APPENDIX D
Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Sixth Biennial Update) and Staff Biographies

John J. Stegeman, Ph.D. (Chair), is a Senior Scientist, former Chair of the Biology Department at the Woods Hole Oceanographic Institution, and Director of the Woods Hole Center for Oceans and Human Health, in Woods Hole, Massachusetts. He received his Ph.D. in biochemistry, concentrating on enzymology, from Northwestern University, Evanston, Illinois. His research interests center on metabolism of foreign chemicals in animals and humans, and the structure, function, and regulation of the enzymes that accomplish this metabolism. Dr. Stegeman served on the committees for Veterans and Agent Orange: Update 2000 and Update 2002, and chaired the committee for Veterans and Agent Orange: Update 2004.


Richard A. Fenske, Ph.D., M.P.H., is a Professor and Associate Chair of Environmental and Occupational Health Sciences at the University of Washington School of Public Health and Community Medicine, and is the Director of the Pacific Northwest Agricultural Safety and Health Center at the University of Washington in Seattle. Dr. Fenske’s work has focused on the evaluation of environmental health risks in special populations. Specialty areas include health risks of pesticide exposures, development of new exposure assessment methods, children’s exposure to hazardous chemicals, and investigation of the role of dermal exposure for workers. Dr. Fenske serves on the Science Advisory Board of the US Environmental Protection Agency (EPA), and also serves as a member of EPA’s Human Studies Review Board. He had previously served on the committees for Veterans and Agent Orange: Update 2002 and Update 2004.


Jordan Firestone, M.D., Ph.D., M.P.H., is Assistant Professor of Medicine, with Adjunct appointments in Neurology and Occupational and Environmental



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APPENDIX D Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Sixth Biennial Update) and Staff Biographies John J. Stegeman, Ph.D. (Chair), is a Senior Scientist, former Chair of the Biology Department at the Woods Hole Oceanographic Institution, and Director of the Woods Hole Center for Oceans and Human Health, in Woods Hole, Massa- chusetts. He received his Ph.D. in biochemistry, concentrating on enzymology, from Northwestern University, Evanston, Illinois. His research interests center on metabolism of foreign chemicals in animals and humans, and the struc- ture, function, and regulation of the enzymes that accomplish this metabolism. Dr. Stegeman served on the committees for Veterans and Agent Orange: Update 2000 and Update 2002, and chaired the committee for Veterans and Agent Orange: Update 2004. Richard A. Fenske, Ph.D., M.P.H., is a Professor and Associate Chair of En- vironmental and Occupational Health Sciences at the University of Washington School of Public Health and Community Medicine, and is the Director of the Pacific Northwest Agricultural Safety and Health Center at the University of Washington in Seattle. Dr. Fenske’s work has focused on the evaluation of en- vironmental health risks in special populations. Specialty areas include health risks of pesticide exposures, development of new exposure assessment methods, children’s exposure to hazardous chemicals, and investigation of the role of der- mal exposure for workers. Dr. Fenske serves on the Science Advisory Board of the US Environmental Protection Agency (EPA), and also serves as a member of EPA’s Human Studies Review Board. He had previously served on the commit- tees for Veterans and Agent Orange: Update 2002 and Update 2004. Jordan Firestone, M.D., Ph.D., M.P.H., is Assistant Professor of Medicine, with Adjunct appointments in Neurology and Occupational and Environmental 778

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779 APPENDIX D Health Sciences. He is Director of the University of Washington Occupational and Environmental Medicine Clinic at Harborview Medical Center in Seattle. Dr. Firestone’s research involves chemical exposures and their interactions with individual genetic susceptibility in neurological disease, with a special focus on Parkinson’s disease. His clinical specialty is in occupational neurotoxicology. Dr. Firestone previously served on the committee for Veterans and Agent Orange: Update 2004. Peter H. Gann, M.D., Sc.D., is a Professor and Director of Pathology Research at the University of Illinois at Chicago. A physician-epidemiologist by training, his research work focuses on the causes of breast and prostate cancer, with par- ticular emphasis on the development and application of novel biological markers. His interest in biological markers actually originates with his service as a Project Director at the National Academy of Sciences in the 1980s. Prior to his current position, Dr. Gann spent 13 years in the Department of Preventive Medicine at Northwestern University Medical School. He received a B.A. degree from Swarthmore College, M.D. and M.S. (epidemiology/biostatistics) degrees from the University of Pennsylvania, and his doctorate in epidemiology from Harvard University. Dr. Gann serves on a number of national and international advisory and peer-review panels in the field of cancer prevention. Mark S. Goldberg, Ph.D., is Associate Professor in the Department of Medi- cine, McGill University, Montreal, associate member in the Joint Departments of Epidemiology and Biostatistics and Occupational Health, the Department of Oncology, and Medical Scientist, Royal Victoria Hospital, McGill University Health Centre. Dr. Goldberg is an occupational and environmental epidemiologist and holds an Investigator Award from the Canadian Institute for Health Research. His current research interests include the investigation of occupational and envi- ronmental risk factors for breast cancer and the health effects associated with exposures to ambient air pollution. In addition to being a member of grant review panels, Dr. Goldberg is also a member of Health Canada’s Science Advisory Board. He has served on the committee for Disposition of the Air Force Health Study and the Division of Earth and Life Sciences committee for Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues. Claudia Hopenhayn, Ph.D., is an Associate Professor in the Department of Epi- demiology at the University of Kentucky, College of Public Health. Her primary research interests have focused on cancer and reproductive outcomes, within the context of environmental and occupational epidemiology and cancer control. Dr. Hopenhayn’s expertise combines toxicology, biomarkers of exposure and effect, statistics, risk factors, and assessment of intervention, within a framework of epidemiology and multidisciplinary collaborations, both in the United States

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780 VETERANS AND AGENT ORANGE: UPDATE 2006 and internationally. Dr. Hopenhayn previously served on the committee for Vet- erans and Agent Orange: Update 2004. Nancy I. Kerkvliet, Ph.D., is a Professor in the Department of Environmental and Molecular Toxicology at Oregon State University, Corvallis, Oregon. Dr. Kerkvliet’s research is focused on using animal models to understand how chemi- cals of environmental concern alter immune function. Her primary interest is focused on understanding how activation of the Ah receptor by TCDD and other ligands suppresses immune responses. She previously served on the Committee on Toxicology, the Subcommittee of Jet Propulsion Fuel 8, and the committee for Veterans and Agent Orange: Update 2004. Linda A. McCauley, Ph.D., FAAN, R.N., is a Nightingale Professor of Nurs- ing and Associate Dean for Nursing Research at the University of Pennsylvania, School of Nursing. Dr. McCauley received her doctoral degree in environmental health/epidemiology from the University of Cincinnati. Dr. McCauley has special expertise in the design of epidemiological investigations of occupational and en- vironmental hazards and is nationally recognized for her expertise in occupational and environmental health nursing. Dr. McCauley’s research interests are in the areas of chemical exposure among working populations and young children. DeJuran Richardson, Ph.D., is a Professor and Associate Dean of the Faculty at Lake Forest College and an Adjunct Professor at the University of Illinois at Chicago and the University of Wisconsin-Madison. Dr. Richardson’s areas of expertise include biostatistics and clinical trial data management. He received his B.A., M.S., and Ph.D. degrees from Northwestern University. His professional activities have included appointments to the National Cancer Institute’s ECOG Data Monitoring Committee, the National Institute of Neurological Disorders and Stroke Initial Grant Review Committee, and the Advisory Board for the Harvard School of Public Health Initiatives for Minority Student Development Program in the Department of Biostatistics. Dr. Richardson’s research interests include the design and analysis of large multicenter clinical trials, the recruitment and retention of underrepresented minorities in clinical trials, and performing statisti- cal survival analyses in the presence of informative censoring. Dr. Richardson’s research articles have appeared in many scientific journals. He has served on the committee for Disposition of the Air Force Health Study. Hollie I. Swanson, Ph.D., is Associate Professor in the Department of Molecu- lar and Biomedical Pharmacology and with a joint position with the Toxicology Department at the University of Kentucky College of Medicine. She received her M.S. from Oregon State University, Ph.D. from Purdue University, and post- doctoral training from Michigan State University and Northwestern University. Her research focuses on the study of the aryl hydrocarbon pathway and its role

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781 APPENDIX D in altering cell fate. She currently serves as Councilor of the Drug Metabolism Specialty Section of the National Chapter of the American Society for Pharmacol- ogy and Experimental Therapeutics and is a member of the National and Ohio Valley Chapters of the Society of Toxicology. She is an editorial board member of Toxicology and Applied Pharmacology. Dr. Swanson has published numerous articles pertaining to the molecular and cellular aspects of the Ah receptor and dioxin. Mary K. Walker, Ph.D., is a Professor of Pharmacology and Toxicology at the University of New Mexico, College of Pharmacy. Her research interests focus on the mechanisms by which high affinity ligands for the AHR increase the risk of cardiovascular disease; and the structural, functional, and molecular changes in adult cardiovascular physiology in a genetic mouse model which lacks the AHR gene. Dr. Walker has also authored and coauthored several articles on these topics. Stephen D. Walter, Ph.D., is Professor of Clinical Epidemiology and Biosta- tistics in the Faculty of Health Sciences at McMaster University. Dr. Walter has published extensively on epidemiology and biostatistical methods. His research interests include disease screening and diagnosis; risk assessment; environmental health; and analysis of spatial and temporal data patterns. He is a former Editor of the American Journal of Epidemiology and is the Section Editor for Clinical Epidemiology in the Wiley Encyclopedia of Biostatistics. Dr. Walter has served previously on the IOM Committee on Medicare Coverage of Routine Thyroid Screening. Staff Biographies Mary Burr Paxton, Ph.D., is Senior Program Officer in the Institute of Medi- cine (IOM) Board on Population Health and Public Health Practice. Before joining IOM, she worked as a consultant on the regulation of toxic substances and managed the conduct and analysis of several epidemiology studies on vet- erans’ health. She received a master’s of science in biostatistics from the Johns Hopkins School of Hygiene and Public Health and a doctorate in genetics from the George Washington University. She is a diplomate of the American Board of Toxicology. Dr. Paxton has worked on several National Academies reports, including Issues in Risk Assessment; Environmental Neurotoxicology; Gulf War and Health: Insecticides and Solvents; Gulf War and Health: Fuels, Combustion Products, and Propellants; Asbestos: Selected Cancers; and Veterans and Agent Orange: Update 2004. Jennifer A. Cohen is a Program Officer in the IOM Board on Population Health and Public Health Practice. She received her undergraduate degree in art history

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782 VETERANS AND AGENT ORANGE: UPDATE 2006 from the University of Maryland. She is currently attending the University of Maryland where she is working towards her masters in public health. She has been involved with the IOM committees that produced Organ Procurement and Transplantation; Clearing the Air: Asthma and Indoor Air Exposures; Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes; Veterans and Agent Orange: Update 2000; Veterans and Agent Orange: Herbicide/Dioxin Exposure and Acute Myelogenous Leukemia in the Children of Vietnam Veterans; and Veterans and Agent Orange: Update 2004. Rose Marie Martinez, Sc.D., is Director of the IOM Board on Health Promotion and Disease Prevention. Before joining IOM, she was Senior Health Researcher at Mathematica Policy Research, where she studied the effects of health-system change on the public-health infrastructure, access to care for vulnerable popula- tions, managed care, and the health care workforce. Dr. Martinez is former As- sistant Director for Health Financing and Policy with the US General Accounting Office, for which she directed evaluations and policy analysis on national and public-health issues. Dr. Martinez received her doctorate from the Johns Hopkins School of Hygiene and Public Health. Tia S. Carter is a senior program assistant on the IOM Board on Population Health and Public Health Practices. She is working on a master’s in health care administration at the University of Maryland University College. She received her undergraduate degree in community health from the University of Maryland, College Park. Before coming to IOM, she worked at the Greater Washington Urban League in the Division of Aging and Health Services as the health promo- tions coordinator, where she was responsible for health-promotion and disease- prevention education services and activities among the elderly. She has been involved with the IOM committee on Asbestos: Selected Cancers. Veterans and Agent Orange: Update 2006 is Tia’s second report with IOM. Sonia J. Cheruvillil, M.P.H., is a senior program assistant (until June 2006) in the IOM Board on Health Promotion and Disease Prevention. She received her masters in public health from George Washington University School of Public Health. She received her undergraduate degrees in English literature (B.A.) and microbiology (B.S.) from the University of Iowa. She has been involved with the IOM committee on the Disposition of the Air Force Health Study (AFHS) and Veterans and Agent Orange: Update 2002 and Update 2004. Norman Grossblatt, ELS(D), is a senior editor at the National Academies. Be- fore joining the National Research Council Division of Medical Sciences in 1963, he worked as an analyst in information storage and retrieval at Documentation Incorporated and as a technical editor at the Allis-Chalmers Manufacturing Co., Nuclear Power Department, in Washington, DC. He received a B.A. in English

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783 APPENDIX D from Haverford College. Mr. Grossblatt is a diplomate editor in the life sciences and was the founding president of the Board of Editors in the Life Sciences. He is a fellow of the American Medical Writers Association and a recipient of its President’s Award; a member of the Council of Science Editors and since 1997 the manuscript editor of its journal, Science Editor; and a member of the Euro- pean Association of Science Editors. At the National Academies, he has edited over 300 reports.

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Index Note to the reader: This index contains entries for each of the seven volumes of the Veterans and Agent Orange series released to date: Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (I), Veterans and Agent Orange: Update 1996 (II), Veterans and Agent Orange: Update 1998 (III), Vet- erans and Agent Orange: Update 2000 (IV), Veterans and Agent Orange: Update 2002 (V), Veterans and Agent Orange: Update 2004 (VI), and Veterans and Agent Orange: Update 2006 (VII). Page numbers for the discussions of topics in spe- cific volumes follow the roman numerals denoted above. Thus, for example, the entry “Agent Blue, I: 27, 89–90, 93, 97, 100; III: 136, 137; IV: 118” first refers to material found on pages 27, 89–90, 93, 97, and 100 in Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam, then to material found on pages 136 and 137 of Veterans and Agent Orange: Update 1998 and on page 118 of Veterans and Agent Orange: Update 2000. 784

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785 INDEX diabetes prevalence, data by age, III: 492 A epidemiologic studies, control of aging Abortions. See Spontaneous abortion effects, II: 261–262; III: 409; IV: 3, 13, ACC. See US Army Chemical Corps 23 Acquired immune deficiency syndrome. See female reproductive system cancer AIDS/HIV incidence, data by type, for selected age ACS. See American Cancer Society groups, III: 329, 330; IV: 321; V: 310 ACTH. See Adrenocorticotropic hormone gastrointestinal tract cancer incidence, data Acute lymphocytic leukemia. See Leukemia by type for selected age groups, III: Acute myelogenous leukemia. See Leukemia 267; IV: 250; V: 244 Acute myeloid leukemia. See Leukemia Hodgkin’s disease incidence, data for AD. See Alzheimer’s disease selected age groups, III: 372; IV: 365; ADA. See American Diabetes Association V: 355 Adipose tissue immune system, IV: 31, 79 TCDD distribution, I: 130, 131, 168-169, kidney cancer, V: 334 259, 269, 280; IV: 42, 43, 64, 116, 117; laryngeal cancer incidence, data for selected VI: 67–68; VII: 89 age groups, III: 292; IV: 277; V: 268 Adrenocorticotropic hormone (ACTH), IV: 59 latency and, II: 261–262, 273, 275; III: 409, Aerial spraying, I: 3, 24; III: 135, 137, 139; 414–415, 425, 428, 430; IV: 254, 256, IV: 117, 120, 123, 150, 160, 303; VI: 264, 265 l75–177, 185 leukemia incidence, data by type, for military early research, I: 25–26; III: 28; selected age groups, III: 384; IV: 378; IV: 150 V: 367 records of, I: 84–85, 287 liver/intrahepatic bile duct cancers See also Herbicide application methods; incidence, data for selected age groups, Herbicides III: 282; IV: 267; V: 260 AFHS. See Air Force Health Study lung cancer incidence, data for selected age Aflatoxin, I: 453; IV: 267 groups, III: 296; IV: 281; V: 272 Africa, sub-Saharan, II: 181; III: 282; IV: 267; melanoma incidence, data for selected age VI: 221 groups, III: 313; IV: 300; V: 288 Age and aging menopause, VII: 148 acute lymphocytic leukemia incidence, data multiple myeloma incidence, data for for selected age groups, III: 384; IV: 9, selected age groups, III: 377; V: 361 378 nasal/nasopharyngeal cancer incidence, data acute myeloid leukemia incidence, data for for selected age groups, III: 289; IV: selected age groups, III: 384; IV: 378 273; V: 265 amyotrophic lateral sclerosis, V: 524 non-Hodgkin’s lymphoma age of onset, I: bone/joint cancer incidence, data for 436 selected age groups, III: 302; IV: 288; non-Hodgkin’s lymphoma incidence, data V: 279 for selected age groups, III: 362; IV: brain cancer incidence, data for selected age 356; V: 344 groups, III: 356; IV: 351; V: 339, 524 parkinsonism, V: 524 breast cancer incidence in US women, data prostate cancer incidence, data for selected for selected age groups, III: 324; IV: age groups, III: 334; IV: 10, 327; V: 314; V: 301 317, 524 cancer age-specific incidence, I: 436–438 renal cancers incidence, data for selected chronic lymphocytic leukemia incidence, age groups, III: 352; IV: 346 data for selected age groups, III: 384; reproductive disorders, IV: 51–52, 59, 63, IV: 378 66, 71, 80, 200 chronic myeloid leukemia incidence, data for research recommendations, V: 524 selected age groups, III: 384; IV: 378 soft-tissue sarcoma age of onset, I: 436

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786 INDEX soft-tissue sarcoma incidence, data for Orange II formulation, I: 90; III: 137; IV: selected age groups, III: 306; IV: 292; 119 V: 282 product liability litigation, I: 34–35 TCDD half–life, IV: 24, 28, 45 spontaneous abortion, II: 283; IV: 399–400, testicular cancer incidence, data for selected 409–412; V: 414 age groups, III: 343; IV: 335; V: 325 suspension of use, I: 92–93; II: 26 urinary bladder cancer incidence, data for TCDD as contaminant of, I: 91, 114, selected age groups, III: 347; IV: 340; 126–127; II: 102; III: 140; IV: 133–135 V: 328 Vietnam amount used, I: 1, 27, 74, 90, See also Demographic data, Vietnam 97–98, 106; II: 1, 26; III: 136; IV: 115, veterans 118–119 Agent Blue, I: 27, 89–90, 93, 97, 100; III: 136, Vietnam military application, I: 1, 3, 27, 74, 137; IV: 118; VI: 183–185 84–85, 90, 92–93, 97–107, 543–545; II: volume used in Operation Ranch Hand, 1, 26–27; III: 1, 25, 136, 137, 138, 140; data, III: 136 IV: 125–126 Agent Green, I: 27, 90, 92, 114; III: 136, 137, Vietnam surplus disposal, I: 93–94 140, 146; IV: 118; VI: 183 Vietnam veterans’ concerns, I: 32–34; II: volume used in Operation Ranch Hand, 26–27 data, III: 136; IV: 123 Vietnam veterans’ increased disease risk, Agent Orange, II: 308; III: 130, 159, 315, 344, II: 22–23; III: 22–23, 272; IV: 8–9, 12, 359, 389, 407, 444, 460, 462, 489, 491; 256, 270, 275, 279, 284, 290, 296, 305, IV: 117–118, 150, 156; V: 1, 12; VI: 311, 318, 323, 332, 338, 343, 348, 353, 1, 183 359, 367, 374, 381, 388 Air Force research activities, II: 31–32; III: volume used in Operation Ranch Hand, 28–29 data, II: 136; IV: 120, 123, 150 birth defects association, II: 298, 300; III: See also Herbicides; Incineration, of Agent 435; IV: 400 Orange breast cancer association, V: 307 Agent Orange, the Deadly Fog, I: 33 cancer latency issues, II: 260–276; III: Agent Orange Act of 1991. See Public Law 407–431; IV: 284 102-4 chemical composition, I: 27; II: 102; IV: 119 Agent Orange Briefs, I: 56; II: 31; III: 28 chloracne association, II: 317, 318; III: 479; Agent Orange Registry (AOR), I: 20, 53, 56, IV: 138, 463; V: 478 729; II: 29, 31, 153, 228; III: 28, 344 congressional hearings, II: 27–28; III: 25 See also Department of Veterans Affairs, defoliant effectiveness, I: 90 US (DVA) Department of Veterans Affairs activities, II: Agent Orange Review, I: 56; II: 31; III: 28 29–31, 153, 156–157; III: 27–28; IV: 15 Agent Orange Scientific Task Force, I: 60–61 Environmental Protection Agency research Agent Orange Study, I: 19, 57, 58–59, 63–64, activities, II: 32; III: 29–30 276–278; II: 102; III: 147, 148; IV: 124 exposure opportunity index (EOI), II: Agent Orange Task Force, II: 24–26; III: 290–291; III: 146, 147, 148; IV: 124, 24–25, 148; IV: 124 405 See also Department of Veterans Affairs, federal government action/research, I: (DVA) 45–60; II: 27–32; III: 27–32; IV: 13 Agent Orange Validation Study, III: 240; IV: health effects of, concerns, I: 2; II: 19–23, 156, 159, 160, 162, 283, 304, 327, 403; 26–27; III: 19–20, 236, 237, 240, 242, VI: 139, 190; VII: 245 243 Agent Orange Victims International, I: 34 International Agency for Research on Agent Orange Working Group, I: 19, 46, 58, Cancer research activities, III: 30 277, 743 legislation, I: 47–52; II: 28–29; III: 26–27; research methodology, I: 728 IV: 1, 15

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787 INDEX Agent Pink, I: 27, 90, 92, 114; III: 136, 137, non-Hodgkin’s lymphoma, I: 9, 256–257, 140, 146; IV: 118, 122–123; VI: 183 530–540; II: 138, 139, 232–234; III: volume used in Operation Ranch Hand, 364–365; IV: 359–361 data, III: 136; IV: 123 parkinsonism in, V: 6 Agent Purple, I: 27, 89, 92, 114; III: 136, 140, prostate cancer, I: 11, 518, 519, 575; II: 146; IV: 118, 122–123; VI: 183 8–9; III: 335; IV: 327–329 Operation Ranch Hand, IV: 123 reproductive outcomes, I: 510–511, 598 TCDD in, I: 126; IV: 122 respiratory cancer, I: 11, 466; II: 197–198 volume used in Operation Ranch Hand, soft-tissue sarcomas, I: 37, 326–328, data, III: 136 479–481, 486–488 Agent White, I: 27, 90, 92–93, 97, 115, 189; sperm dysfunction, I: 632 III: 136, 137; IV: 118–119; V: 36, 40; suicide, I: 650 VI: 43, 183–185 See also Forests; Professional herbicide/ volume used in Operation Ranch Hand, pesticide applicators data, III: 136 Agricultural Health Study (AHS), IV: 142; VI: Agricultural/forestry workers, VI: 119, 124– 126, 175; VII: 156–159, 229,655 128; VII: 156–162, 227–230, 729–739 See also Iowa brain tumors, I: 320, 523; II: 136 Agricultural herbicides, I: 24, 35, 39, 174–175, Canadian Farmer Cohort, II: 135–136 181; II: 137–139 cancers, I: 13, 37, 320–323, 443, 447, 454; See also Herbicides II: 133–137, 179 Agriculture. See Agricultural/forestry workers; case-control studies, I: 326–341, 486–488; Food crops; Forests II: 118–122, 138–140; III: 185–195, Ah receptor (AhR), I: 3, 123, 134; II: 3–4, 228–232; V: 113–114; VI: 127–128 51–53, 54–56, 57–62; III: 54–58, 129; cohort studies, I: 318–323; II: 118–120, IV: 25–26, 29–30, 42, 47, 50–58, 60, 135–137, 197–198; III: 178–185, 68, 69, 70–73, 76, 80, 82, 84, 85, 86, 224–228; IV: 197–202; V: 6, 109–113; 87, 90, 93, 94, 95, 99–100; V: 24–25, VI: 124–127 52–55; VI: 55–66; VII: 93 epidemiologic studies, I: 37, 318–323; II: animal studies and, I: 114, 123; II: 3–4, 118–120, 135–137, 232–234, 238–239, 51–53, 54–56, 57–62, 92–93; III: 33, 241–243; III: 178–195, 224–232, 284– 34, 35, 54–58, 62–63, 67–69, 129; IV: 285, 335, 364–365, 379–380, 387–388; 48–49, 61–62, 64–67, 74–75; VI: 55–57 IV: 134, 141–142, 145, 257, 260, 263, anti-estrogenicity and, II: 62; III: 67–69 265, 271, 285, 290, 296, 306, 312, 318, biological consequences of activation, II: 324, 333, 338, 349, 353, 360, 368, 374, 57; III: 62; IV: 56–60, 323 381, 401; V: 3, 143–153, 222–224; VI: blood abnormalities, I: 125 124–125 cacodylic acid acute toxicity, I: 188 female reproductive and breast cancers, I: cacodylic acid and mechanism of toxicity, 510–511; IV: 324–325 II: 50–51; IV: 24 hepatobiliary cancer, I: 454; II: 183–184; cacodylic acid carcinogenicity, I: 118, 119, III: 284–285; IV: 271 187; IV: 5, 387 herbicide exposure assessment, I: 265–266; cacodylic acid chronic exposure, I: 188–189 III: 154–157; IV: 202 cacodylic acid developmental toxicity, I: 189 Hodgkin’s disease, I: 550–553; II: 135 cacodylic acid genotoxicity, I: 187–188 Irish agricultural workers study, II: 136–137 cacodylic acid mechanism of action, I: kidney cancer, I: 515 188–189 leukemia, I: 332–335, 566–568; II: 136; III: cacodylic acid pharmokinetics, I: 186–187 387–388 cacodylic acid renal toxicity, II: 50–51 malignant lymphoma in, IV: 201 cacodylic acid reproductive toxicity, I: 189 multiple myelomas, I: 11–12, 558–561; cacodylic acid toxicity summary, II: 50; III: II: 138–139, 238–239, 241–243; III: 48; IV: 38 379–380

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788 INDEX cacodylic acid toxicokinetics, I: 188–189; bone/joint cancer in, III: 303; IV: 289 IV: 24, 27, 38 cancer and latency in, III: 423, 424, 425, combinatorial interactions, II: 57–58 427 DNA binding capability and transcription, chronic persistent peripheral neuropathy, V: activation of, II: 56–57; III: 58–61 465–466 free radicals and, II: 60; III: 64–65 circulatory disease in, I: 703–705, 706; II: growth/differentiation signaling, III: 62–63 336; III: 514, 517; IV: 508–509 growth factor and, II: 59 cognitive/neuropsychiatric disorders, V: 449 inconsistencies in, II: 57–62 data sources, I: 385–386; II: 150–151 interactions, VI: 58–59 diabetes mellitus in, I: 684; II: 330; III: 495, ligand-independent activation, II: 58 498–500, 502; IV: 485–487 multiple forms of, II: 57 epidemiological studies, II: 31, 32, 149, nervous system and, I: 161; V: 470–471 150–152, 154–156, 293–295; III: 28–29, protein and, VI: 56–58 206–207, 218, 237–240, 303, 309–310, protein kinases and, II: 60–62; III: 65–67; 313–314, 318, 321, 322, 339, 340, 385, IV: 69–71 436, 438, 439, 446–447, 449, 452–453, redox signaling, III: 64–65; IV: 67–69 457–458, 481, 486, 495, 498–500, 502, signaling interactions, II: 59–62; III: 62–69; 505, 506, 507, 510, 513, 514, 517; IV: 60–61, 64, 71–74 IV: 291, 294–295, 298, 301, 305–306, structural and functional aspects of, II: 308–311, 313, 327, 329, 331, 334–336, 54–56; III: 54–58; IV: 54–56; VI: 56–66 342, 345, 347, 350, 352, 355, 357, 362, TCDD biologic plausibility and, I: 3, 366, 370, 373, 376, 380, 383 133–138, 452–453; IV: 4, 25–26, 29, exposure assessment in, I: 279–280, 281, 42, 47–53, 322, 386 386; II: 4–5, 101, 103, 109; III: 6, TCDD carcinogenicity and, I: 118, 439 146–147, 157–158, 162; IV: 123–124 TCDD hepatotoxicity and, I: 151, 152, 457; gastrointestinal ulcers in, I: 691; III: 510, II: 3–4 513 TCDD immunotoxicity and, I: 122, 150 immune system disorders in, I: 696 TCDD interactions with, V: 24–25, 52–54, infertility in, II: 280; III: 446–447, 449 309 laryngeal cancer in, V: 272 TCDD reproductive toxicity and, I: 123 lipid abnormalities in, I: 689; II: 333; III: TCDD teratogenicity and, I: 159–160 505, 506, 507; IV: 494 transcriptional-independent responses, II: liver toxicity in, II: 332; III: 510, 513; IV: 58–59 502 See also ARNT low birthweight in, I: 626, 627; III: AHS. See Agricultural Health Study 457–458 AIDS/HIV, I: 338, 527, 541, 695; II: 326; IV: melanoma in, III: 313–314; IV: 303–304 144, 214, 356, 475, 476 methodology, I: 230–231, 385–386, 445, Air Force. See US Air Force 757–762 Air Force Health Study (AFHS), I: 62–63, 260, multiple myelomas in, I: 562; II: 244, 245; 272, 622; II: 284, 293–295, 336; III: 23, IV: 373 25, 29, 239, 438–439, 495, 505, 514; neurological disorders in, I: 659; IV: IV: 13, 232, 233, 234, 235; V: 10, 513; 441–443, 445, 454–455, 459 VI: 120, 260, 406, 492; VII: 173–181, non-Hodgkin’s lymphoma in, I: 541; IV: 241–242, 647–649, 763–767 362 appropriation for, I: 51 participants, I: 722–723; II: 150–152 autoimmune disease in, I: 698 perinatal death in offspring, III: 452–453 basal/squamous cell skin cancer in, III: 318, peripheral nervous system disorders in, I: 321, 322; IV: 309 665; IV: 454–455 baseline mortality studies, II: 151 porphyria cutanea tarda in, I: 681–682; II: birth defects in offspring, II: 286, 293–295; 321–322; III: 481 III: 436, 438, 439; IV: 402

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862 INDEX childhood cancer studies summary, II: 299; V IV: 418, 429; VII: 356–357 Valvular heart disease, VI: 7 chloracne studies summary, II: 318; III: VAO. See Veterans and Agent Orange: Health 479–480; IV: 465; V: 478; VII: 600 Effects of Herbicides Used in Vietnam chronic persistent peripheral neuropathy Verona, Missouri, II: 128–129; III: 219, 220; studies summary, II: 310; IV: 454 IV: 135, 148; V: 105 circulatory disorders studies summary, II: Very low density lipoprotein (VLDL) receptors, 335–336; III: 514; IV: 506; V: 503; VII: II: 333; III: 503 645 VES. See Vietnam Experience Study cognitive/neuropsychiatric disorders studies Veterans. See Foreign veterans; Vietnam summary, II: 307; III: 468–469; IV: veterans; Women veterans 441–442; V: 448–449; VII: 568–569 Veterans Administration. See Department of congressional hearings on Agent Orange, II: Veterans Affairs, US (DVA) 27–28; III: 25 Veterans and Agent Orange: Health Effects of Department of Veterans Affairs Task Force, Herbicides Used in Vietnam (VAO), II: II: 4–26; III: 24–25 1, 2, 5, 8, 10, 11, 12, 35, 45, 63, 65, 71, diabetes mellitus studies summary, II: 330; 89, 90, 91, 96, 97, 99, 101, 102, 104, III: 496–497; IV: 482, 487, 488, 490, 107, 112, 132, 176, 179, 180, 181, 187, 492; V: 486; VII: 623 190, 196, 207, 209, 210, 214, 218, 225, endocrine cancers, VII: 434 228, 232, 236, 237, 246, 247, 249, 250, endometriosis, VII: 676 266, 271, 278, 279, 286, 293, 296, 300, eye cancer, VII: 421 305, 312, 323, 328, 357; III: 1, 2, 3, 5, federal government response to concerns 12, 32, 43, 85, 124, 125, 126, 132, 150, over military use of herbicides in 157, 169, 220, 221, 223, 286, 303, 311, Vietnam, II: 27–32; III: 25–30 320, 359, 389, 390, 416, 434, 435, 519, female reproductive cancers studies 522; IV: 5, 156–159; V: 1–2, 12–14, summary, II: 211–212; III: 330–331, 16–18, 20–21, 104; VI: 2–3, 11, 20, 332, 333; IV: 321, 324–325; VII: 33–34, 119, 121–124, 126, 129, 133, 383–384 135; VII: 2, 48, 146–150 gastrointestinal tract tumors studies acute myelogenous leukemia, VII: 491–493 summary, II: 177–178; III: 268, background, II: 17–19; III: 17–23; IV: 15, 274–281; IV: 251, 256; V: 244–245 103–104, 110, 132, 137, 249, 268, 351 gastrointestinal ulcers studies summary, basal/squamous cell skin cancer studies II: 334; III: 510; IV: 500; V: 500; VII: summary, III: 317–318, 321, 323; 641–642 IV: 308, 312–313; V: 295–296; VII: health outcomes conclusions, II: 19–23; III: 366–369 19–20; IV: 11, 18–19, 20, 21, 384, 385, birth defects studies summary, III: 436–439; 414, 465, 467, 471, 513, 514; V: 6–9; IV: 400–401, 404, 435; V: 394; VII: VI: 13–18; VII: 19–20 535–536 hepatobiliary cancers studies summary, III: bladder cancer studies summary, II: 282–283, 287–288; IV: 268, 269; V: 225–226; III: 347–348, 350–351; IV: 259–260 340, 343–345; V: 329; VII: 408 herbicide environmental exposure studies, bone/joint cancer studies summary, II: 204; II: 142–143, 144, 145–146; III: III: 302, 305; IV: 288, 290–291; V: 279; 197–202, 203–205, 275, 277, 279, 281, VII: 392 283, 288, 291, 301, 316, 323, 328, 336, brain tumor studies summary, II: 229; III: 342, 345, 350–351, 354, 369, 382, 392, 356–357, 360, 361; IV: 351, 353–355; 437, 454, 455, 456, 459, 479, 520; IV: V: 339; VII: 425 147–149, 261, 264, 266–267, 271–272, breast cancer studies summary, III: 276, 286, 291 324–326, 328; IV: 314–315, 319–320; V: 301; VII: 372–373

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863 INDEX herbicide occupational exposure studies, II: nasal/nasopharyngeal cancer studies 114, 115–116, 117–118, 119–120, 121– summary, III: 290, 291; IV: 274; V: 265, 126; III: 170–174, 176–178, 180–182, 274; VII: 267–268 183–185, 188–196, 274–275, 276–277, neuroblastoma, V: 426 278–279, 280, 282–283, 286, 291, 294, next edition of, VI: 94 300–301, 305, 310, 312, 316, 317, 321, non-Hodgkin’s lymphoma studies summary, 323, 324–326, 328, 332, 333, 335–336, II: 231–232; III: 362–363, 367–369, 345, 350, 354, 360, 367–369, 374–376, 370–371; IV: 356, 360–363; V: 344; 381–382, 391–392, 454, 455, 456, VII: 444 459, 496, 520; IV: 137, 139, 140–142, parkinsonism, VII: 571–572 144–146, 257–261, 263, 265–266, 271, perinatal death studies summary, II: 285; 276, 280, 285, 290 III: 451, 454, 455, 456; IV: 412; VII: Hodgkin’s disease studies summary, II: 235; 530 III: 372, 374–375, 376; IV: 365, 368; V: peripheral neuropathy studies summary, III: 356; VII: 458 470–471, 473; IV: 454; VII: 586–589 immune system disorders, studies summary, porphyria cutanea tarda studies summary, II: 327; III: 488–489; IV: 477; V: 484; II: 321–322; III: 481–482; IV: 467; V: VII: 618 479; VII: 603 impact of report, II: 24–26; III: 23–25 prostate cancer studies summary, III: infertility studies summary, II: 280; III: 335–336, 341, 342; IV: 327, 333–335; 445–446, 450; IV: 406, 409; VII: 518 V: 317–318; VII: 389–398 laryngeal cancer studies summary, III: 293, renal cancer studies summary, II: 224; III: 294; IV: 277, 280; V: 268–269; VII: 326 352–353, 354, 355; IV: 346, 349–350; legislation on Agent Orange, II: 28–29; III: VII: 415 26–27 research recommendations, II: 23–24; III: leukemia studies summary, II: 245; III: 23; IV: 21 385–386, 391–392; IV: 378–379, 381, respiratory disorders studies summary, II: 383; V: 368; VII: 476 324–325; III: 483; IV: 471; V: 481; VII: lipid abnormalities studies summary, II: 605 333; III: 504, 520, 521; IV: 483; VII: sex ratios of offspring, IV: 429–430; V: 433 633 skin cancer studies summary, III: 312; IV: liver toxicity studies summary, II: 332; III: 299–314; VII: 355–356, 366–369 510; IV: 500; VII: 641–642 soft-tissue sarcomas studies summary, low birthweight studies summary, III: II: 205–206; III: 306–308; IV: 292, 456–457, 459; IV: 399, 400, 412; V: 297–299; V: 283; VII: 347 423; VII: 532 spontaneous abortion studies summary, II: lung cancer studies summary, III: 296, 283; IV: 410; V: 410; VII: 525–526 300–301; IV: 281, 285–286; V: 273; summary of, II: 37–42 VII: 331 testicular cancer, VII: 402 melanoma studies summary, III: 313–314, toxicology, overview, III: 36; IV: 22, 38, 41; 316, 317; IV: 302, 306; V: 290; VII: V: 30–31; VI: 33 355–356 Veterans and Agent Orange: Herbicides/Dioxin metabolic and digestive disorders, studies Exposure and Acute Myelogenous summary, II: 330, 332, 333, 334; IV: Leukemia in the Children of Vietnam 500; VII: 641–642 Veterans, V: 2, 13, 14, 16–17, 21; VI: 2, motor/coordination dysfunction studies 12, 16; VII: 19–20 summary, II: 309; III: 469–470; IV: Veterans and Agent Orange: Herbicides/Dioxin 443–444 Exposure and Type 2 Diabetes, IV: multiple myeloma studies summary, III: 1, 10–11, 16, 104; V: 2, 12–13, 16, 377–378, 381–382; IV: 372, 375–376; 486–487; VI: 2, 12, 15, 135; VII: 19–20 V: 362; VII: 466

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864 INDEX Veterans and Agent Orange: Length of gastrointestinal ulcers studies summary, III: Presumptive Period for Association 510; IV: 500; V: 500 Between Exposure and Respiratory health outcomes conclusions, III: 19–20; Cancer, VI: 12, 27, 135; VII: 19–20 VI: 13–18; VII: 19–20 Veterans and Agent Orange: Update 1996, III: hepatobiliary cancers studies summary, III: 1, 2, 3, 6, 8, 10, 32, 37, 43, 44, 50, 85, 282–283, 287–288; IV: 267–272; V: 106, 109, 125, 126, 132, 150, 157, 159, 259–260 169, 220, 221, 222, 223, 266, 286, 295, herbicide environmental exposure studies, 298, 303, 309, 311, 319, 320, 339, 349, III: 197, 201, 203, 275, 277, 279, 283, 359, 389, 390, 416, 417–418, 424, 426, 288, 323, 328, 336, 342, 345, 354, 369, 428, 434, 435, 444, 458, 519, 522, 533; 375, 382, 392; IV: 147, 149 IV: 1; V: 2, 12–14, 16–18; VI: 2, 11, herbicide occupational exposure studies, 33–34, 121–129, 133, 135; VII: 2 III: 170, 172, 174, 175–176, 179, 183, background, III: 17–23; IV: 15–21, 110, 186–187, 274, 276, 278, 280, 282–283, 132, 137, 247, 251 286, 291, 294, 300, 305, 316, 317, 321, basal/squamous cell skin cancer studies 324–326, 328, 332, 333, 335–336, 345, summary, III: 317–318, 321, 323; IV: 350, 354, 360, 367, 374, 381, 391, 496; 308–314; V: 295–296 IV: 135–137, 140–142, 144 birth defects studies summary, III: 436–439; Hodgkin’s disease studies summary, III: IV: 400–401, 435; V: 394 373, 374, 375, 376; IV: 364–371; V: 356 bladder cancer studies summary, III: impact of report, III: 23–25 347–348, 350; IV: 330–345; V: 329 infertility studies summary, III: 445–446; bone/joint cancer studies summary, III: 302, IV: 406–408 305; IV: 287–291; V: 279 laryngeal cancer studies summary, III: 293, brain tumor studies summary, III: 356–357, 294; IV: 277–281; V: 268–269 360, 361; IV: 350–355; V: 339 legislation on Agent Orange, III: 26–27 breast cancer studies summary, III: leukemia studies summary, III: 385–386, 324–326, 327, 328; IV: 314–320; V: 301 391, 392; IV: 377–383; V: 368 childhood cancers, IV: 418 lipid abnormalities studies summary, III: chloracne studies summary, III: 479–480; 504; IV: 493 IV: 465; V: 478 liver disorders studies summary, III: 510; circulatory disorders studies summary, III: IV: 500 514; IV: 506; V: 503 low birthweight studies summary, III: cognitive/neuropsychiatric disorders studies 456–457; IV: 412; V: 423 summary, III: 468–469; IV: 441–442; V: lung cancer studies summary, III: 296, 298, 448–449 300; IV: 281–287; V: 273 congressional hearings on Agent Orange, melanoma studies summary, III: 313–314, III: 25 316, 317; IV: 302–308; V: 290 Department of Veterans Affairs Task Force, motor/coordination dysfunction studies III: 24–25 summary, III: 469–470; IV: 444 diabetes mellitus studies summary, III: 496; multiple myeloma studies summary, III: IV: 482–483, 490; V: 486 377–378, 381, 382; IV: 371–377; V: 362 federal government response to concerns nasal/nasopharyngeal cancer studies over military use of herbicides in summary, III: 290, 291; IV: 273–276; V: Vietnam, III: 25–30 265 female reproductive system cancers studies non-Hodgkin’s lymphoma studies summary, summary, III: 330–331, 332, 333; IV: III: 362–363, 367, 369, 370; IV: 321–326; V: 310 355–364; V: 344 gastrointestinal tract tumors studies pancreatic cancer, IV: 264–267 summary, III: 268, 274–281; IV: perinatal death studies summary, III: 451; 257–264; V: 244–245 IV: 412

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865 INDEX peripheral neuropathy studies summary, III: hepatobiliary cancers studies summary, IV: 470–471, 473; IV: 18 267–272; V: 259–260 porphyria cutanea tarda studies summary, Hodgkin’s disease studies summary, IV: III: 481–482; IV: 467; V: 479 364–371; V: 356 prostate cancer studies summary, III: infertility studies summary, IV: 406–408 335–336, 341, 342; IV: 326–335; V: laryngeal cancer studies summary, IV: 317–318 277–281; V: 268–269 renal cancers studies summary, III: leukemia studies summary, IV: 377–383; V: 352–353, 354, 355; IV: 345–350 368 research recommendations, III: 23 low birthweight studies summary, IV: 412; respiratory disorders studies summary, III: V: 423 483; IV: 471–472; V: 481 lung cancer studies summary, IV: 281–287; sex ratios of offspring, IV: 429–430; V: 433 V: 273 skin cancer, IV: 299–301 melanoma studies summary, IV: 302–308; soft-tissue sarcoma studies summary, III: V: 290 306–308; IV: 291–299; V: 283 mortality in, IV: 254 testicular cancer studies summary, III: multiple myeloma studies summary, IV: 343–344, 345; IV: 335–339; V: 325 371–377; V: 362 toxicology, overview, III: 36; IV: 22; V: nasal/nasopharyngeal cancer studies 30–31; VI: 33 summary, IV: 273–276; V: 265 Veterans and Agent Orange: Update 1998, non-Hodgkin’s lymphoma studies summary, V: 2, 12–14, 16–18; VI: 2, 11, 33–34, IV: 355–364; V: 344 121–129, 133, 135; VII: 2 occupational exposure, IV: 135–137, Australian Veterans, IV: 159 139–142, 144 background of, IV: 1, 3, 8–10, 110, 132, Operation Ranch Hand, IV: 150, 152 247, 251, 399–400 pancreatic cancer, IV: 264–267 basal/squamous cell skin cancer studies prostate cancer studies summary, IV: summary, IV: 308–314; V: 295–296 326–335; V: 317–318 birth defects studies summary, IV: 400–401, quantitative structure-activity relationship 435; V: 394 (QSAR) models, V: 27 bladder cancer studies summary, IV: renal cancers studies summary, IV: 345–350 330–345; V: 329 sex ratios of offspring, IV: 429–430; V: 433 bone/joint cancer studies summary, IV: skin cancer, IV: 299–301 287–291; V: 279 soft-tissue sarcoma studies summary, IV: brain tumor studies summary, IV: 350–355; 291–299; V: 283 V: 339 spontaneous abortion, IV: 408–412; V: 410 breast cancer studies summary, IV: testicular cancer studies summary, IV: 314–320; V: 301 335–339; V: 325 childhood cancers, IV: 418, 426 toxicology overview, IV: 22; V: 30–31; VI: cognitive/neuropsychiatric disorders studies 33 summary, V: 448–449 Veterans and Agent Orange: Update 2000, V: Department of Veterans Affairs and, IV: 2, 12–18, 21, 103; VI: 2, 11, 21, 33–34, 157–158 58, 121–126, 129; VII: 2 environmental exposure, IV: 148–149 amyloidoisis, VII: 473 epidemiology, IV: 257 basal/squamous cell skin cancer studies female reproductive system cancers studies summary, IV: 308–314; V: 295–296 summary, IV: 321–326; V: 310 birth defects studies summary, V: 394 gastrointestinal tract tumors studies bladder cancer studies summary, V: 329 summary, IV: 257–264; V: 244–245 bone/joint cancer studies summary, V: 279 health outcomes conclusions; VI: 13–18; brain tumor studies summary, V: 339 VII: 19–20

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866 INDEX breast cancer studies summary, IV: Veterans and Agent Orange: Update 2004, VII: 314–320; V: 301 2, 19–22, 580–581 carcinogenicity, V: 37 Veterans and Agent Orange: Update 2006, VII: cell stress responses, V: 34 30-34, 40–41, 139–208 cognitive/neuropsychiatric disorders studies herbicide environmental exposure studies, summary, V: 449–450 VII: 141–143, 145–146, 148 developmental toxicity, V: 35–36 herbicide occupational exposure studies, disease outcomes, V: 34–37 VII: 141, 144–145, 147 energy metabolism, V: 33–34 Veterans’ benefits. See Compensation, veterans female reproductive system cancers studies Veterans’ compensation. See Compensation, summary, V: 310 veterans gastrointestinal tract tumors studies Veterans’ Dioxin and Radiation Exposure summary, V: 244–245 Compensation Standards Act of 1984. genotoxic effects, V: 33 See Public Law 98-542 health outcomes conclusions, VI: 13–18; Veterans’ Education and Benefits Expansion VII: 19–20 Act of 2001. See Public Law 107-103 Hodgkin’s disease studies summary, V: 356 Veterans’ Health Care, Training, and Small immunotoxicity, V: 37 Business Loan Act of 1981. See Public laryngeal cancer studies summary, V: Law 97-72 268–269 Veterans’ Health Care Eligibility Reform Act of leukemia studies summary, V: 368 1996. See Public Law 104-262 lung cancer studies summary, V: 273 Veterans’ Health Programs Extension and mechanisms of toxic action, V: 33–34 Improvement Act of 1979, III: 240 melanoma studies summary, V: 290 Veterans’ service organizations, VI: 20 mitochondrial function, V: 33–34 Vibrotactile abnormalities, V: 466, 468 multiple myeloma studies summary, V: 362 Vietnam, III: 533; VI: 134, 181–182; VII: nasal/nasopharyngeal cancer studies 170–171, 172–186 summary, V: 265 herbicide latency issues, methodology, II: neuroblastoma, V: 426 13; III: 12–14 neurotoxicity, V: 35 herbicide targeting in, I: 99–106; IV: non-Hodgkin’s lymphoma studies summary, 116–117 V: 344 herbicide use in, concerns about, I: 29–32, parkinsonism, V: 453, 460 45; II: 1, 2, 4, 11, 17, 18, 26; III: 1, 2, 5, prostate cancer studies summary, IV: 12, 13, 17, 18, 25; V: 3, 30–31, 229–232 326–335; V: 317–318 research in, I: 30–31 reproductive toxicity, V: 35–36 troop movements in, I: 52–53, 96, 287 respiratory disorders studies summary, V: US casualties in, I: 82–83 481 US involvement, I: 75–76, 84 sex ratios of offspring, V: 433 US military herbicide use in, I: 1, 3, 24, soft-tissue sarcoma studies summary, V: 283 27, 84–85, 89–93, 94–96, 98–107, 286; testicular cancer studies summary, V: 325 II: 17, 18, 26, 27–32; III: 135–142; V: thyroid hormones, V: 34 116–117; VI: 120 toxicology overview, V: 30–31 See also Ca Mau peninsula; Con Thieu Veterans and Agent Orange: Update 2002, VI: province, Vietnam; Hanoi, Vietnam; Ho 2, 5–7, 11, 33–37, 43, 51, 55, 58–60, Chi Minh City, Vietnam; Khe Sanh- 66–73, 83–84, 88–92, 118, 121–126, Thonh Son Lam area; Mekong Delta; 129–130, 135; VII: 2, 580–581 Rung Sat Special Zone; Vietnamese health outcomes conclusions, VI: 11–18; Vietnam Experience Study (VES), III: 26, 240, VII: 19–20, 487, 580–581 512; VI: 139, 186; VII: 651 toxicology overviews, VI: 33, 37 birth defects in offspring, II: 288, 289, 290; III: 436, 438, 439, 445

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867 INDEX cancer mortality in, I: 444–445 autoimmune disease in, I: 698, 699 childhood cancer in, I: 629; II: 300 basal/squamous cell skin cancer in, III: 323; chloracne in, I: 677 IV: 309–310; V: 298, 300; VI: 265; VII: circulatory disorders in, I: 702 369–370 exposure assessment use, II: 101; III: 146 birth defects in children of, I: 609–615, hepatobiliary cancers, II: 185; III: 283 618; II: 288–296, 298, 300; III: 435, Hodgkin’s disease in, I: 556 436, 437–438; IV: 7, 402; V: 402–403; immune system disorders in, I: 696 VI: 365; VII: 539–541, 543 infertility in, II: 280 bladder cancer in, I: 517; II: 223–224; III: liver cancer in, I: 455 349, 351; IV: 7, 342; V: 332, 333; VI: low birthweight outcomes in, I: 626 292; VII: 411–413 lung cancer in, I: 469 bone/joint cancer in, I: 473, 474–475; II: methodology, I: 57–58, 281, 284, 389–391 204; III: 303, 305; IV: 7, 289; V: 281; multiple myeloma, II: 244 VI: 245; VII: 344–345 neonatal death in, I: 622 brain tumors in, I: 522, 523, 525; III: neurologic/neuropsychiatric outcomes in, I: 358–359, 361; IV: 7, 352; V: 342, 343; 656 VI: 302; VII: 429–432 non-Hodgkin’s lymphoma in, I: 542–543 breast cancer in, II: 213, 217, 218; III: 326, origins, I: 50 328, 329; IV: 7, 316; V: 304, 309; VI: reproductive outcomes in, I: 601, 609, 270; VII: 376–377, 379 610–611, 626, 632 cancer expected incidence, I: 439–440, respiratory cancer in, II: 201 442, 446, 452, 461, 501, 505, 513, 522, respiratory disorders in, I: 710–711 526, 564; II: 176–177; III: 266–267, spina bifida in offspring, II: 9; IV: 8 430–431; IV: 249–250 Vietnam herbicides used by military, II: 26–27; cancer in children of, I: 629, 630–631; II: VI: 182–186 299; IV: 7, 420–422; V: 430–431; VII: Vietnam Veteran Agent Orange Health Study, 550–552 I: 741 cancer mortality, I: 444–445 Vietnam veterans, I: 1; II: 2; V: 20–21; VI: 2, 5, cancer studies, I: 391–393, 401, 402–403, 10, 491–493; VII: 148–149, 763–777 405, 436–438; II: 176–177; III: acute and subacute transient peripheral 266–267, 430–431; VII: 149 neuropathy, II: 313; III: 473; IV: 6, 459 cancers of the digestive organs, VII: 286 acute myelogenous leukemia, VII: 493–494 cancers of the eye and orbit, VII: 422–423 advocacy groups, I: 60–61 cardiovascular findings, VII: 148 Air Force research activities, II: 31–32; chloracne in, I: 677–679; II: 317, 318, 321; III: 28–29; IV: 13, 42–43, 150–156, III: 479–480; IV: 6, 135, 485; V: 479; 160–161 VI: 438 altered sperm parameters in, I: 632, 634; chronic lymphocytic leukemia, VII: 489 III: 445, 446, 450; IV: 7 chronic persistent peripheral neuropathy in, amyloidosis, IV: 7; V: 507; VI: 473 II: 311; IV: 7, 456 amyotrophic lateral sclerosis, VI: 422 circulatory disorders in, I: 702–705; II: 336; Australian, I: 61, 91, 406, 418, 444, 470, III: 516–518; IV: 7, 508–509; VI: 471; 496–497, 546, 614–615, 633, 702, VII: 646–654, 666–669 710; II: 113, 149, 160, 202, 293; III: class action suit, I: 34–35 9, 216–217, 218, 237, 244–245, 273, cognitive/neuropsychiatric disorders in, II: 285–286, 290, 294, 295, 298, 299, 303, 318; III: 469; IV: 7, 443; V: 449–451 310, 311, 314, 315, 327, 329, 339, 340, colon cancer in, V: 252; VII: 303–304 343, 346, 349, 353, 355, 359, 365, 380, colorectal cancer, VII: 309 389, 413, 424, 425, 469, 486, 489, 500, compensation for, I: 34–35, 47, 50–51, 506, 512–513, 517; IV: 9, 10, 159–160, 55–56; II: 28–29, 30–31; III: 26–27, 28 322–333, 402, 421–422; VI: 141; VII: congressional responses to concerns of, I: 775–777 46–52; II: 27–29; III: 25–28

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868 INDEX defining, I: 78 255, 269, 275, 278, 283, 294–295, demographics, I: 79, 80–84 303–304, 309–310, 316, 322–323, 329, developmental toxicity, II: 72 336–337, 342, 347, 357–358, 366–367, diabetes mellitus in, I: 684, 685, 698; II: 373, 380, 402, 411, 420–422, 474, 330; III: 495, 497, 498, 500, 502; IV: 485–487, 494, 502–504, 508–509; V: 6, 485–487; V: 489–490, 491; VI: 177–193; VI: 132–133, 551–568; VII: 450–455; VII: 148–149, 626–630 240–247 disabilities discharges, I: 32 esophageal cancer, VII: 290 disease increased risk for, I: 14–15, 221, exposure assessment, I: 234–235; VI: 225–226, 247–248, 578; II: 14, 22–23, 17–18, 186–191 88, 89, 91, 218, 223, 251, 276, 298, federal government activities/research on 300–301, 314, 321, 323; III: 14–15, military use of herbicides, II: 27–32; III: 22–23, 124, 127–128, 329, 334, 343, 25–30 397, 430–431, 444, 462, 475–476, 491, female reproductive system cancers in, I: 503, 507–508, 525; IV: 12, 256, 270, 505, 511–512, 577; II: 211, 212; III: 275, 279, 284, 290, 296, 305–306, 311, 333; IV: 7, 322–323; V: 311, 312, 313, 318, 323–324, 332, 338, 343, 348, 353, 314–315; VI: 275 359, 367, 374, 381, 403, 407, 411–412, gastrointestinal disorders in, I: 691, 692; III: 413, 417, 426, 466, 468, 475, 489, 495, 512–513; IV: 502–504; V: 502; VI: 466 505, 510, 513; V: 246, 264, 268, 272, gastrointestinal tract cancers in, I: 446; II: 278, 282, 287, 295, 300, 309, 316, 324, 177, 180–181; IV: 7, 255; V: 245–246; 328, 333, 338, 343, 355, 361, 366, 372, VI: 220 376, 405, 409, 420–421, 422, 425, 432, genitourinary tract cancers in, I: 513, 518, 441, 472, 479, 480, 483, 485, 492, 498, 522; II: 223–224; III: 272–273, 275, 502, 506, 510, 518–519; VI: 221, 226, 277–278, 279, 281; IV: 7, 342 230, 234, 241, 245, 251, 261, 265, 270, health care of, II: 28, 29; III: 26, 27 275, 283, 284, 292, 296, 302, 312, 319, health concerns of, I: 1, 32–34, 46–47; II: 325, 333, 337, 341, 365, 372, 378, 379, 17–24, 26–27; III: 17–30 383, 398, 410, 420, 422, 429, 430–431, hepatic enzyme disorders in, I: 687 438, 440, 443, 448, 456, 463, 466, 471, hepatobiliary cancers in, I: 455, 457; II: 473, 478, 481 181, 185, 187; III: 283, 285–286, distribution by branch of service, I: 81 288; IV: 7, 269; V: 264; VI: 226; VII: endocrine cancers, VII: 437, 441–442 316–317 endometriosis in, VI: 478 herbicide exposure assessment issues, II: Environmental Protection Agency research 4–5, 14, 17–24, 26–27; III: 2, 5–6, 142, activities, II: 32; III: 29–30 143, 146–150; IV: 122–127; V: 28 epidemiologic studies, I: 50, 57–59, 62–63, herbicide exposure assessment strategies 384–418; II: 3, 6–7, 28, 113, 149–161; for, I: 270–284; II: 99–109; III: 144–145 III: 26, 206–217, 236–245, 272–273, Hodgkin’s disease in, I: 526, 554–556, 557; 275, 277–278, 279, 281, 283, 285–286, II: 235, 236; III: 372, 373, 376; IV: 6, 288, 290, 291, 294–295, 298, 301, 303, 366–367; V: 359–360, 361; VI: 319; 305, 309–310, 312, 316, 317, 323, 326, VII: 462–465 328, 333, 336, 338, 339, 340, 342, immune modulation in, I: 695–696, 699; 343–344, 345–346, 349, 351, 353, 355, III: 489, 491 358–359, 361, 363, 365, 370–371, 372, immune system disorders, VI: 448; VII: 619 373, 376, 380, 382, 385, 386, 389, 392, individual exposures, VI: 18 435, 436, 437–438, 445, 446, 450, 454, infertility, I: 632, 633, 634; II: 280; III: 445, 455, 456, 457, 459, 467, 468, 469, 470, 446, 450; IV: 7; VI: 372; VII: 521, 523 473, 479, 480, 481, 482, 485–486, 489, International Agency for Research on 491, 495, 497, 498, 500, 502, 505–506, Cancer research activities, III: 30 512–513, 516–518, 521; IV: 150–160, kidney cancer in, VI: 286; VII: 418–420

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869 INDEX laryngeal cancer in, III: 294–295; IV: 6, 9, outreach activities, II: 31; III: 28 (See 278; V: 272; VI: 234; VII: 328–329 also Air Force Health Study [AFHS]; latency relevance for assessing herbicides Compensation, veterans; Demographic effect on cancer risk in, II: 276; III: data, Vietnam veterans; Operation 12–13, 430–431 Ranch Hand; Risk assessment) legislation concerning herbicide exposure ovarian cancer, VII: 388 and health of, II: 28–29; III: 26–27 pancreatic cancer in, V: 258–259; VII: leukemia in, I: 13, 564, 570, 571–572; II: 321–324 245, 246; III: 385, 386, 389, 392; IV: 7, parkinsonism in, II: 309–310; VI: 420 380; V: 371; VI: 333, 337; VII: 482–484 perinatal deaths in offspring, II: 285; III: lip cancer, VII: 278 454, 455, 456; IV: 7; VI: 379 lipid abnormalities in, I: 689, 692; II: 333; peripheral nervous system disorders in, I: III: 505–506, 521; IV: 7, 494; VI: 463; 665, 666; II: 311, 313; III: 473, 475; IV: VII: 148, 635–637 6, 7, 456; VI: 429 liver toxicity in, II: 332; III: 512–513; IV: porphyria cutanea tarda in, I: 681, 682–683; 502–504; VII: 643 II: 321–322, 323; III: 481, 482; IV: 6, 8; low birthweight outcomes for, I: 626, 628; V: 480; VI: 440 III: 457, 459; IV: 7; V: 423–424, 425; prostate cancer in, I: 513, 518, 519, 522; VI: 383; VII: 534 II: 9, 217–218, 221, 223; III: 336, 338, lung cancer in, III: 298, 301; IV: 6, 283; V: 339, 340, 342; IV: 6, 8, 10, 329; V: 278; VI: 240; VII: 336–340 321, 322; VI: 281, 283; VII: 143, 148, melanoma in, III: 316, 317; IV: 303–304; V: 393–395, 399–401 288, 289, 292, 293–294; VI: 256–259; records-based exposure assessment, I: VII: 359–363 271–280; IV: 121–126 military experiences, I: 75, 82, 272, 286, records identification, II: 24–25 399 rectal cancer in, V: 256; VII: 307–308 mortality, VII: 149 renal cancers in, III: 352, 353, 355; IV: 7, motor/coordination dysfunction in, I: 347; VI: 296 659–660, 662; II: 309, 310; III: 469, reproductive outcomes, I: 405–406, 418, 470; IV: 7, 448 601–603, 609–615, 618, 620–622, 625; multiple myeloma in, I: 526, 562, 563; II: II: 71, 278, 300–301; III: 435, 436, 244; III: 380, 382; IV: 6, 10, 373; V: 437–438, 445, 446, 450, 454, 455, 456, 365; VI: 325; VII: 469–472 457, 459; IV: 7, 402; VI: 398 nasal/nasopharyngeal cancer in, I: 459, 460; research recommendations, II: 23–25; III: II: 189; III: 290, 291; IV: 7, 275; V: 23; V: 523–525 268; VI: 229–230; VII: 272–275 respiratory cancers in, I: 469–470, 472; II: National Personnel Records Center listing, 190, 201–202, 203; IV: 6, 283 I: 17 respiratory disorders in, I: 710–712, neural tube defects in offspring, numbers, 713–714; III: 485–486; IV: 7, 474; V: II: 297; IV: 7, 18, 404–405; V: 16 483; VI: 443; VII: 610–615 neurobehavioral disorders in, II: 305, 308, risk assessment for, I: 14–15, 221, 225–226, 309, 310, 311, 313, 314; III: 467, 468; 247–248, 578; II: 14, 22–23, 89, 91, IV: 457–459; V: 472; VI: 410 251, 276, 298, 300–301, 314, 321, neuropsychiatric outcomes, I: 653–656, 323, 349–357; III: 14–15, 22–23, 124, 658; II: 308; III: 469; IV: 443; VI: 127–128, 430–431; IV: 20, 105–108; V: 430–431 7, 9–10, 23; VI: 9–10, 221 non-Hodgkin’s lymphoma in, I: 526, serum testing, I: 20–21 541–548, 549; II: 234; III: 363, 365, skin cancer in, I: 501, 505; II: 209; III: 370–371; IV: 6, 357–358; V: 348–350, 312; IV: 7, 301; VI: 256–259, 265; VII: 354, 355; VI: 312; VII: 451–453, 456 359–363 number of, I: 3, 4, 74, 75–80

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870 INDEX soft-tissue sarcoma in, I: 475, 492–498, herbicide environmental exposure, II: 500; II: 205, 208; III: 309–310; IV: 6, 144–145, 148, 287–288; III: 283; VII: 294–295; V: 286–287; VI: 251; VII: 236–237, 757–758 351–353 herbicide exposure assessment, I: 269, 370– South Koreans, I: 61–62; VI: 1, 6–7, 372; II: 4–5, 108–109; III: 156–157; IV: 188–189 116–117; V: 3, 229 spina bifida in offspring, II: 9–10, 296, herbicide exposure indices development, II: 298, 301; III: 7, 8, 9–10, 21, 24–25, 107–108 437–438; IV: 7, 10, 18, 402 reproductive outcomes, I: 599–601, spontaneous abortions in, I: 601–603, 605; 608–609; IV: 148–149 II: 283; IV: 7, 411; V: 420–421; VI: research recommendations, I: 731; V: 11, 378; VII: 528–529 526; VI: 10, 491–493; VII: 703 state-sponsored studies of, II: 152–153, scientists in, studies of Vietnamese veterans, 158–159, 161, 202, 292; III: 213–215, III: 245; VI: 493 243–244; IV: 158–159 Vietnamese Veterans, IV: 160; VII: 186 stomach cancer in, V: 249; VII: 295–298 Viral infection suicide incidence, I: 655–656 immune system response, I: 692–693 testicular cancer in, II: 153; III: 343–344, TCDD-enhanced susceptibility, I: 149 345–346; IV: 7, 336–337; V: 326–327; teratogenic potential, I: 607 VI: 284; VII: 404–406 See also Immune system disorders thyroid homeostasis, VI: 481; VII: 683–684 Vitamin A, I: 174 tongue cancer, VII: 280 VLDL. See Very low density lipoprotein twin studies, I: 398–399, 406, 703, 711 receptors uterine cancer, VII: 386–387 Vietnamese veterans, Vietnamese studies of, W III: 245 women, I: 50, 83–84; II: 152–153, 180, WAIS. See Wechsler Adult Intelligence Scales 181, 190, 201, 204, 205, 209, 211, 212, Wales. See United Kingdom 213, 216–217, 218, 223, 226, 228, 229, Walking abnormalities. See Motor/coordination 231, 245, 278, 280; III: 326–329, 333, dysfunction 434–435; IV: 316 War Research Service, I: 25 Vietnam veterans’ exposure studies, II: 154, Washington, D.C., II: 343; III: 533; V: 5, 400 156–157, 158–159; III: 206–209, 210– Washington state, I: 336–338, 341, 487–488, 217, 275, 278, 279, 281, 283, 288, 291, 535; II: 149, 241; III: 229, 230, 232, 305, 310, 312, 316, 317, 323, 326, 328, 234; IV: 149, 215; V: 117; VI: 129, 133 336, 342, 345–346, 351, 355, 370–371, Waste incineration workers, V: 6; VII: 226–227 376, 382, 437–438, 450, 454, 455, 456, Wasting syndrome, TCDD-induced, I: 162–166; 459, 497, 521; IV: 150, 156–158, 262, II: 76–77; III: 80–83; IV: 25, 31, 57, 76; 264, 272–273, 276–277; V: 118–127, V: 56; VI: 67–68; VII: 88–89 232–235; VI: 134–142, 181–187 Weakness. See Motor/coordination dysfunction Vietnam veterans’ increased disease risk, II: Wechsler Adult Intelligence Scales (WAIS), I: 22–23; III: 22–23 641; V: 450–451 Vietnam Veterans of America, I: 60 Wechsler Memory Scale (WMS), V: 450–451 Vietnamese West Germany, II: 328–329; III: 223, 337, 379, birth defects and herbicide exposure, II: 387, 483, 506, 511, 515 287–288; V: 394, 400 West Virginia, I: 60, 404, 470, 496, 546, 621, cancer in, II: 148; III: 283 662–663, 686, 689, 700; II: 202; III: epidemiologic studies, I: 599–601; II: 113, 243; IV: 364, 371; VII: 184 144–145, 148, 184, 287–288; III: 202, See also Nitro, West Virginia 234, 283; V: 172–173 Western Europe, II: 268; III: 510

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871 INDEX WHO. See World Health Organization mortality studies, I: 394–395, 470, 545; II: Wide Range Achievement Test (WRAT), V: 152–153, 180, 201 450–452 reproductive outcomes, III: 434–435; IV: Wilm’s tumor, I: 594; V: 334; VI: 292 399–400; V: 5 See also Children, cancer in; Kidney cancer reproductive system cancers in, II: 211, Wisconsin, I: 37, 60, 336, 404–405, 445, 455, 212; III: 333; IV: 320–326; V: 314–316 470, 496, 517, 523, 534, 546, 556, 560, research recommendations, I: 728 702, 710; II: 185, 202, 226, 229, 239, spontaneous abortions, VII: 528–529 241; III: 229, 243, 283, 313, 348; IV: statistics, I: 83–84 259, 262, 264, 267, 272, 291, 299, 301, See also Reproductive system cancers, 335, 339, 345, 350, 355, 361, 363–364, women 371, 375; VII: 184, 652 Women Veterans Health Programs Act of 1992. WMS. See Wechsler Memory Scale See Public Law 102-585 Women. See Breast cancer; Cervical cancers; World Health Organization (WHO), II: 282; III: Demographic data, Vietnam veterans; 30, 454, 492; IV: 413, 415; V: 372, 422; Gender; Ovarian cancer; Reproductive VI: 37, 334, 379 disorders; Reproductive system cancers, TEF factors, V: 26–27 women; Uterine cancer World War II, I: 25, 32, 82; II: 150, 268; III: Women veterans, I: 79; II: 30 237, 420; VI: 135 breast cancer estimated risk, II: 218; III: WRAT. See Wide Range Achievement Test 329; IV: 318; V: 301 breast cancer expected incidence, I: 440, X 461, 501, 505, 513, 522, 526, 564; II: 213; IV: 314; V: 301 Xenobiotic responsive elements (XREs), II: 56, breast cancer in, II: 213, 216–217; III: 322, 57, 58, 71; III: 66, 67, 104 324–328, 329; IV: 314–320; V: 300–301 circulatory disease in, I: 702 epidemiologic studies, I: 50, 81; II: 28, Y 152–153, 180, 181, 190, 201, 204, 205, 209, 211, 212, 213–217, 218, 219–223, Yorkshire, England, III: 234; IV: 149; V: 117 226, 228, 229, 231, 245, 278, 280; III: 324–328, 333; IV: 314–320

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