that resulted from herbicide spraying in Vietnam even if they did not go ashore during their tour of duty (ADVA, 2005).

The current committee engaged Steven Hawthorne as a consultant to review the Mueller et al. (2002) publication and to comment generally on the ability of organic compounds to codistill during the production of potable water. Hawthorne is an environmental chemist at the University of North Dakota’s Energy and Environmental Research Center and has specific expertise in the study of organic emissions from water (Hawthorne et al., 1985). He affirmed the findings of the Australian study, citing Henry’s law for an explanation of how contaminants with low water solubility would evaporate from water and noting that the distillation process would enhance the process by adding heat and reducing pressure (SB Hawthorne, University of North Dakota Energy Research Center, personal communication on October 23, 2008). No measurements of dioxin concentrations in seawater were collected during the Vietnam conflict, so it is not possible to ascertain the extent to which drinking water on US vessels may have been contaminated through distillation processes. However, it seems likely that vessels with such distillation processes that traveled near land or even at some distance from river deltas would periodically collect water that contained dioxin. Thus, a presumption of exposure of military personnel serving on those vessels is not unreasonable.

In its charge to the original VAO committee, the Department of Veterans Affairs asked the committee to include military personnel who served in inland waterways, offshore of the Republic of Vietnam, and in the airspace above the Republic of Vietnam. A presumption of exposure to Agent Orange and other herbicides used as defoliants applied to each of those groups as well as to those who served on land. In light of the findings of the Australian study regarding potential drinking-water contamination and those serving offshore, the presumption seems well founded.

Studies of exposure to herbicides among the residents of South Vietnam have compared nonexposed residents of the South with residents of the North (Constable and Hatch, 1985). Other studies have attempted to identify wives of veterans of North Vietnam who served in South Vietnam. Records of herbicide spraying have been used to refine exposure measurements, comparing people who lived in sprayed villages in the South with those living in unsprayed villages. In some studies, village residents were considered exposed if a herbicide mission had passed within 10 km of the village center (Dai et al., 1990). Other criteria for classifying exposure included length of residence in a sprayed area and the number of times the area reportedly had been sprayed.

A small number of studies have provided information on TCDD concentrations in Vietnamese civilians exposed during the war (Schecter et al., 1986, 2002,

Front Matter (R1-R24)

Summary (1-12)

1 Introduction (13-26)

2 Evaluating the Evidence (27-45)

3 Exposure to the Herbicides Used in Vietnam (46-64)

4 Information Related to Biologic Plausibility (65-103)

5 Epidemiologic Studies - New Citations and Background on Repeatedly Studied Populations (104-201)

6 Cancer (202-434)

7 Reproductive Effects and Impacts on Future Generations (435-509)

8 Neurologic Disorders (510-545)

9 Other Health Effects (546-650)

10 Conclusions and Recommendations (651-662)

Appendix A: Agendas of Public Meetings Held by the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Seventh Biennial Update) (663-665)

Appendix B: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers (666-675)

Appendix C: Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Seventh Biennial Update) and Staff Biographies (676-682)