VETERANS RESOURCES NETWORK (04/02/2000) Below is information from Trevor Hunt, the National Secretary of the Vietnam Veterans Association of Australia. It concerns the fact that the Australian Government allows compensation for Diabetes Mellitus as a result of Agent Orange exposure. See item "8" and "5.r" The medical reports and research on this issue would be helpful, if I get my hands on any, I will post them. While this relates to the Australian Government, it can be one more piece of helpful information to gain the "benefit of reasonable Doubt" when filing your VA claim. You will of course need your own Doctor's statement that you have Diabetes Mellitus and that it is related to your Agent Orange exposure while in Vietnam. Also present any reports and journal findings, that support your contention. Argue the Benefit of Doubt as provided by law. If anyone wins based on the benefit of doubt, contact me with your claim docket number at the Board of Veterans Appeals, or Veterans Court, and I will broadcast the case.

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Attached is the info as used by the Australian Government to accept Diabetes as war related Regards Geoff Trevor-Hunt OAM National Secretary Vietnam Veterans Association of Australia Instrument No.82 of 1999 Revocation and Determination of Statement of Principles concerning DIABETES MELLITUS ICD-10-AM CODES: E10, E11, E12, E13, E14 Veterans' Entitlements Act 1986 1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans' Entitlements Act 1986 (the Act): (a) revokes Instrument No.46 of 1999; and (b) determines in its place the following Statement of Principles. Kind of injury, disease or death 2. (a) This Statement of Principles is about diabetes mellitus and death from diabetes mellitus. (b) For the purposes of this Statement of Principles, "diabetes mellitus" means an endocrine disease characterised by: (i) a fasting venous plasma glucose concentration equal to or greater than 7.8 millimoles per litre on at least two separate occasions; or (ii) a venous plasma glucose concentration equal to or greater than 11.1 millimoles per litre both within two hours and at two hours after ingestion of 75 grams of glucose, attracting ICD-10-AM code E10, E11, E12, E13 or E14. Basis for determining the factors 3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that diabetes mellitus and death from diabetes mellitus can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces. Factors that must be related to service 4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person. Factors 5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting diabetes mellitus or death from diabetes mellitus with the circumstances of a person's relevant service are: (a) in relation to type 1 diabetes mellitus, being infected with rubella virus or Coxsackie B virus before the clinical onset of diabetes mellitus; or (b) in relation to type 2 diabetes mellitus, being obese for a period of at least ten years before the clinical onset of diabetes mellitus; or (c) in relation to type 2 diabetes mellitus, smoking at least 10 pack years of cigarettes or the equivalent thereof in other tobacco products, before the clinical onset of diabetes mellitus, and where smoking has ceased, the clinical onset has occurred within 10 years of cessation; or (d) suffering from gestational diabetes before the clinical onset of diabetes mellitus; or (e) suffering from acute pancreatitis or chronic pancreatitis before the clinical onset of diabetes mellitus; or (f) suffering from pancreatic cancer before the clinical onset of diabetes mellitus; or (g) undergoing surgery to the pancreas before the clinical onset of diabetes mellitus; or (h) suffering from cystic fibrosis before the clinical onset of diabetes mellitus; or (j) suffering from haemochromatosis before the clinical onset of diabetes mellitus; or (k) suffering from Cushing's syndrome before the clinical onset of diabetes mellitus; or (m) suffering from acromegaly before the clinical onset of diabetes mellitus; or (n) suffering from phaeochromocytoma before the clinical onset of diabetes mellitus; or (o) having been treated with pentamidine within the two years immediately before the clinical onset of diabetes mellitus; or (p) being treated with a drug reported to have caused hyperglycaemia, for a condition for which the drug cannot be ceased or substituted, at the time of the clinical onset of diabetes mellitus; or (q) being treated with immunosuppressive drugs, for organ transplantation, at the time of the clinical onset of diabetes mellitus; or (r) undertaking work involving hand decanting or spraying of 2,3,7,8-TCDD contaminated herbicides; or undertaking work involving filling, cleaning and maintenance of spray equipment used to apply 2,3,7,8-TCDD contaminated herbicides on more days than not, during a period of at least six months before the clinical onset of diabetes mellitus; or (s) the presence of a serum 2,3,7,8-TCDD level of at least 5 ppt at the time of the clinical onset of diabetes mellitus; or (t) in relation to type 1 diabetes mellitus, being infected with rubella virus or Coxsackie B virus before the clinical worsening of diabetes mellitus; or (u) in relation to type 2 diabetes mellitus, being obese for a period of at least ten years before the clinical worsening of diabetes mellitus; or (v) in relation to type 2 diabetes mellitus, smoking at least 10 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical worsening of diabetes mellitus, and where smoking has ceased, the clinical worsening has occurred within 10 years of cessation; or (w) being pregnant before the clinical worsening of diabetes mellitus; or (x) suffering from acute pancreatitis or chronic pancreatitis before the clinical worsening of diabetes mellitus; or (y) suffering from pancreatic cancer before the clinical worsening of diabetes mellitus; or (z) undergoing surgery to the pancreas before the clinical worsening of diabetes mellitus; or (za) suffering from cystic fibrosis before the clinical worsening of diabetes mellitus; or (zb) suffering from haemochromatosis before the clinical worsening of diabetes mellitus; or (zc) suffering from Cushing's syndrome before the clinical worsening of diabetes mellitus; or (zd) suffering from acromegaly before the clinical worsening of diabetes mellitus; or (ze) suffering from phaeochromocytoma before the clinical worsening of diabetes mellitus; or (zf) having been treated with pentamidine within the two years immediately before the clinical worsening of diabetes mellitus; or (zg) being treated with a drug reported to have caused hyperglycaemia, for a condition for which the drug cannot be ceased or substituted , at the time of the clinical worsening of diabetes mellitus; or (zh) being treated with immunosuppressive drugs, for organ transplantation, at the time of the clinical worsening of diabetes mellitus; or (zj) inability to obtain appropriate clinical management for diabetes mellitus. Factors that apply only to material contribution or aggravation 6. Paragraphs 5(t) to 5(zj) apply only to material contribution to, or aggravation of, diabetes mellitus where the person's diabetes mellitus was suffered or contracted before or during (but not arising out of) the person's relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70 (5A)(d) of the Act refers. Inclusion of Statements of Principles 7. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles. Other definitions 8. For the purposes of this Statement of Principles: "2,3,7,8-TCDD contaminated herbicides" means Agent Orange and other herbicides containing 2,4,5- trichlorophenoxyacetic acid alone or in combination; "acromegaly" means a chronic disease of adults due to hypersecretion of the pituitary growth hormone and characterised by enlargement of many parts of the skeleton e specially the distal portions, the nose, ears, jaws, fingers and toes; "acute pancreatitis" means an acute inflammatory condition due to auto-digestion of pancreatic tissue by its own enzymes, typically presenting with abdominal pain, and usually associated with raised levels of pancreatic enzymes in blood or urine; "being obese" means an increase in body weight by way of fat accumulation beyond an arbitrary limit, and due to a cause specified in the Repatriation Medical Authority's Statement about the causes of "being obese" signed by the Chairman of the Authority on 16 August 1996. The measurement used to define "being obese" is the Body Mass Index (BMI). The BMI = W/H2 and where: W is the person's weight in kilograms and H is the person's height in metres. "Being obese" is considered to be present when the BMI is 30 or greater. This definition excludes weight gain not resulting from fat deposition such as gross oedema, peritoneal or pleural effusion, or muscle hypertrophy. "Being obese" develops when energy intake is in excess of expenditure for a sustained period of time. For a factor to be included as a cause of "being obese" it must have resulted in a significant weight gain, of the order of a 20% increase in baseline weight, and in association with a BMI of 30 or greater; "chronic pancreatitis" means a continuing inflammatory disease of the pancreas characterised by irreversible morphological change that is typically associated with pain or permanent impairment of exocrine (steatorrhoea) and endocrine (diabetes mellitus) function or both; "Coxsackie B virus" means one of a heterogeneous group of viruses of the genus Enterovirus, that in humans has a tendency to affect the meninges and occasionally the cerebrum, but which can cause a wide spectrum of clinical illness; "Cushing's syndrome" means a condition due to the increased production of glucocorticoids in the adrenal gland, or increased blood levels of glucocorticoids from exogenous therapeutic administration of glococorticoids or adrenocorticotropic hormone (ACTH); "cystic fibrosis" means a generalised, autosomal recessive disorder, in which there is widespread dysfunction of the exocrine glands, characterised by signs of chronic pulmonary disease, pancreatic deficiency, abnormally high levels of electrolytes in the sweat, and occasionally by biliary cirrhosis; "death from diabetes mellitus" in relation to a person includes death from a terminal event or condition that was contributed to by the person's diabetes mellitus; "gestational diabetes" means carbohydrate intolerance of variable severity with onset or first recognition during pregnancy; "haemochromatosis" means a genetic disorder of iron storage in which an inappropriate increase in intestinal iron absorption results in the deposition of excessive quantities of iron in parenchymal cells, with eventual tissue damage and functional impairment of the organs involved, especially the liver, pancreas, heart and pituitary; "ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), effective date of 1 July 1998, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86451 340 3; "immunosuppressive drugs" means drugs or agents capable of suppressing immune responses; "pack years of cigarettes or the equivalent thereof, in other tobacco products" means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes (being the "standard" cigarette pack contents) per day for a period of one calendar year, or 7 300 cigarettes. One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack year of tailor made cigarettes equates to 7 300 cigarettes, or 7.3kg of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination; "pancreatic cancer" means a malignant neoplasm of the cells of the pancreas; "phaeochromocytoma" means a neoplasm of chromaffin tissue usually located in the adrenal medulla or sympathetic ganglion, which produces, stores and secretes catecholamines; "ppt" means parts per trillion; "relevant service" means: (a) operational service; or (b) peacekeeping service; or (c) hazardous service; "reported to have caused hyperglycaemia" means a drug reported to have caused hyperglycaemia in the published peer-reviewed medical literature; "rubella virus" means a member of the Togavirus family which causes rubella (German measles); "serum 2,3,7,8-TCDD" means 2,3,7,8-tetrachlorodibenzo-para- dioxin as measured from an appropriately derived blood sample; "terminal event" means the proximate or ultimate cause of death and includes: a) pneumonia; b) respiratory failure; c) cardiac arrest; d) circulatory failure; or e) cessation of brain function; "type 1 diabetes mellitus" means insulin dependent diabetes mellitus. Insulin dependence is not equivalent to insulin therapy. Rather, it means that the patient is at risk of ketoacidosis in the absence of insulin; "type 2 diabetes mellitus" means non-insulin dependent diabetes mellitus. Note: The National Diabetes Group Classification is detailed in the table: CLASS CLINICALCHARACTERISTICS DIAGNOSTICCRITERIA insulin dependent diabetes mellitus(IDDM, type 1) Ketosis prone; dependent on insulin for survival; usual onset in youth; absolute insulin deficiency; anti- islet cell antibodies often present at diagnosis unequivocal elevation of blood glucose with polyuria, polydipsia, weight loss and weakness non-insulin dependent diabetes mellitus (NIDDM, type 2) Ketosis resistant, usual onset after 40 years of age; majority obese; insulin resistance often present with inadequate insulin secretion same criteria for IDDM blood glucose levels as per definition of diabetes mellitus Application 9. This Instrument applies to all matters to which section 120A of the Act applies. Dated this Twenty-eighth day of October 1999 The Common Seal of the ) Repatriation Medical Authority ) was affixed to this instrument ) in the presence of: ) KEN DONALD CHAIRMAN Health: The agency says exposure to the chemical comes from the foods Americans eat. Levels in the atmosphere have declined during last two decades.
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EPA Report Declares Dioxin a Cancer-Causing Agent

By MARLENE CIMONS , Times Staff Writer


     WASHINGTON -- The long-expected government announcement Monday that the chemical dioxin causes cancer--and that the risk is greater than originally believed--has set off a new debate: what to do about it?
     The Environmental Protection Agency declared for the first time Monday that dioxin is a carcinogen, and said that the vast majority of exposure to the chemical comes from the food Americans eat--a connection that likely will prompt further concerns about the safety of the U.S. food supply.
     Dioxin comes from both natural and industrial sources, primarily waste incineration and the production of plastics and paper pulp. It can contaminate soil and water and enter the food supply from fish in tainted water and animals that eat plants containing the chemical.
     It accumulates in the fat of fish and animals and has been associated with several human lymphomas and lung cancer. It also can be passed through the breast milk of nursing mothers.
     In its report, the EPA said the chemical "can alter the fundamental growth and development of cells," leading to cancer and reproductive problems in animals "and potentially in people."
     The EPA report, a draft that will undergo further scientific review before being released in final form this fall, also sought to reassure Americans by stressing that dioxin levels in the atmosphere have declined substantially during the last two decades, the result of regulatory and other actions that have reduced dioxin emissions.
     The agency said that, based on a more complete understanding of dioxin toxicity, "the risks to people may be somewhat higher than previously believed, even though actual exposure seems to be declining among the general population."
     The conclusions about the chemical's cancer-causing properties came as no surprise. Dioxin has long been associated with cancer and other health consequences, such as birth defects.
     Dioxin first came to widespread public attention as a contaminant in the herbicide Agent Orange--used by American forces during the Vietnam War to defoliate enemy hiding places--after Vietnam veterans began complaining of a range of health problems, from skin rashes to cancer and birth defects in their offspring.
     Also, in 1983, the EPA essentially demolished the entire town of Times Beach, Mo., after substantial dioxin contamination was discovered on city streets.
     A fact sheet issued by the Public Health Service, the Agriculture Department and the EPA emphasized that the agencies have been monitoring dioxin levels in food for many years and will continue to do so. Furthermore, it said, Americans should follow the U.S. dietary guidelines which, among other things, urge a reduction in fat consumption.
     It also said that it was safe to continue to breast feed, saying that "dioxin has been in breast milk for many years and breast-fed infants show no increase in the number of cases of childhood cancer."
     It also declared that the U.S. food supply is "among the safest and most nutritious in the world," adding: "Food will never be without some risk and we are constantly working to reduce those risks."
     The EPA report issued no new dietary recommendations. But it did draw a direct link between fatty foods and dioxin residues, prompting criticism from both environmental and industry groups.
     "A lot of people eat a fatty diet, and EPA is insinuating that Americans should cut back on fat," said Monica Rhode, an official with the Falls Church, Va.-based Center for Health, Environment and Justice, a grass-roots environmental group founded in the wake of the Love Canal toxic dump crisis. "This should not be about a fat-free diet for Americans but a dioxin-free diet for polluters."
     And at least one restaurant industry group complained that the publicity almost certainly would provoke a consumer backlash in dining out.
     "The EPA says that dioxin is found in beef, fish and poultry--all the wonderful things that Americans like to eat--and that our members are in business to sell," said Scott Wexler, of the Empire State Restaurant Assn., which represents 5,000 restaurant and tavern owners in New York state.
     "Americans are very health-conscious and our members are very fearful that, if Americans react the same way that Europeans reacted, it would cause serious economic strife for American restaurant owners," he said.
     A year ago, several European countries--including Belgium, Germany, France and the Netherlands--took a series of actions after reports that dioxin had contaminated the food supply through tainted animal feed.
     Belgium banned chickens and egg-based foods from hundreds of farms and took butter off store shelves, while French agriculture officials stopped chicken production on dozens of French farms.
     The New York restaurant group has filed a lawsuit in federal district court here seeking to block the release of the final report "based on the fact that they haven't proven the case that the potential risk of dioxin is outweighed by the economic damage it would cause," Wexler said.
     Meanwhile, dozens of environmental groups sent a letter to President Clinton and Vice President Al Gore Monday urging the administration to further regulate industrial sources of dioxin pollution.
     But Kip Howlett, executive director of the Arlington, Va.-based Chlorine Chemistry Council, said the industry has cooperated with EPA actions in the past to reduce levels of dioxin, "and will continue to do so," adding: "We do not have a public health crisis or emergency here."

Search the archives of the Los Angeles Times for similar stories about:  Dioxin, Public Health, Hazardous Materials, Environmental Protection Agency, Carcinogens, Health Hazards.
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SOURCE: American Liver Foundation

U.S. Veterans to Get Free Hepatitis C Test Kits

Newly Formed Veterans Council of the American Liver Foundation Urges U.S. Veterans to Test for Hepatitis C

NEW YORK, June 22 /PRNewswire/ -- The American Liver Foundation's (ALF) newly formed Veteran's Council on Hepatitis C and Liver Disease is urging veterans nationwide to get tested for hepatitis C -- a potentially life-threatening illness that is four to five times more prevalent among veterans than it is among the general public. The Veterans Council also is making free in-home hepatitis C test kits available to all U.S. veterans from Monday, July 3, through Sunday, July 9.

This important testing opportunity for veterans is the first program of ALF's Veterans Council, which held its inaugural meeting last week in Washington, DC. Several veterans service organizations (VSOs), experts in the field of hepatitis C, and health professionals from within the Veterans Health Administration (VHA) make up the Council. The free test kits will be made available to veterans via the internet and through a toll-free help line.

``Initiatives such as this free test program are vital for identifying and treating those who served our country and are infected with this disease,'' said Representative Vic Snyder (D-AR), who serves on the Armed Forces and Veterans Affairs committees, as well as the Veterans Affairs Health Subcommittee, when he addressed members of ALF's Veterans Council last week. ``I urge veterans to participate in this important program and applaud the American Liver Foundation's Veterans Council for making this program available when there is such great need.''

Study Shows Increased Prevalence of Hepatitis C Among Veterans

A study conducted by the VHA, and involving 26,000 veterans, shows that eight to 10 percent of all veterans in the VHA system tested positive for hepatitis C. In this study, veterans who served in Vietnam accounted for more than 60 percent of those with positive test results.

The hepatitis C virus (HCV) is spread by infected blood and many ways of getting infected have been identified. Combat and even military training often bring soldiers into contact with blood. Exposure to bleeding wounds or transfusions are other ways that soldiers can become infected. The injection of drugs and sexual contact with multiple partners are other risks. Tattoos applied with unsterile equipment and snorting drugs may also be risk factors.

``I've lived with hepatitis C for many years and am struck by the growing number of men I know who served in Vietnam and who are now also fighting this disease,'' said Jerry Kahn, a Vietnam veteran who underwent surgery and blood transfusions after being wounded in battle. ``It's so important that veterans realize the higher incidence of hepatitis C among our ranks, and that they take steps to get tested and get the treatment that can help save their lives.''

The American Legion, AMVETS, Disabled American Veterans, Paralyzed Veterans of America, the Veterans of Foreign Wars and the Vietnam Veterans of America are co-sponsoring this testing program with the American Liver Foundation, and these organizations are also members of ALF's Veterans Council.

``Veterans, particularly those who served in Vietnam, need to be acutely aware of hepatitis C and its potential consequences,'' explained George Duggins, president of the Vietnam Veterans of America (VVA). ``Getting tested is the first step in properly fighting this disease, and the VVA and other veterans service organizations are working closely with medical experts in this field to ensure that veterans do not face this fight alone.''

Free Hepatitis C Test Kits Available Via the Internet and Toll-Free Help Line

According to the American Liver Foundation, veterans should speak to their physician about getting tested, or they can obtain a free, FDA-approved at-home hepatitis C test kit by visiting www.liverfoundation.org, or by calling 1-888-888-HEPC from Monday, July 3, through Sunday, July 9. (Veterans receiving a free test kit, valued at about $70.00, will be required to pay only a shipping and handling fee of $6.00.) The testing and test results are completely confidential.

When visiting the website, veterans can take a simple quiz to determine their hepatitis C risk and, if they are at risk, receive the free and easy to use at-home test kit. The same process occurs when veterans call the toll-free number, which is staffed by professional counselors who can provide additional information about hepatitis C, the locations of local VHA facilities, or the names of local physicians who are expert in the management of the disease.

``Hepatitis C is frequently a disease without symptoms and it can go undetected for 20 or even 30 years,'' explained John Vierling, MD, ALF Board Chair and Chair of the newly formed ALF Veterans Council. ``Often, the disease is not diagnosed until serious liver damage has already occurred. That's why the work of the Veterans Council is so important. We need to get the word out to veterans so that they can benefit from testing and access to effective treatments.''

Hepatitis C: A Pressing Public Health Concern

Hepatitis C is a potentially life-threatening disease. Left unchecked, it can lead to cirrhosis (scarring of liver) and liver cancer. It is the leading cause of liver transplantation in the U.S. Each year, up to 10,000 people in this country die due to hepatitis C, and the annual number of HCV-related deaths could triple in the next 10 years. An estimated 4 million people in this country have been exposed to HCV.

The free, at-home test kits being provided in conjunction with this veterans program are being supplied by Home Access Health Corporation, manufacturers of the only FDA-approved, at-home test for hepatitis C. With this easy to use test, a person collects a small blood sample in the privacy of their home and then mails it to a certified blood-testing laboratory. Using a personal identification number that guarantees confidentiality, the person can then call a toll-free number to learn their test results within five to 10 days.

The American Liver Foundation is a leading national voluntary health agency dedicated to the improved understanding and care of viral hepatitis and other forms of liver disease through research and education.

The American Liver Foundation's Veterans and Hepatitis C Program is supported by an educational grant from Hoffmann-LaRoche, Inc.

SOURCE: American Liver Foundation

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