A new Institute of Medicine report that found veterans were exposed to Agent Orange while flying in C-123 aircraft after the Vietnam War came three years after another federal agency reached a similar conclusion.

But despite a pronouncement in January 2012 by the Agency for Toxic Substance and Disease Registry that these crews' levels of exposure to dioxin were 182 times higher than acceptable amounts, representing a 200-fold risk for cancer, the Veterans Affairs Department refused to acknowledge any link between the veterans' current illnesses and a history of serving on that aircraft.

Instead, VA public health officials insisted that trace amounts of dioxin on internal aircraft surfaces were not "biologically available for skin absorption or inhalation because dioxin is not water- or sweat-soluble and does not give off airborne particles."

Meanwhile, since veterans found out in 2011 they may have been exposed, at least 10 with diseases associated with Agent Orange have had VA disability claims denied and some have died — although just how many have passed away as a result of exposure-related illnesses is difficult to pin down, said retired Air Force Maj. Wes Carter, founder of the C-123 Veterans Association.

Carter said that between 1,500 and 2,100 veterans flew the aircraft, used during the Vietnam War to spray the highly toxic defoliant and then kept in service for almost a decade after the conflict. He said his association knows of fewer than a handful of veterans whose claims have been approved, including just one who triumphed without having to file an appeal.

"[The numbers] are terribly vague. We scattered decades ago, and unlike many Navy folks, had no ship's association to keep us in touch. ... We want to simply say that there has been death and suffering," said Carter, a C-123 medical services officer who is among those whose claims were denied.

VA's fight to deny health treatment and claims to what may amount to a small number of former service members comes as no surprise to veterans organizations and lawmakers who have pushed VA for years to recognize certain environmental exposures.

Related: Report: C-123 fliers exposed to Agent Orange

From potential harm posed by depleted uranium, burn pits, tainted anthrax vaccines, anti-malarial medication, the water supply at Camp Lejeune, North Carolina, an incinerator at Atsugi Naval Air Station, Japan, and more, VA's approach regarding illnesses related to environmental pollution has been "delay, deny, wait 'til they die," said Rick Weidman, legislative director for Vietnam Veterans of America.

"We don't pay VA to be veteran antagonists, and we don't expect them to be advocates for the cause. What we expect is they be fair and neutral arbiters who have the best interest of veterans at heart," Weidman said. "But that's not what happened here. It's not what usually happens."

As part of its ongoing efforts to study Agent Orange, VA awarded a $600,000 contract in 2012 to researchers to develop a directory of exposures and paid IOM $500,000 to look specifically at the C-123 issue.

The amount spent on issues that already have been examined and supported by "widely accepted science" vexes Sen. Richard Burr, R-N.C., whose office has worked since 2011 on the C-123 issue.

"The VA's delay has gone on long enough. IOM's report confirms what the VA already knew: C-123 crew members were exposed to dangerous levels of Agent Orange. Instead of ... commissioning an expensive study of [already] well-founded science, the VA could have been caring for these veterans," Burr said.

In 2001, VA established the War Related Illness and Injury Study Center to provide care for service members with complex medical cases and medically unexplained illnesses. The center provides environmental exposure assessments and medical evaluations to veterans with difficult-to-diagnose symptoms related to deployment.

But not everyone who served in the military is eligible to be seen at the WRIISC, including many of the C-123 veterans who don't meet a requirement that they be combat veterans.

Weidman said it should be up to VA to get veterans in the door and help them instead of denying them care for what he calls "toxic wounds."

"The question is to get health care to these veterans who were exposed. These people are sick right now. they can't afford health care, they are too sick to work, they've lost their jobs. The [VA] secretary has the authority to immediately grant them access to care," Weidman said.

According to VA officials, the department has set up a working group to review the IOM report and is moving forward to respond.

Weidman said he hopes the findings by IOM will help pave the way for other veterans with exposure-related illnesses to get help at VA.

"The C-123s were the canary in the coal mine. If [VA] could have gotten away with it, they would have kept doing it to Gulf War vets, Iraq and Afghanistan veterans and any other young people who have been exposed to environmental toxins or will be exposed," Weidman said.

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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