 2004 (http://www1.va.gov/environagents/docs/EnduringFreedomVeteransNewsletterDec2004.pdf) As a result of Iraq’s refusal to comply with United Nations’ mandates, U.S. began deploying troops to the Gulf region in late 2002. Coalition forces subsequently won a decisive victory against the forces under the regime of Saddam Hussein, during April 2003, in Operation Iraqi Freedom. Coalition forces remain in Iraq today as part of ongoing peacekeeping/nation-building activities. “Iraqi Freedom Veterans: Information for Veterans Who Served in Southwest Asia in 2003”, Veterans Health Administration, May 2003 (http://www1.va.gov/gulfwar/docs/IraqiFreedomMay21.pdf) Image: http://www.behindthebadge.net/bloodstripes/memory/images/marines.jpg Following the September 11, 2001, terrorist attacks on the World Trade Center and the Pentagon, the United States responded by deploying military personnel in Southwest Asia. By January 2002, more than 30,000 active duty were involved. Additional reserve personnel continue to be called to duty. Currently, as part of OEF, U.S. troops are on the ground in Afghanistan, Pakistan, and neighboring countries of the former Soviet Union. Reference: “Enduring Freedom Veterans: Information for Veterans Who Served in Afghanistan and For Their Families”, Veterans Health Administration, December 2004 (http://www1.va.gov/environagents/docs/EnduringFreedomVeteransNewsletterDec2004.pdf) As a result of Iraq’s refusal to comply with United Nations’ mandates, U.S. began deploying troops to the Gulf region in late 2002. Coalition forces subsequently won a decisive victory against the forces under the regime of Saddam Hussein, during April 2003, in Operation Iraqi Freedom. Coalition forces remain in Iraq today as part of ongoing peacekeeping/nation-building activities. “Iraqi Freedom Veterans: Information for Veterans Who Served in Southwest Asia in 2003”, Veterans Health Administration, May 2003 (http://www1.va.gov/gulfwar/docs/IraqiFreedomMay21.pdf) Image: http://www.behindthebadge.net/bloodstripes/memory/images/marines.jpg

46. OEF/OIF Unique Health Risks: Infectious disease Cold injury High altitude illnesses Environmental Hazards: Exposure to sewage Exposure to agricultural and industrial contamination of water and food Air pollution Severe sand and dust storms Reference: http://www.va.gov/oaa/pocketcard/ Reference: http://www.va.gov/oaa/pocketcard/

47. OEF/OIF Additional Risks Combined penetrating, blunt trauma, and burn injuries (blast injuries) Traumatic brain or spinal cord injury Vision loss Traumatic amputation Multi-drug resistant acinetobacter Leishmaniasis (sandfly-transmitted infection of the skin) Depleted uranium (DU) Mental health issues Reference: http://www.va.gov/oaa/pocketcard/ Reference: http://www.va.gov/oaa/pocketcard/

48. Haunted by combat… “War means something different to those of us that have looked through the sights of a rifle at another human being’s face. Collateral damage means something different to those of us that have seen the lifeless body of a 9-year-old girl caught in the crossfire. Or for those of us that have struggled to save the life of a 7-year-old boy. I’ve only mentioned a fraction of what still haunts me from Iraq. I’ve been diagnosed with PTSD…” – An Iraq veteran from New Jersey (Meagher, 2007, p. xix) Image: http://debbyestratigacos.mu.nu/archives/GI%20and%20dying%20Iraqi%20girl%200_22_450_baby.jpg Moving a Nation to Care: Post-traumatic Stress Disorder and America’s Returning Troops. Ilona Meagher, IG Publishers, (2007) ISBN 0977197271Image: http://debbyestratigacos.mu.nu/archives/GI%20and%20dying%20Iraqi%20girl%200_22_450_baby.jpg Moving a Nation to Care: Post-traumatic Stress Disorder and America’s Returning Troops. Ilona Meagher, IG Publishers, (2007) ISBN 0977197271

49. OEF/OIF Resource Edited by Terri Tanielian and Lisa H. Jaycox Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments — many involving prolonged exposure to combat-related stress over multiple rotations — may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. Reference: www.rand.org/pubs/monographs/MG720/ Image: http://www.ccebook.cn/upload/1208593424.gif Edited by Terri Tanielian and Lisa H. Jaycox Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments — many involving prolonged exposure to combat-related stress over multiple rotations — may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. Reference: www.rand.org/pubs/monographs/MG720/ Image: http://www.ccebook.cn/upload/1208593424.gif

50. Honoring veterans preferences at the end of life… What’s so special about the veteran’s end-of-life experience? Military culture and training influences a soldier’s life and death (Battlemind) War may leave men and women with physical and mental wounds Posttraumatic stress symptoms may surface at end of life Military experiences and relationships may also be a source of strength and comfort Image: http://www.wolfhounds.net/Admin/Images/fallen_flag.jpgWhat’s so special about the veteran’s end-of-life experience? Military culture and training influences a soldier’s life and death (Battlemind) War may leave men and women with physical and mental wounds Posttraumatic stress symptoms may surface at end of life Military experiences and relationships may also be a source of strength and comfort Image: http://www.wolfhounds.net/Admin/Images/fallen_flag.jpg

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