RALEIGH, N.C. — By his own reckoning, a Navy electrician spent just eight hours in Vietnam, during a layover on his flight back to the United States in 1966. He bought some cigarettes and snapped a few photos.
The jaunt didn't make for much of a war story, and there is no record that it ever happened. But the man successfully argued that he might have been exposed to Agent Orange during his stopover, and it might have caused his diabetes — even though decades of research into the defoliant have failed to find more than a possibility that it causes the disease.
Because of worries about Agent Orange, about 270,000 Vietnam veterans — more than one-quarter of the 1 million receiving disability checks — are getting compensation for diabetes, according to Department of Veterans Affairs records obtained by The Associated Press through the Freedom of Information Act.
More Vietnam veterans are being compensated for diabetes than for any other malady, including post-traumatic stress disorder, hearing loss or general wounds.
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Tens of thousands of other claims for common ailments of age — erectile dysfunction among them — are getting paid as well because of a possible link to Agent Orange.
And the taxpayers might soon be responsible for more: The VA said Monday that it will add heart disease, Parkinson's disease and certain types of leukemia to the list of conditions that might be connected to Agent Orange. The agency estimates that the new rules, which will go into effect in two months unless Congress intervenes, will cost $42 billion over the next 10 years.
Lawmakers and federal officials who have reservations about the spending are loath to criticize a program that helps servicemen. They have largely ignored a 2008 report in which a group of scientists said the decision to grant benefits to so many on such little evidence was "quite extreme."
"There needs to be a discussion about the costs, about how to avoid false positives while also trying to be sure the system bends over backwards to be fair to the veterans," said Jonathan M. Samet, a public health expert who led the 2008 study and now is director of the Institute for Global Health at the University of Southern California.
The VA uses a complex formula when awarding benefits and does not track how much is spent for a specific ailment, but AP calculations based on the records suggest that Vietnam veterans with diabetes should receive at least $850 million each year. That does not include the hefty costs of retroactive payments or additional costs for health care. The agency spends $34 billion a year on disability benefits for all wars.
Dr. Victoria Anne Cassano, director of radiation and physical exposures at the Veterans Health Administration, part of the VA, pointed to the wording of the 1991 federal law on Agent Orange that said officials should find a positive link to diseases "if the credible evidence for the association is equal to or outweighs the credible evidence against the association."
It's a low bar. But Cassano said the law requires the VA to act without consideration of cost. She also said it is the best way to ensure that deserving veterans don't get lost in the shuffle.
"Does it make you take a deep breath? Does it give you pause? Yes," she said. "But you still do what you think is the right thing to do."
Agent Orange was a dioxin-laden defoliant that was sprayed over jungles to strip the Viet Cong of cover. American forces often got a soaking, too, and Agent Orange was later conclusively linked to several horrific health ailments, including cancers. So Congress and the VA set up a system to award benefits automatically to veterans who needed only to prove they were in Vietnam at any time during a 13-year period and later got one of the illnesses connected to Agent Orange.
But over time, the VA, interpreting that 1991 law and studies that indicated potential associations, has added ailments that have no strong scientific link to Agent Orange. The non-profit Institute of Medicine's biennial scientific analysis of available research, to which the VA looks for guidance, has repeatedly found only the possibility of a link between Agent Orange and diabetes, and that even a chance of a correlation is outweighed by factors such as family history, physical inactivity and obesity.
"Whatever the relationship between dioxin or Agent Orange and diabetes, it's a very small piece of the puzzle," said Dr. David Tollerud, an environmental health professor at the University of Louisville. He led an Institute of Medicine committee that first reported in 2000 on a possible link between diabetes and Agent Orange.
Tollerud's committee concluded that evidence was limited and that chance or other factors could not be ruled out. Yet the VA in 2001 put diabetes on the list of ailments that get automatic approval for benefits.