IHD and Agent Orange - use a direct claim

Hello Jim,

I came across your website as I was researching IHD and herbicides. My questionsiare: Since every scientific study published describes IHD as "Ischaemic or ischemic heart disease (IHD), or myocardial ischaemia, is a disease characterized by ischaemia (reduced blood supply) of the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries). Its risk increases with age, smoking, hypercholesterolaemia (high cholesterol levels), diabetes, and hypertension (high blood pressure), and is more common in men and those who have close relatives with ischaemic heart disease" or some variance of that, why does the VA refuse to acknowledge that herbicide (dioxin) exposure causes atherosclerosis and therefore ALL of the other major and often fatal diseases such as Peripherial Artery disease and Ischemic Stroke? I have found literally thousands of websites posting studies by such credible organizations as the National Institute of Health (NIH), the National Heart, Lung and Blood Institute (NHLBI) as well as prestigeouis institutions such as the Mayo Clinic and various universities that document a direct nexus between TCDD (Dioxin) exposure and atherosclerosis. I have also found studies from those same very credible organizations that link atherosclerosis and Ischemic Stroke and Peripheral Artery Disease (P.A.D.). Yet the VA continues to deny each and every veteran's claim for compensation for either or both of those diseases. Do they actually think that we veterans are so ignorant that we do not realize that the plaques that cause the ischemia resulting in IHD travel in the same blood that flows through every other artery, capillary and vein in our bodies and do not treat the heart as a major exit point like getting off the "blood train" and only targeting the heart? Doesn't Public Law 102-4 (the agent orange act of 1991) State:)(1) Whenever the Secretary determines, on the basis of sound medical and scientific evidence, that a positive association exists between (A) the exposure of humans to an herbicide agent, and (B) the occurrence of a disease in humans, the Secretary shall prescribe regulations providing that a presumption of service connection is warranted for that disease for the purposes of this section.

"(2) In making determinations for the purpose of this subsection, the Secretary shall take into account (A) reports received by the Secretary from the National Academy of Sciences under section 3 of the Agent Orange Act of 1991, and (B) all other sound medical and scientific information and analyses available to the Secretary. In evaluating any study for the purpose of making such determinations, the Secretary shall take into consideration whether the results are statistically significant, are capable of replication, and withstand peer review."?

Aren't these studies that are posted on the internet available to the Secretary and therefore to the rest of the VA as well"? Or arethey not considered "sound medical and scientific information and analyses "? And if they're not shouldn't the government close down the NIH and NHLBI, since they're tasked with providing sound information on all OTHER aspects of medical and health issues?

So, if none of the above is resolved, how long is the VA going to be allowed to continue to deceive veterans through their lies and avoidance of publishing complete information? And, finally how long are they going to be allowed to violate a law that was written by congress?

I look forward to hearing back from you soon.


As it happens, I agree with you. I'm a retired health care professional. I spent 35 years working in cardiac cath labs, radiology special procedures labs, and vascular/heart surgery operating rooms. I was a tech...a certified surgical first assistant. I directly assisted physicians in procedures and worked in operating rooms, trauma centers and other heart-associated jobs most of my life. I first trained in the Army for all of this (MOS 91D-20) and my career eventually led me to become an administrator and consultant to heart centers across America. I also served as a volunteer on boards for the American Heart Association at local, state and national levels.

I tell you all that only to say; I know a little about arterial vascular disease. I know that vascular disease is a total body condition. While vascular (arterial) disease may manifest clinical symptoms in one place or another, there is no question that if you have heart disease (coronary artery disease, IHD, atherosclerosis) you have similar disease in all the other arteries in your body.

I believe the Secretary chose heart disease based on the complex process that is in effect for most such things. Ischemic Heart Disease (IHD) is the most studied disease ever. There is such an overwhelming statistical knowledge when compared to renal artery, peripheral artery or carotid artery disease, for example, that it was simpler to push that through the red tape barriers than to try to get it all done. I believe that had he tried to get Congress to approve the whole ball of wax, he may have lost the battle.

The projected expense of caring for IHD victims was enough to make Congress balk at the proposal of the new agent orange presumptives. If you weren't close to all this at the time that it was happening, you may not remember that Congress strongly opposed any new presumptives for IHD because of the enormous expense. Of course much of that was politics as usual because Secretary Shinseki is a political appointee of President Obama and the Congress has opposed anything that any Obama appointee does just because.

As it happened, the addition of IHD was the action that allowed the Nehmer court ruling that ordered that all Vietnam veterans who had ever filed for IHD to be brought back up to the decision making authority and subsequently awarded benefits. Many thousands of veterans who fell into the Nehmer claims class were awarded hundreds of thousands of dollars in retroactive pay. It was too little, too late, in my opinion but at the same time it brought some degree of justice and closure to the affected vets.

Secretary Shinseki was adamant that he was going to see to it that Vietnam veterans were finally settled up with what they deserved. He chose the biggest of all the disabling conditions and he won. It has cost the taxpayer hundreds of millions of dollars. On a side note, the addition of IHD and the Nehmer case has a lot to do with why there is a huge backlog today. The court that decided Nehmer ordered VBA to make the resolution of all claims a swift and sure process. Most of the VBA was put on hold as a task force was created at the 56 regional offices to tackle the hugely complex work of sorting out which veterans and which survivors were to be awarded benefits. This created a clog at the VBA that lasted 1 1/2 years as other claims were set aside while the Nehmer class cases were worked on.

The bottom line is that Congress didn't write the rules for the new presumptives. The VA did that at the direction of Secretary Shinseki. You probably know that he's close to the Vietnam war veteran as he's a disabled vet himself. He lost most of a foot when he stepped on a mine while on a patrol in Vietnam.

It's my belief that although he couldn't get it all done, he accomplished one of the greatest feats ever by doing what he did...getting IHD approved in the face of a Congress that is so anti-veteran that it boggles the mind. I watched some of the hearings and he was harshly, rudely treated by the mostly non-veteran Congress. I applaud him for what he managed to do in the face of such adversity.

While he did do a good job representing us for the purposes of the IHD benefit, along with settling the Nehmer cases, that makes me wonder why he can't now get the backlog resolved. But, I suppose I'm comparing apples and oranges.

In any case, I understand your frustration and I agree...you're right. The concept of total body atherosclerosis was not seen in the proper light as it should have been. Having said that, we have to remember that the VA is in Washington, D.C. and everything there is politics. There is no right and wrong there, only politics. Shinseki may have settled for a 2/3's measure rather than the whole thing but it was a major victory for the Vietnam veteran.

Yes, the law does say, "(1) Whenever the Secretary determines, on the basis of sound medical and scientific evidence, that a positive association exists between (A) the exposure of humans to an herbicide agent, and (B) the occurrence of a disease in humans, the Secretary shall prescribe regulations providing that a presumption of service connection is warranted for that disease for the purposes of this section." But any time the Secretary promulgates a new regulation, the Congress must approve the budgetary impact. In this case, Congress was against it all. They did not want to spend any more money to take care of Vietnam vets.

We won...not the whole thing but most of it.

Veterans who have peripheral, carotid, renal or pudendal arterial vascular disease today can usually prevail in a claim by using a nexus letter. This is called a direct claim rather than a presumptive claim. If a qualified physician writes a letter stating that it is more likely than not that the vascular condition is associated with agent orange exposure and cites a little literature, most of those claims are going to be awarded.

Also, if the Vietnam veteran has DMII and subsequent arterial vascular disease, all affected body systems are covered as DMII is recognized as the precipitating cause. I've assisted many veterans with direct cause agent orange claims and there have been few problems once the proper nexus letter is written.