A story incorrectly reported that hypertension is one of the maladies that the Department of Veterans Affairs considers to be caused by exposure to the herbicide Agent Orange in Vietnam. Some experts are urging the VA to add hypertension to list of Agent Orange-caused illnesses, but the agency has not done so.
SAN JOSE -- After his eighth round of chemo, Trai Nguyen was exhausted, his body ravaged. The 60-year-old has a rare and aggressive form of cancer that he believes resulted from his contact with the defoliant Agent Orange during the Vietnam War.
His doctors say his cancer may now be in remission, but that is little comfort. "My hands shake violently. I can't do anything," he said, sitting on a mattress in the two-bedroom apartment he shares with relatives.
The aftermath of war brought Trai to the United States, where he rebuilt his life, but now he's destitute. His fortunes could have taken a better turn had one thing been different in his past: the uniform he wore during the conflict.
As a soldier in the South Vietnamese army, Trai gathered intelligence that helped American soldiers. He fought alongside the Americans and was exposed to the defoliants that are known to have injured them. But he's excluded from the compensation and health care afforded to U.S. veterans for the same service-connected disabilities.
Vietnam War veterans in the United States, Australia, New Zealand and South Korea receive Agent Orange disability benefits through their governments. Canada has compensated citizens who were exposed to herbicides during prewar testing of the chemicals. The U.S. Department of Veterans Affairs has paid billions in disability benefits related to herbicide exposure to eligible American veterans.
In contrast, Vietnamese Americans who were exposed and are now sick -- a group that includes both veterans and civilians -- haven't received a dime.
For the most part, Vietnamese Americans, especially former South Vietnamese veterans, have not demanded redress for harm caused by herbicides, even though there's evidence they are suffering from higher rates of some cancers tied to Agent Orange exposure. By blaming American military action for their community's illnesses, many feel, they would be siding with a Vietnamese Communist government they disdain against their new country, the United States, to which they are fervently devoted.
In the last two years, members of the U.S. Congress have proposed legislation that could help Vietnamese Americans and other victims of wartime defoliants. But the chances of passage are slim, advocates say, especially without support from Vietnamese Americans and mainstream U.S. veterans groups.
Bernard Edelman, deputy director for policy and government affairs for Vietnam Veterans of America, says he believes Vietnamese veterans are suffering from exposure to Agent Orange, but his group fears that advocating for them would undermine its efforts for American veterans.
"We do not begrudge our Vietnamese brothers and sisters," he said. "We don't want to see American veterans and (their) children and children's children getting lost in the shuffle."
As a 19-year-old army private in the South Vietnamese Army, Trai says he spent days and nights in the jungle as a "spy," gathering intelligence on enemy forces along the Ho Chi Minh Trail, a collection of footpaths and roads used by North Vietnamese soldiers to carry supplies to the South.
U.S. forces doused the area with defoliants to destroy forests that gave enemy troops cover and to destroy crops. From 1962 to 1971, U.S. forces dumped more than 19 million gallons of herbicides on South Vietnam and border areas between Laos and Cambodia, according to the VA.
While Trai's work in the jungle began the year after the spraying stopped, he noticed the herbicide's impact on the countryside. But no one understood at the time that Agent Orange contained the carcinogen dioxin, and Trai never gave a thought to risks to his health.
Now, nearly four decades after the end of the war, the past may have finally caught up with Trai.
He has been diagnosed with an aggressive form of non-Hodgkin's lymphoma, a cancer of a part of the immune system. It is one of more than a dozen illnesses for which U.S. veterans have been able to get compensation.
Gordon Smith, a sergeant in the U.S. Air Force in Vietnam in 1970, is one who benefited.
Smith, who lives in Monterey, worked during the war at a former U.S. military air base in Bien Hoa, now considered a "hot spot" for dioxin contamination.
In 2002 at age 52, he was diagnosed with prostate cancer. The VA granted him a 100 percent disabled status, entitling him to about $2,800 a month in compensation. He also receives free doctor's visits and prescription drugs.
"My Vietnamese comrade in arms should be treated just as I was," said Smith, who is active in the local chapter of Veterans for Peace, a national progressive veterans group.
For Trai, who is struggling to cover his expenses, the additional benefits could provide him with resources that he desperately needs.
Too weak to work as a landscaper -- laying cement and building decks -- Trai says, "Life is very hard for me right now."
Most of Trai's medical expenses are covered by the state's Medi-Cal program. He's currently not paying rent or other household expenses. Trai says he applied for SSI, a special Social Security program that pays benefits to very poor disabled adults. He was told his illness wasn't a long-term disability.
The disability benefits that veterans like Gordon Smith now receive resulted from a long and hard fight by U.S. veterans to get Washington to recognize the harm of Agent Orange.
After the war, the VA initially denied that herbicides were linked to cancers, birth defects in veterans' children, and other illnesses, despite mounting evidence of the deadly effects of dioxin. Attorneys with the National Veterans Legal Services Program sued the VA in 1986 and negotiated a consent decree that requires the VA -- when it identifies that a disease is scientifically associated with herbicide exposure -- to compensate veterans who had previously been denied benefits for those diseases.
In 1991, President George H.W. Bush signed legislation that created a new system for determining when a disease is scientifically associated with herbicide exposure.
Today, the VA recognizes more than a dozen cancers and other illnesses as being caused by wartime herbicides, including soft tissue sarcoma, non-Hodgkin's lymphoma, chronic lymphocytic leukemia, Hodgkin's lymphoma, chloracne, cancers of the respiratory system, prostate cancer, AL amyloidosis, Parkinson's disease, ischemic heart disease, Type 2 diabetes and spina bifida in the children of exposed individuals.
"All a Vietnam veteran needs to prove to be entitled to the presumption that he was exposed to Agent Orange was that he set foot on the land mass of Vietnam, for even a moment, or he served on the inland waterways of Vietnam," NVLSP Joint Executive Director Bart Stichman said in an email.
There is no debate that Agent Orange and other such chemicals were widely used in Vietnam during the war years.
A 2003 study published in the journal Nature, by Columbia University professors Jeanne and Steven Stellman, estimated that as many as 4.8 million Vietnamese civilians were exposed to herbicides.
More than 739,000 Vietnamese entered the U.S. from 1971 to 2000, according to federal immigration data. Although it is hard to pinpoint, tens of thousands to hundreds of thousands of Vietnamese immigrants in the United States could have been exposed to herbicides.
For U.S. veterans, there are extensive studies that tie herbicide exposure to higher rates of specific cancers. No such studies have been conducted for Vietnamese Americans, but an analysis of cancer statistics for Vietnamese immigrants show alarming trends.
Cancer epidemiologist Scarlett Lin Gomez with the Cancer Prevention Institute of California used statewide California Cancer Registry data to compare incidence rates for 14 of the most common cancers among six Asian subgroups and whites.
While whites tend to show the highest incidence, an analysis of the study data by New America Media found Vietnamese Americans in California, compared with other Asians, suffer from greater rates of the following conditions that have been previously linked to Agent Orange exposure:
The finding that Vietnamese men in the state suffer from higher rates of cancer, in general, compared with other Asians, aligns with studies that have found dioxin exposure increases risk for all cancers, not just one type in particular.
We found an "elevated risk of cancer, period," said Dr. Brenda Eskenazi, a professor in the School of Public Health at UC Berkeley, referring to her research on dioxin exposure during a large industrial accident in 1976 in Seveso, Italy.
High lung cancer rates among Vietnamese Americans may also be explained by high rates of smoking and exposure to secondhand smoke, but that does not discount the impact of Agent Orange, researchers say.
In 2011, then-Rep. Bob Filner introduced a bill in Congress that would have provided assistance to Vietnamese veterans and civilians affected by Agent Orange. The bill failed, but Rep. Barbara Lee, D-Oakland, reintroduced it in June, with strong advocacy from Veterans for Peace.
Among its provisions, HR 2519 directs the Secretary of Health and Human Services to provide funds to conduct health assessments of Vietnamese Americans, and calls for the department to open treatment centers in areas with large Vietnamese populations to address Agent Orange exposure.
Lee concedes the bill again faces an uphill battle in Congress, but said, "It's the right thing to do from a moral perspective, from a public health perspective."
San Jose resident Vicky Nguyen, 82, lived in Da Nang, near the former U.S. air base, which is now considered a dioxin "hot spot." She believes exposure to chemicals during the war killed her husband, a policeman, and eldest daughter, who both had rare cancers.
"If it happened to one person in the family then it might be an isolated incident, but ... there were two people in my family (who) had the same illness," said Vicky, sitting in her living room near a traditional ancestral altar with their portraits.
Vicky's daughter, Ngoc, was diagnosed with non-Hodgkin's lymphoma in 1998. She died six months later at 45 from complications from the cancer and other illnesses. In 2004, Vicky's husband passed away from non-Hodgkin's lymphoma at 80.
Vicky says she wants the U.S. government to compensate her for her losses.
"After you lose your loved ones, what is left but money?" she said.
But many of those affected do not share Vicky's view. For the most part, Vietnamese Americans, especially former South Vietnamese veterans, have not demanded redress for harm caused by herbicides. A strong anti-Communist streak in the community causes some of its most outspoken members to view the dangers of Agent Orange as a Communist hoax.
"There is only one group (that has) not admitted to have an Agent Orange problem -- Vietnamese Americans," said Nhan Ngo, a researcher at New York University who tried unsuccessfully to mobilize Vietnamese American support for a lawsuit against herbicide manufacturers in 2004.
Phu Nguyen makes no such admission. An infantry captain stationed near a former U.S. air base in Pleiku, he recalled having herbicides "rain down" over his head.
"I'm one of the people in the South exposed to Agent Orange, and I'm not sick," said Phu, who now lives in San Francisco. "My children are not sick. They don't have birth defects or mental deficiencies. My daughter has a Ph.D."
He said the community believes the reason Hanoi claims there are many victims of Agent Orange spraying is because "they want to make money from U.S."
At the height of the war in 1968, Nhan Ngo came to the United States as a student. During that time, Ngo says, he became critical of the war and Washington's use of herbicides and napalm.
Decades later, he took up the cause to help Vietnamese victims win redress for harm caused by Agent Orange. In 2000, Ngo tried to mobilize the largest coalition of Vietnamese American social service organizations -- the National Alliance of Vietnamese American Service Agencies -- to draft a letter calling on President Bill Clinton to fund a health assessment of Vietnamese Americans.
The effort, he said, was "shot down by leaders of the Vietnamese American community."
Thang Nguyen, president of Boat People SOS, a national Vietnamese American social services organization, says the community wants to ignore the issue, "because they view it as a ploy used by the Communist government (of Vietnam) to attack the U.S."
Nguyen says the issue is highly politicized, with Hanoi now calling Agent Orange a human rights violation to deflect criticism of its detention of political dissidents.
Before looking at health impacts of herbicides on Vietnamese Americans, researchers say, the first step is to ask -- were they exposed? Research on this front also has faced obstacles.
Dr. Arnold Schecter, a professor of environmental sciences at the University of Texas School of Public Health in Dallas, says he's tried to study dioxin levels in Vietnamese Americans, but his informal outreach to the community was unsuccessful. The biggest barrier to the research is the politically sensitive nature of Agent Orange in the community, he said.
"Certainly a survey should be done of those Vietnamese Americans old enough to have been exposed to Agent Orange, because they were in a heavily sprayed area or ate food contaminated with Agent Orange," he said.
When it comes to Agent Orange's lasting legacy, many Vietnamese Americans believe it is an issue that only affects people living in Vietnam. Nhan Ngo says Vietnamese Americans must come to realize there is no shame in acknowledging their own suffering.
"I wanted to make sure we could push the U.S. government to recognize Vietnamese who fought alongside the U.S. in Vietnam," he said. "They (South Vietnamese veterans) lost the most, more than anybody, and they are still faithful."
Ngoc Nguyen is a reporter for New America Media, a nonprofit news service. The research for this story was paid for by a grant from the Fund for Investigative Journalism.
Sources: U.S Department of Veterans Affairs, reporting by New America Media