THE WHITE HOUSE
Office of the Press Secretary
PRESS BRIEFING BY SECRETARY OF VETERANS ADMINISTRATION JESSE BROWN, UNDER SECRETARY OF VETERANS ADMINISTRATION KENNETH KIZER
The Briefing Room
1:47 P.M. EDT
MR. MCCURRY: Good afternoon everybody. You have all just heard the President announce the -- make the announcement he just made concerning adding as service-connected diseases two diseases directly related to Agent Orange in Vietnam. I've asked Secretary of Veterans Affairs Jesse Brown to be here to answer any questions you might have.
He's accompanied by the Under Secretary for Health at the Veterans Administration Ken Kizer. We also have available, in case there are any other questions that need to be answered, Ed Scott, who's the Assistant Secretary for Congressional Affairs over at V.A; Dr. Fran Murphy, Director of Environmental Agents Services at the Department; and also Bob Bell, who is our Senior Director for Defense and Arms Control at the NSC who has also worked on the issue.
Q How many additional claims for benefits --
MR. MCCURRY: I'm going to turn it over to them to --
Q -- does the V.A. expect as a result of the President's action today? And do you have any dollar estimates, either annual or over a five- or ten-year period?
MR. MCCURRY: Secretary and Under Secretary, have at it.
SECRETARY BROWN: First of all, I think that it is important for everyone to understand that from our perspective, from a philosophical perspective, we looked at the dollar amount last. We believe very strongly when people are placed at risk as a result of serving in the Armed Forces and something that happens to them that there is an inherent obligation assumed by our society as a whole.
With that in mind, let me just respond to the numbers that we looked at after we had established that we were going to move forward in assuming the responsibility for these three conditions.
With respect to spina bifida and also cancer of the prostate, we looked at the total universe that actually served in Vietnam, and that is around 3 million veterans -- actually more like 2.6 million. And in terms -- so from our -- the way we look at it from a regulatory standpoint, we don't have to prove, or veterans do not have to prove that they were exposed to anything. The mere fact that they were there we assume that they were exposed to Agent Orange and other defoliants and herbicides.
And so as a result, once that is established, we take the position that anyone who subsequently develop, say, prostate cancer, we will grant service connection for that. The first-year cost, we looked at somewhere around $65 million. For the five-year cost, it's somewhere around $350 million.
Now, I must tell you that those numbers have to be looked at with suspect because we built in some assumptions that we have no idea on whether or not they are true. For instance, of the 2.6 million veterans that served in Vietnam, we took the position that if each and every one of them had a child, then there would be X number of -- based on what is known from the general population --X number of that 2.6 million would have children that are suffering from spina bifida. And so we used that as a basic criteria. I'm going to ask Dr. Kizer to give you more information on the formula that we use in constructing that approach.
Q Could you just -- the question really was not so much formulas, but if you just had a number that you could give us of how many individuals you would expect to be covered under this.
SECRETARY BROWN: Okay, fine.
UNDER SECRETARY KIZER: I promise I won't give you a formula. As far as the specific numbers, let me just start in the reverse order of probably the expected frequency.
On peripheral neuropathy, I think it's important to clarify that what we're talking about is what would be considered acute or sub-acute peripheral neuropathy as opposed to chronic peripheral neuropathy -- that the data or the association is for the acute and sub-acute. We have operationally defined that as occurring within a year of exposure.
We expect that there will probably be very few cases in that regard. At this point, it's impossible -- because of the time that that would be expected to occur, it should have manifested itself years ago. Those individuals generally have a good clinical prognosis, so many of them would probably have recovered at this point.
As far as spina bifida, the numbers there are very imprecise at this point. We've tried to get some best estimates that we have in talking with folks from some of these spina bifida-related organizations. They have talked about knowing of cases among Vietnam veterans in the several hundred. Numbers have ranged from 200 to 400 to 600. By some of the projections that we've done, we think that may be as many 3,000. So it's somewhere in that range.
As far as prostate cancer, again, recognizing that the average age of diagnosis of prostate cancer is 72 years, we would expect these to probably not manifest until quite some time in the future. So over the next several years, the impact will be relatively small, perhaps in the range of 1,200 to 1,500 cases. Again, the numbers are somewhat soft.
The dollar figures associated with that, specifically with prostate cancer over the next five years, would probably be assumed somewhere around $3.5 million. The figure that was -- I'm sorry, over the next five years would probably be about $25 million for prostate cancer. The $350 million that the Secretary quoted included both prostate cancer and spina bifida. We are anticipating that the fiscal impact for spina bifida would be considerably more in the short-term than for prostate cancer.
Q You say that the age -- that it usually hits at the age of 72. So do you have any projection as to how many people you would think of the veterans that were exposed to Agent Orange might develop prostate cancer? Do you have any projections of that?
UNDER SECRETARY KIZER: At this time, we don't have a specific projection. About nine to ten percent of men aged 72 or older develop prostate cancer. For the incidents among younger individuals, say, less than 60 years of age, is considerably smaller, seven, eight percent or so. So at that, we are going to have to do a considerable amount of, if you will, actuarial work to get better figures in this regard for, particularly for spina bifida and for prostate cancer.
Q On the eligibility, are you basically -- assuming if you were there you were exposed, or is some greater establishment required of exposure to Agent Orange to be eligible?
SECRETARY BROWN: We assume that if you were there, you were exposed.
SECRETARY BROWN: Yes, in Vietnam where -- that's exactly right. In country.
Q So you might be sitting around some headquarters office in Saigon the whole time and never -- and be counted as exposed just because you were there?
SECRETARY BROWN: That is true.
Q That's going to get very costly, isn't it?
SECRETARY BROWN: Well, we don't think -- first of all, there is no way that we can separate out because we do not have a model that will give us any reliable data on whether or not a person received X amount of exposure or nonexposure. So what we have to do is to kind of take a more global perspective on it. And that's one of the reasons why we take the position that anyone who served in country was actually exposed to Agent Orange.
Q Has that procedure been used, that sort of eligibility procedure been used for other diseases that you can think of?
SECRETARY BROWN: Yes, it has been used for chloracnia, Non-Hodgkin's Lymphoma, soft tissue sarcoma, Hodgkin's Disease, PCT, multiple myeloma and respiratory cancers.
Q All related to Agent Orange, right, or not?
SECRETARY BROWN: Yes, all related to Agent Orange.
Q Has it been used for exposure to other health hazards?
SECRETARY BROWN: Yes, those are the only seven that we recognize.
Q Any non-Agent Orange exposure in any war at any time?
SECRETARY BROWN: No. Absolutely not. This is a kind of a special approach because we are operating from a standpoint that we don't have the necessary science in order to -- for us to be exact in terms of our adjudication of these cases. So what we have to do is to make some conclusions based on what we refer to as the doctrine of reasonable doubt.
Q Mr. Secretary, when you talk about service-connected disabilities, can you just be brief and tell us what that entails? Also, the dollar figures that you have given us, does that include the amount of money you are going to pay for pensions up to a certain percentage, a certain -- for service-connected disability?
SECRETARY BROWN: Well, yes. It includes -- the amount of money that we talked about only includes those with respect to spine bifida, acute and sub-acute peripheral neuropathy, and prostate cancer -- the numbers that we gave you.
Q If they're not drawing benefits now I assume they're going to get benefits. They will get a percentage of their base pay or something?
SECRETARY BROWN: They would get a percentage based on the rating schedule which is designed to measure residual disability. For instance, if a person has lost a leg below the knee, that's 40 percent. So what we will look at, to see exactly what impact did the prostate cancer have. I think, for instance, if we removed the prostate itself, that's only a 30-percent evaluation in and of itself. So that's the kind of approach that we're taking.
Q Mr. Secretary, how much are we now spending for treatment for Agent Orange and related diseases?
SECRETARY BROWN: Dr. Murphy, do you know? All right, we can get that information for you.
Q Can we get a rough approximation?
SECRETARY BROWN: Well, no, I don't. I can tell you we spend about $18 billion a year in health care, but we don't have it broken down to, as far as I know, in terms of how many people -- how much of that money has been set aside just for people who suffer from Agent Orange.
Q Secretary Brown, is this the last of the major decisions to be made on Agent Orange-related ailments? Does this kind of close the book on the Agent Orange --
SECRETARY BROWN: Just about, almost. But what you have to remember what is different from the way we have operated in the past is that for the first time in the history -- in the country's history, we are now talking about providing compensation to the children of veterans that were exposed to something. So with that in mind, we, under Dr. Kizer's direction, we are establishing a commission or a task force or advisory committee to look at environment outcomes of children that were suffering from various types of defects to determine -- and veterans -- to determine if there is any cause and effect relationship to something that happened to the veteran while he or she served in the military.
Q What effects, for example? What kind of effects?
SECRETARY BROWN: Well, for instance, I'm sure you heard that in our Persian Gulf veterans, many of them are now saying that their children are suffering from various types of birth defects. So what we need to do it to be about the business of trying to really understand if there is a scientific basis for that -- I don't want to call it an allegation -- but for that concern.
Q Mr. Secretary, you have said that the evidence pro and con is quite evenly balanced as to whether these diseases were caused by Agent Orange. Was it the same kind of even balance as to evidence for the previous nine diseases that were found --
SECRETARY BROWN: The previous seven -- yes, you're absolutely right. In fact, what I think is important to state here is that we are operating and using a criteria that was established by Congress. And the only point that I wanted to make within my oral statement is that, in some instances, we were very liberal in that interpretation. But it is totally consistent with the criteria and the mandate that we received from our Congress.
Q Secretary Brown --
UNDER SECRETARY KIZER: Let me perhaps respond to that because I think it's an important issue that may warrant a further comment. That none of these conditions is the -- would we consider the scientific evidence such that it establishes a clear cause and effect relationship. Indeed, the law specifically says that that is not required. Under the law that this presumption is made, it says basically that the evidence for an association, a statistical association, needs to be equal to or greater than the evidence against it. And credible evidence is assumed to be studies that have been peer-reviewed, that show some statistical association, and that have a credible methodology.
Q What is the law exactly? That is what year, what --
UNDER SECRETARY KIZER: Public Law 102-4. The Agent Orange Act of 1991.
Q Why exactly are you doing this right now? Why now?
UNDER SECRETARY KIZER: The law specifies that every two years for a 10-year period after the law was enacted, the National Academy of Sciences will review the literature dealing with diseases that might possibly be associated with Agent Orange. They will produce a report every two years. Within 60 days of that report, the Department will review the data and make recommendations to the Secretary. The National Academy of Sciences released their report in mid-March. We have convened the task force and have reviewed it, and that's why the timing is now.
Q You cited nine to ten percent of people age 72 get prostate cancer. And what percentage of Vietnam veterans, if you have estimates, would get it?
UNDER SECRETARY KIZER: What I said is that the average age of diagnosis of prostate cancer is 72. I also said separately that about 9 to 10 percent of cancers in adults is prostate cancer. As far as specifically what is the incidents in Vietnam veterans, again, we're at a point in time where we can't really answer that because they are just approaching the age at which prostate cancer will become manifest.
Q Are you assuming you're going to end up having to pay for a lot of treatment that wasn't related just as a consequence of providing treatment for that which was?
UNDER SECRETARY KIZER: Well, clearly, under this law, the benefit of the doubt is given to the veteran.
Q Do you expect higher incidents, however, in Vietnam vets of prostate cancer?
UNDER SECRETARY KIZER: There's no data at this point to suggest that. And again, given the age of that population, it's too early to know what the ultimate numbers will be.
Q But if you believe that Agent Orange is a likely cause of it, surely -- and you believe that these people would be exposed in high numbers, surely you must believe you're going to see a higher incidence of prostate cancer in this part of the population, don't you think?
UNDER SECRETARY KIZER: Again, you're dealing with the difference between a scientific establishment of cause and effect and the standard that is created by Public Law 102-4, which merely requires that there be a statistical association.
Q That's true, but the question you were asked is what you believe, and I'm just saying you must believe you're going to see a higher percentage, don't you -- or do you?
UNDER SECRETARY KIZER: No, at this point, I don't know and I don't think there is a sufficient evidentiary base to make any sort of firm predictions either way.
Q Secretary Brown --
Q When these diseases were put on the list in the past, was there --
Q Could we get some questions back here, please?
Q When these diseases were put on the list in the past, was there a presidential announcement? I'm sorry, I don't remember.
SECRETARY BROWN: When we did the last two that were done under this administration was multiple myeloma and respiratory cancers in September '93. And there was a presidential announcement. And there was also a presidential announcement when we supported legislation that would grant compensation for undiagnosed illnesses in Persian Gulf veterans.
Q Was that a piece of paper or a personal appearance by the President?
SECRETARY BROWN: I can't -- let us check for you on that.
Q Secretary Brown, forgive a sort of personal question, but do you recall being exposed to it when you were over there?
SECRETARY BROWN: No, I don't recall being exposed to it. All I saw while I was there was just the -- it's kind of hard to understand. If you look at all of the beautiful greenery and the vegetation that we have here, it's like that one day, and then you look back over that same area another day and there's nothing. All you do is just see the trunks and limbs of trees. So it's not something that you would feel or something that you can quantify by saying, yes, I was exposed to it.
And that is one of the reasons why we just accepted the responsibility by saying that anyone who served in Vietnam was exposed because when you put this stuff down it blows with the winds. You can carry it from -- it is contact transferable. It can be transferred from one person to another by their clothes and so forth. So it's these kinds of risk hazards that our people were exposed to over there.
Q What were troops told about it?
SECRETARY BROWN: We didn't know anything about it. That was one of the things -- none of this began to become clear to us until we returned many years after. You've got to remember that war was over in 1975. And I was there for many years earlier than that. And now all of the sudden, the science is telling us about these cause and effect relationships.
And we're seeing a lot of that. You take, for instance, our veterans who were prisoners of war. We just now are beginning to understand that there is a relationship between being incarcerated and having wet beri-beri and ischemic heart disease. That is scientifically a proven situation.
So there are many risks that people are exposed to long after the wars are ended. And I want to say something to you again -- is that this is getting worse in terms of modern warfare. For instance, when in World War II, Korea and in, to some extent, Vietnam, which was the beginning of it, but if you look at what's going on in the Persian Gulf or what has gone on in the Persian Gulf and what our people over there have been exposed to -- let's just look at some of the pathogenic entities.
We're talking about exposed to the hazards of the environment because of the burning of the oil wells and what that does to the respiratory system. We're a looking at carp*, which is a paint that they put on tanks in order to ward off the effects of chemical and biological agents. You're looking at possible exposure to chemical and biological agents themselves. You're looking at depleted uranium. You're looking at the inoculation process they use in order to protect our soldiers against those kinds of things.
So all of these kinds of manmade things that we're learning more and more about have consequences far down the road, and that is why it's so important that we continue our scientific research not only to help those that are sick, but also to not put them back -- our sons and daughters and grandchildren -- to put them back into that kind of situation without having a full understanding on what could happen to them.
Q When was the use of Agent Orange suspended for good?
SECRETARY BROWN: We have to get that information for you; I don't know.
UNDER SECRETARY KIZER: It was either in late '70 or early '71, as I recall.
Q Some veterans have raised some questions about President Clinton's signing of the Soldiers and Sailors Relief Act in his brief, asking for a delay of the sexual harassment case. I wonder what you think of the raising of that issue. Do you think it was appropriate for him, and do you think these attacks on him for using it are fair?
SECRETARY BROWN: I think it was just simply political. The bottom line is, it has nothing whatsoever to do with veterans benefits. This President has been the greatest advocate for veterans since Roosevelt signed the G.I. Bill -- if you just look at all of the issues that he took on.
When he asked me if I wanted this job, one of the reasons -- he didn't know me. He had heard about my work, and this is the first time they have ever had an advocate for veterans in the Cabinet. But he said to me very clearly in Little Rock, Arkansas, I want someone in there that's going to fight for veterans, because it's going to be tough times, and I want someone in there to fight for them, to take on the tough issues, to make sure that the nation can live up to its obligation of responding to the needs after they have served honorably.
So this issue about this lawsuit I think is just a political attack that's designed to embarrass the President. And I think we should separate that and leave that in the legal arena, and we go on with the business of responding to the needs of our veterans and their families.
THE PRESS: Thank you.
END 2:10 P.M. EDT