A new review of Agent Orange research has found evidence that bladder cancer and hypothyroidism are more strongly linked to exposure to the herbicide than previously thought, but the science does not support a previously held belief that spina bifida occurs in the offspring of exposed veterans at higher rates.

A report released Thursday by the Institute of Medicine on the health effects of Agent Orange also recommended the Veterans Affairs Department grant service-connected presumption to veterans with "Parkinson's-like symptoms," not just those diagnosed with Parkinson's disease related to Agent Orange exposure.

"There is no rational basis for exclusion of individuals with Parkinson's-like symptoms from the service-related category denoted as Parkinson's disease," members of the IOM panel wrote in the report.

The 1,115-page review is the final in a series conducted by the IOM on health problems related to Agent Orange and other herbicide use during the Vietnam War.

The panel, chaired by Kenneth Ramos, professor of medicine at the Arizona Health Sciences Center, University of Arizona, reviewed the scientific literature on Agent Orange released between October 2012 and September 2014 for its review.

The decision on bladder cancer and hypothyroidism was tied to results of a large study of Korean War veterans who served in the Vietnam War suggested an association, while the choice to downgrade spina bifida was based on a lack of data, panel members said.

"[The inclusion of] spina bifida in the limited or suggestive category of association was based on preliminary findings from [an ongoing Air Force study]. However, to date, a complete analysis of the data from that study for neural tube defects has not been published … [and] no subsequent studies have found increases in spina bifida with exposure to components of the herbicides sprayed in Vietnam," they wrote.

The upgrade for bladder cancer and hypothyroidism from the category "inadequate or insufficient evidence" to "limited or suggestive evidence," of a link, as well as the recommendation to include Parkinson's-like symptoms to the service-connected list could pave the way for thousands of veterans to receive health care and disability compensation from VA.

The downgrading of spina bifida marks only the the second time the IOM Agent Orange committee has demoted a health outcome related to the herbicide.

Roughly 2.6 million U.S. veterans served in Vietnam, many of whom may have been exposed to Agent Orange during the Vietnam War. The herbicide, named for the color of the metal containers used to store it, was sprayed over 20 percent of the country to strip the jungle of its vegetation where enemy troops could hide.

Veterans who served in Vietnam on the ground or on boats that patrolled the country's inland waterways are eligible for health care and compensation for certain conditions presumed to be connected to their service.

Other groups of veterans, including those who served after the war on aircraft that had been used to spray Agent Orange, have won recognition for illnesses they say are related to exposure to chemical residue.

Some veterans continue to seek recognition and presumption for exposure to the herbicide, including those who served on ships in the bays, harbors and territorial seas of Vietnam. Attorneys for Military-Veterans Advocacy and the Blue Water Navy Vietnam Veterans Association on Thursday presented oral arguments to the U.S. Court of Appeals for the District of Columbia to recognize that the court has jurisdiction to decide whether the VA should not have excluded these veterans from the presumption.

Retired Navy commander Cmdr. John Wells, executive director of Military-Veterans Advocacy, said the sailors who served on these ships should be included because the vessels' distillation systems used water contaminated with Agent Orange to produce drinking water as well as water used for their boilers.

"There was no magic, invisible Agent Orange filter at the mouth of the rivers," Wells said. "We have documented proof of its presence in Nha Trang Harbor, 20 years after the war. That evidence has been presented to the VA. The distillation system which produced drinking water and water for the boilers did not remove the dioxin — it enriched it."

In their report, the IOM panel made several recommendations to VA to address illnesses in Vietnam veterans, to include recommending that VA continue to study their health, develop protocols to investigate transmission of adverse effects to offspring by exposed fathers and design a study on the health consequences of dioxin exposure on humans.

They also recommended that the Defense Department and VA monitor potential service-related health effects in military personnel, to include creating and maintaining rosters of individuals deployed on missions and linking DoD and VA databases to identify, record and monitor trends in diseases.

Patricia Kime covers military health care and medicine for Military Times. She can be reached at pkime@militarytimes.com

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

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