Dear Chairman and Committee members,

I am Alan Oates, a Vietnam Veteran.  I have Parkinson’s disease.  I am a member of an organization called “US Military Veterans with Parkinson’s “(USMVP).   Our organization and members haven’t received any Federal Grant Funds nor do we have any Contracts with the US Government.

Parkinson’s is a degenerative, progressive disease without a cure.  The physical, mental and financial burden on Vietnam Veterans suffering with this disease and their families is devastating. 

Public Law 102-4 was passed to provide a better means to address Agent Orange and the health issues that Vietnam Veterans faced.   Congress recognized the need for an agency outside of the VA to look at these issues.  Especially since the VA’s own report by Admiral Zumwalt stated that the VA’s review committee on Agent Orange was so biased to Veterans that they should be fired.  The VA classified this report to keep it from the public. 

However due to flaws and failed implementation of Public Law 102-4, the system created by Congress to help these Vietnam veterans has failed them.  It has failed the Veteran who recently emailed me, pleading for help as his Parkinson’s had left him unable to work and almost homeless…. and the Veteran who at 58 years of age was left so helplessly immobile in bed that his wife has to cauterizes him twice a day.   Let there be no doubt that their Parkinson’s is a result of their service to their Country in Vietnam.

I have met with the staff of many of the members on this committee and have provided extensive documentation and justification for passing this bill.   As in written testimony I am limited to ten pages total, I am only including selected exhibits.

After extensive research we have found:

• Vietnam Veterans were exposed to a large number of toxic chemicals including Agent Orange and Organophosphates.
• Evidence that connects Parkinson’s disease to service in Vietnam and to exposure to various chemicals used in military operations.
• The Department of Veterans’ Affairs and the system established under Public Law 102-4 to look at the disease in Vietnam Veterans has failed these Veterans.

1. Vietnam Veterans were exposed to a multitude of chemicals during their military service in Vietnam.  Agent Orange and Malathion (Malaoxon) are two of those. 

1. Agent Orange consisted of two herbicides, 2,4-D and 2,4,5-T.  The production of 2,4,5-T  created the toxic dioxin, TCDD.  This is considered one of most toxic dioxin known to man. 

1. The Institute of Medicine in the Agent Orange Review reports that the TCDD in Agent Orange could be up to 1,000 time more toxic than that in the same herbicide used  outside of military operations (farming and home use).  This is important as most studies using the 2,4,5-T herbicide are based on a less toxic form than that used in Agent Orange.            

2. Malathion is an organophosphate insecticide. Organophosphates were developed by Nazi Germany in the late 1930’s as a Chemical Warfare Nerve Agent.  These agents impact the Central and Peripheral Nervous System.

1. Operation Flyswatter exposed Vietnam Veterans to Malathion routinely every 9 days weather permitting.
2. The long storage times, high heat and exposure to sunlight cause Malathion to break down into a highly toxic Malaoxon.

3. Agent Orange and Malathion individual and in combination are scientifically associated to Parkinson’s disease.

4. Evidence of Association between Parkinson’s disease and military service in Vietnam.

1. Stanford University Military Deployment Study Abstract (Exhibit A)  found an
2. Increase of 2.6 times in the risk for Parkinson’s disease in veterans who deployed to Vietnam compared to those who did not.
3. Dr. Chris Reid provides a nexus between service in Vietnam and Parkinson’s. 

V.     Agent Orange Association

1. In the Iowa Agriculture Health Study Update 2007 (Exhibit B), Dr.  Kamel found that 2,4,5-T (Agent Orange herbicide) was associated with an increased risk in Parkinson’s disease.
2. In the BMC Neurology Study published March 28, 2008, a strong Odds Ratio was found between 2,4-D and Parkinson’s disease even though the association had not reached a scientific significant level. 
3. A study showing how 2,4-D can impact the portion of the brain related to dopamine productions. “Intracerebral administration of 2,4-diclorophenoxyacetic acid induces behavioral and neurochemical alterations in the rat brain. Bortolozzi A.”
4. A study showing  alterations in dopamine in basal ganglia by 2,4-D in neonatal exposed rats, mediated by a serotonergic modulation on the dopaminergic system. 
5. A study shows that 2,4-D can damage the cytoskeleton structure of brain cells and disrupts the microtubule of neuron cells. (2,4-D Acid Disrupts the Cytoskeleton and Disorganizes thee Golgi apparatus of Cultured Neurons) Silvan B. Rosso April 5, 2000).   Another study shows that when the microtubule is disrupted in a dopamine carrying cell, it causes dopamine to leak from the cell and kill the dopamine cells.   (Jian Feng Microtubule: A Common Target for Parkin and Parkinson’s Disease Toxins).   The loss of dopamine cells causes Parkinson’s disease. 
6. A study (2,3,7,8-Tetracholorodibenzo-p-dioxin exposure disrupts granule neuron precursor maturation in the developing mouse cerebellum. Collins LL.) Demonstrates the ability of alter neuron cells.

6.  Organophosphates Malathion Evidence of  Association

1. The BMC Neurology Study published 28 March 2008 finds scientifically significant association between Organophosphates (Malathion) and Parkinson’s disease.
2. There are numerous studies showing how organophosphates are suspect in the development of Parkinson’s disease.

7. Public Law 102-4 has failed the Vietnam Veterans. 

1. The law failed to address the issue that were many chemicals exposure and not just Agent Orange  for Vietnam Veterans and narrowly focused on only the herbicides used in military operations. 
2. The Institute of Medicine (IOM) in conducting its research for the Agent Orange Reviews is limited to researching only the Diseases as they are associated with herbicides used in Vietnam.
3. The IOM charge is to look for a scientific connection between a disease and the herbicides and not to look for a connection between a disease and Veterans service in Vietnam. 
4. An example of this is in the IOM AO 2006 review as cited by the Department of Veterans’ Affairs in the Federal Register on presumptiveness for Peripheral Neuropathy.  A study found some association with service in Vietnam but not to the chemicals of interest.  The focus should be, is there evidence of an association between the disease and the Veterans service in Vietnam. 
5. IOM will not look at other chemicals such as Organophosphates as their charge by law is limited to herbicides.  There are many cases where other chemical exposures such as Organophosphates and solvent contribute to or cause a disease. 

8. The Department of Veterans Affairs (DVA) has failed to implement requirements of the law. 

1. Public Law 102-4 required the DVA to conduct studies that were recommended by the IOM in the Agent Orange Reviews.

1. DVA failed to conduct studies recommended by the IOM in the Agent Orange Reviews.

1. Since 1994 in each review IOM has stated  the importance of seeing if there is an early onset of Parkinson’s disease in exposed veterans.

2. The importance of studies comparing exposed to non exposed veterans.

2. DVA failed to collect and review the clinical data on illnesses and disease related to Agent Orange in Vietnam Veterans. 

1. This is evident by the fact that the DVA has been unable to provide even the number of Vietnam War Zone Veterans they are treating for Parkinson’s disease.  A request was made on my behalf by Congressman Goodlatte on April 9 for information on Vietnam Veterans with Parkinson’s, as of this date DVA has not provided this information.

3. DVA failed to recognize that a finding of a biologic plausible mechanism in the IOM Agent Orange review is a causal relationship. 

1. Public law 102-4 required the NAS (IOM) to look to see if there is evidence of a biologic plausible mechanism “or other” causal association. 

1. By using the words “or other” Congress and the law is clear that a finding of evidence of a biologic plausible mechanism is a causal association.  

2. The VA Appeal Board has found service connection for Parkinson’s disease due to herbicide exposure in two cases that we have found. In one of those cases the VA admits a finding of Biologic Plausibility and the appeal court judge rules in favor of the Veteran based partly on that point.

9. DVA is required by law to evaluated the evidence for and against presumptiveness of a disease and rule in favor of presumptiveness if the evidence for is equal to or greater than the evidence against an association.  DVA must also publish it findings on presumptiveness in the Federal Register and give the scientific basis for that finding. 

1. In the 2006 Agent Orange Review, IOM stated,  “In pursuing the question of statistical association, the committee recognized that an absolute conclusion about the absence of association is unattainable. As in science generally, studies of health effects associated with herbicide exposure cannot demonstrate that a purported effect is impossible or could never occur. Any instrument of observation, even the most excellent epidemiologic study, is limited in its resolving power. In a strict technical sense, therefore, the committee could not prove the absence of an association between a health outcome and exposure to any of the compounds of interest. That contributed to the current committee’s decision to re-evaluate findings on the health endpoints classified in Update 2004 as having “suggestive evidence of no association.”

 This is a dramatic change from the prior position of the IOM.  “Studies of health effects associated with herbicide exposure cannot demonstrate that a purported effect is impossible or could never occur.”  Since a negative association is not technically possible the credible evidence provided by the IOM at the worst can only be viewed as neutral by DVA when evaluating a disease for presumptiveness.

10. Since a positive causal association exists, not only because of the biologic plausibility but because of other credible evidence, DVA should have already approved presumptiveness for Parkinson’s disease.

The system and the DVA have failed Vietnam Veterans.  We bring our issues to the Veterans’ Affairs Committee and the House of Representatives (The Peoples House) to correct and right this injustice.  We ask that the Committee do two things

• First, pass HR 6032 and  give these Veterans, who on the average have already suffered with this service connected disease for six years and individually up to twenty-five years, the help they so desperately need.  They can not afford to wait any longer for the system to be fixed and to then address this issue. 
• Second, make the necessary changes to the system to insure that they will correct the problems and issues we have addressed in this document.

Thank you for the opportunity to provide input on this important issue.