The Trump administration — specifically the Office of Management and Budget (OMB) and Department of Veterans Affairs (VA) — has been criticized for not rushing to expand the number of medical conditions “presumed” to be caused by exposure to Agent Orange, an herbicide used during the Vietnam War.
The administration is wise to proceed with caution. Expanding the list of diseases presumed to have been caused by exposure to Agent Orange should be dictated by science, not politics. If the list is expanded in a haphazard or rushed manner, veterans will be hurt in the long run.
Some lawmakers in Washington would have you believe the administration is casting Vietnam veterans aside, denying them care and ignoring their ailments.
That could not be further from the truth.
Based on the VA’s current health care eligibility rules, Vietnam veterans have access to VA care, and all enrolled veterans can be treated for health conditions that aren’t service connected. As a result, the VA is already providing medical treatment for enrolled Vietnam veterans suffering from hypertension, hypothyroidism, bladder cancer, and Parkinsonism — the four conditions that are under consideration for Agent Orange presumption.
The current debate around Agent Orange presumption is centered on disability benefits — the rating and subsequent compensation given to veterans by the VA upon review of their service-connected health issues.
After evaluation, the VA assigns a disability rating to a veteran with an injury or illness related to their military service. Sometimes that rating is easy to determine because there is a direct link between an event and the resulting health issue.
But in the case of Agent Orange exposure, the link is often not so clear.
Studies completed in 2016 and 2018 by the National Academies of Sciences, Engineering and Medicine are often cited to justify expansion of Agent Orange presumption, but they are not as conclusive as some claim. The studies found “limited or suggestive evidence” and failed to establish direct, causal links between Agent Orange exposure and the four conditions under consideration for presumption. Furthermore, occurrences of hypertension and bladder cancer are heavily impacted by lifestyle choices, such as tobacco use and diet.
Expanding benefits for Agent Orange exposure despite continued gaps in research sets a bad precedent. If benefits are determined based on incomplete science, those with an illness or injury definitively caused by their service may suffer.
During the Obama administration, the VA expanded the list of illnesses presumed to be caused by Agent Orange. This decision contributed to a massive backlog of disability claims that overwhelmed the VA. Hundreds of thousands of veterans — including many wounded during the height of the wars in Iraq and Afghanistan — waited years to have their claims adjudicated.
Adding new diseases to the list of Agent Orange-related illnesses, even though those conditions can’t be definitively linked to exposure at this time, would almost certainly create another backlog of claims.
Not only would expanding benefits possibly crowd out other veterans from timely claims processing, there is also the cost to consider.
The recent expansion of Agent Orange benefits to Blue Water Navy veterans is estimated by the Congressional Budget Office to potentially cost between $1.4 billion to $4.2 billion over 10 years. An expansion of Agent Orange presumption could cost upwards of $15 billion more — a fact that cannot be ignored in an era of trillion-dollar deficits.
Holding off expanding presumption until we have more complete information on the link between Agent Orange and certain diseases is the responsible thing to do. More data will be available with the release of the Vietnam-Era Mortality Study and Vietnam-Era Health Retrospective Observational Study later this year.
Vietnam veterans will not be denied care. They already qualify for VA health care and a delay in a decision on presumption won’t change that. Additionally, if a disease is found to be caused by Agent Orange exposure, those affected will retroactively be compensated from the date they first filed a disability claim.
To do right by our veterans, we must listen to science and make rational decisions based on proven practices that ensure veterans who were harmed during their service get the compensation they deserve.
Darin Selnick served as veteran affairs adviser on President Trump’s Domestic Policy Council and as senior adviser to the VA secretary. Dan Caldwell is the foreign policy and veterans campaign manager for Stand Together.
Editor’s note: This is an Op-Ed and as such, the opinions expressed are those of the author. If you would like to respond, or have an editorial of your own you would like to submit, please contact Military Times managing editor Howard Altman, haltman@militarytimes.com.
