One of the most common manifestations of Agent Orange in Vietnam veterans is Type 2 diabetes, also referred to as Diabetes Mellitus. In fact, over 270,000 Vietnam veterans receive disability pay for Type 2 diabetes. This does not even include Vietnam veterans who are not receiving disability benefits for this condition. According to the VA, there are approximately 7.2 million Vietnam veterans in the US today. That means that barely 3.8% of the Vietnam veteran population today is receiving benefits for Type 2 Diabetes!
Type 2 Diabetes is the most common form of diabetes and used to be referred to as “adult-onset” diabetes because it is often diagnosed later in life. This condition is caused by the body’s inability to process sugar properly. When we eat, our metabolism converts the food into energy. The pancreas produces a hormone called insulin, which aids in the food conversion process. Insulin triggers the cells in the liver and in the muscle tissue to absorb sugar from the blood. If the body does not respond to insulin properly, the sugar cannot be used in the right way, causing the blood sugar levels to rise. The pancreas can compensate for this temporarily by producing more insulin. But before long the pancreas will not be able to keep up, and blood sugar levels will start to rise.
What makes Type 2 Diabetes different from Type 1 Diabetes is that, with Diabetes II, the pancreas produces a sufficient amount of insulin but the body has stopped responding to that particular hormone. This is what doctors refer to as “insulin resistance”. To treat this condition, doctors prescribe insulin tablets or injections, or other medications.
Type 2 Diabetes is prevalent not only just among veterans, but among a large portion of the US population. Research has identified many factors that contribute to diabetes, including:
- Being overweight and not getting enough physical exercise
- Smoking
- A low-fiber, high-fat and sugary diet
- Some medications that affect the body’s sugar metabolism
- Genetic factors
Because Diabetes Mellitus II is a widespread issue among Americans, particularly in the older populations (65 and up), and because there are so many risk factors, the VA dragged their feet for years before finally adding Diabetes Mellitus II to the list of conditions that are presumed to be related to service. Having added Type 2 diabetes to the original list of conditions being considered in 1991, it was not until 1999 that the Institute of Medicine deemed it probable that veterans who were exposed to Agent Orange in Vietnam may have a higher risk of developing diabetes than if they had not been exposed to the herbicide in the first place.
The Institute of Medicine actually had a few good reasons for taking so long to make this determination. While present-day statistics make it blatantly obvious that Agent Orange was the cause of diabetes in Vietnam veterans today, this was not quite so obvious to the researchers in 1991 or even in 2000. In fact, the statistics then nowhere near supported this link. Consider the US population back in 1991. The Vietnam generation was still young. In 1991, an average Vietnam veteran who enlisted in 1970 (the middle of the Vietnam War) at the age of 20 would be 40 years old. On average, Type 2 diabetes is diagnosed at age 65 and older. So in 1991, there was no reference point to use as a study because very few Vietnam veterans at the time were old enough to be diagnosed with this condition in the first place. In 2000, the average Vietnam veteran would have been 50, which is still well below the typical age of diagnosis. In the 2000 report, the Institute of Medicine stated that “the Vietnam veteran cohort ha[d] only recently entered the age range with sufficient incidence for accurate study. Therefore, past studies of association between dioxin (Agent Orange) and diabetes have been hampered by the relatively low prevalence of diabetes and the even lower death rate attributed to it.”
Without an appropriate population to work with, the Institute of Medicine (IOM) had to go off of reports of herbicide-related diabetes in farming and herbicide manufacturing situations. The IOM also referenced an Air Force Health Study (Operation Ranch Hand) in 2000, a study of US chemical workers by the National Institute for Occupational Safety and Health, and a study of Australian veterans who served in Vietnam. With all of these studies considered together, the IOM stated that the “accumulation of positive evidence was suggestive” of an association between exposure to Agent Orange and a diagnosis of Type 2 diabetes. This standard of limited/suggestive evidence of an association was sufficient for the VA to add Diabetes Mellitus to the list of presumptive conditions.
Today, the large number of Vietnam veterans who have Type 2 diabetes continues to reaffirm the VA’s decision to add this condition to the list. There may not be a cure for this disease, but the least that can be done is recompense the afflicted veterans for the service that caused the condition in the first place.
Author Mary Klements, Hill & Ponton, P.A. Claims Advocate