A Presumption of Illness
Decades after the war, some Vietnam veterans are falling ill to diseases associated with exposure to Agent Orange, unaware of the benefits available to them.
For 30 years, Vietnam was only a memory for Jim Fiebke. Not only had he survived his 1969-70 stint in the Army there, Fiebke returned to the States without wounds or even a hint of post-traumatic stress disorder. “I got back and thought everything was just fine,” he says.
In fact, Fiebke says he “kind of cruised along in life,” earning an M.B.A. from the University of Wisconsin and building a successful career in sales and marketing that eventually took him to Rochester, where he managed major accounts for Midwest Wireless. Vietnam, it seemed, was indeed over and done with for him.
Even in 2000, when bouts with pneumonia piqued the curiosity of his physician, who did tests that revealed Fiebke had multiple myeloma, he didn’t think about Vietnam. “It never entered my mind at all,” he says.
What did go through his mind was why, at 52 years of age, he had a disease that more commonly afflicted 70-year-olds.
Fiebke wouldn’t know the answer for two more years—when a stranger in a parking lot noticed that Fiebke’s car had Vietnam vet license plates and that he was losing his hair to chemotherapy. The woman asked what his condition was, then told him her husband had the same illness. She urged Fiebke to call his county veterans services officer right away.
Fiebke was about to learn that multiple myeloma was on a list of diseases considered “presumptive” to Agent Orange exposure and that he qualified for a string of veterans benefits.
The Not-So-Secret Agent
Fiebke’s long-ignored military service in Vietnam had reinserted itself in his life, manifesting as disease. For the first time in 30 years, he began to think seriously about his time in Vietnam. “We knew that Agent Orange was applied where we were at because there was no foliage,” he says, explaining that he had been stationed on a military base that in aerial photographs looked as barren as Iraq. The military had sprayed roadways and base camps with the dioxin-containing herbicide to kill off the tropical plants that might provide cover to enemy forces. In fact, according to the Department of Veterans Affairs, approximately 20 million gallons of herbicides, primarily the one in the big drum with the orange stripe that earned Agent Orange its nickname, were used in Vietnam between 1962 and 1971.
Shortly after their military service in Vietnam, some veterans began reporting health problems: skin and liver diseases, cancers to soft-tissue organs such as the lungs and stomach, and skin rashes. There also seemed to be an unusually high number of birth defects among children born to these veterans. By the mid 1970s, increasing concern worldwide about dioxin and its effects on health led to scientific studies that tried to link the herbicide and the diseases. Growing pressure from veterans groups led to legal actions to get benefits for those affected.
In 1978, the Veterans Administration, now known as the Department of Veterans Affairs (VA), set up the Agent Orange Registry for Vietnam veterans concerned about the possible long-term medical effects of exposure to the herbicide. Veterans answered questions about possible Agent Orange exposure. They had their medical history taken, a physical examination performed, and a series of basic tests done including a chest X-ray (if appropriate), urinalysis, and blood work. And the VA began following them for health problems.
A variety of military and nonmilitary organizations have studied the data collected through the registry. And since 1991, the Institute of Medicine has been reviewing the relevant scientific literature and advising the VA, which now presumes that a number of diseases are associated with, but not necessarily caused by, Agent Orange exposure (see p. 8). The VA also presumes that all Vietnam veterans who develop diseases on the list and were in Vietnam between 1962 and 1975 were exposed to Agent Orange. For that reason, it has provided both medical care and disability payments to those with Agent Orange-related conditions.
Although Fiebke was certainly aware of the concern about Agent Orange, he had never before considered that he might have been exposed to the substance or that it might affect his health. (He now speculates that his exposure occurred through drinking the water.) So he was stunned to learn that his multiple myeloma was considered 100 percent service connected and his disability was considered permanent and total. He not only qualified for free health care but also for a tax-free disability payment of nearly $2,500 a month. That benefit has proved particularly meaningful, as Fiebke now is too sick to work.
Presumptive Service Connection
The U.S. Department of Veterans Affairs has four categories of service-connected disabilities. One of these is “presumptive service connection.” This classification is given to veterans if their disease was diagnosed and manifested to at least 10 percent within a certain time period following their discharge from service. Veterans do not have to do more to prove that the illness is connected to their service. For most diseases, there are limits to that period of time. For Agent Orange–related illnesses and a few others, there is no delimiting time period.
The list of diseases presumed to be service-connected is extensive. It includes chronic conditions ranging from anemia to ulcers, tropical diseases, and diseases resulting from exposure to radiation, mustard gas, cold, asbestos, and herbicides. Complete information is available at www.warms.vba.va.gov/
Fiebke considers himself fairly typical of a generation of U.S. veterans who returned from Vietnam with the desire to put behind them their involvement in an unpopular war. He says unlike veterans of World War II or Korea, many from Vietnam opted not to join the organizations that might have kept them abreast of news regarding Agent Orange and VA benefits. “Because I wasn’t a member of the VFW or the American Legion or any other veterans organization, I probably didn’t learn about this nearly as quickly as I would have,” he says, adding, “it’s a compliment to them [service organizations] that they’re working to get the word out to their membership.”
But Fiebke is concerned about those who may not be getting the word.
Serving Those Who Served
About a year ago, while walking his dog, Fiebke met another Vietnam veteran. Fiebke share his story, and the man revealed he had just been diagnosed with diabetes. Fiebke gave him the same advice he had received from the stranger in the parking lot: Call his county services officer.
Minnesota happens to be one of 26 states that have a veterans services officer in each county who can help people navigate the labyrinth of policies and paperwork leading to veterans benefits. Located in county seats, the officers provide “one-stop shopping for veterans,” according to Clark Dyrud, commissioner of the Minnesota Department of Veterans Affairs, which runs a certification program for these officers.
Vince Crawford, director of the federal VA regional office, which processes the veterans’ claims, says there are other routes to benefits as well. Veterans can call on his office directly and
ask for forms to fill out. Or they can go to one of the veterans service organizations, which have trained national service officers who can assist veterans with further help.
Conditions Associated with
Agent Orange Exposure*
Porphyria cutanea tarda
Acute or subacute peripheral neuropathy
Type 2 diabetes
Numerous cancers (non-Hodgkin’s lymphoma, soft- tissue sarcoma, Hodgkin’s disease, multiple myeloma, prostate cancer, and respiratory cancers including cancers of the lung, larynx, trachea, and bronchus. The VA recently added chronic lymphocytic leukemia to this list)
* Vietnam veterans’ children with spina bifida are also eligible for benefits.
But getting the word out that veterans should even consider that their cancer or diabetes or psychosis might have something to do with their military service umpteen years ago is the first concern of Dyrud and Crawford. “Where do you market?” Dyrud asks, then raises the issue of how often. “Why do you think Coke and Pepsi buy ad space everyday?” He says that keeping the public aware of the list of diseases that might be service-connected plus the benefits available to veterans would require having a constant and omnipresent advertising presence.
Crawford would like to see physicians and other medical providers help raise awareness about service-connected diseases and about what the VA can offer by asking patients if they are veterans and, if so, when and where they served (and mentioning the possibility that they might qualify for benefits).
Those are questions that Jon Galde, R.N., has started asking patients in the bone marrow transplant unit at Methodist Hospital in Rochester, where he works as a staff nurse. Galde cared for Fiebke prior to his bone marrow transplant there in 2002. A U.S. Army veteran himself, Galde says that if a patient has lymphoma or myeloma and is of a certain age, he’ll ask if they’re a vet. “Usually, they get hooked up with the VA somewhere along the line,” he says, explaining that social workers, physicians, or others can help veterans make the connection between their illness and their military service. But not all do.
A recent patient from Duluth is a case in point. When Galde found out the man was a Vietnam veteran, he asked him if he had applied for benefits. The man hadn’t and didn’t know he could. “The benefits are there, but you have to seek them out,” Galde says.—Carmen Peota