allan

RSG, these confirm dioxins on Treasure Island. http://www.sfgov.org/site/uploadedfiles/tr...ting2.15.05.pdf NAVAL STATION TREASURE ISLAND - (MAP) LINK TO ASSOCIATED GEOTRACKER CASES 529 ACRES; BETWN SAN FRANCISCO & OAKLAND SAN FRANCISCO, CA 94130 SAN FRANCISCO COUNTY SITE TYPE: CLOSED BASE ACRES: 550 ACRES APN: NONE SPECIFIED NATIONAL PRIORITIES LIST: NO CLEANUP OVERSIGHT AGENCIES: DTSC - SITE MITIGATION AND BROWNFIELD REUSE PROGRAM - LEAD<B&NBSP;< FONT> PROJECT MANAGER: RYAN MIYA SUPERVISOR: DANIEL MURPHY DIVISION / BRANCH: OMF - NO (BERKELEY) ENVIROSTOR ID: 38370044 SITE CODE: 201210 ASSEMBLY DISTRICT: 13 SENATE DISTRICT: 03 SPECIAL PROGRAM: FUNDING: BRAC 93 PUBLIC PARTICIPATION SPECIALIST: RICHARD PERRY PRESS CONTACT: ANGELA BLANCHETTE COMMUNITY INVOLVEMENT Cleanup Status ACTIVE AS OF 1/1/1991 Regulatory Profile VIEW DETAILED AREA / SUB-AREA REPORT PAST USE(S) THAT CAUSED CONTAMINATION DRY CLEANING, FIRE TRAINING AREAS, FUEL - AIRCRAFT STORAGE/ REFUELING, FUEL - VEHICLE STORAGE/ REFUELING, FUEL TERMINALS, ILLEGAL DUMPING, LAUNDRY SERVICES, OIL/WATER SEPARATORS, PAINT/DEPAINT FACILITY, SCHOOL - OTHER, WASTE - SEWAGE TREATMENT PLANT POTENTIAL CONTAMINANTS OF CONCERN SLUDGE - PAINT - CONFIRMED UNSPECIFIED OIL CONTAINING WASTE - CONFIRMED BENZENE - CONFIRMED DIOXIN (AS 2,3,7,8-TCDD TEQ) - CONFIRMED LEAD - CONFIRMED METHANE - CONFIRMED POLYCHLORINATED BIPHENYLS (PCBS) - CONFIRMED POLYNUCLEAR AROMATIC HYDROCARBONS (PAHS) - CONFIRMED RADIOACTIVE ISOTOPES - CONFIRMED TETRACHLOROETHYLENE (PCE) - CONFIRMED TPH-DIESEL - CONFIRMED TPH-GAS - CONFIRMED TPH-MOTOR OIL - CONFIRMED TRICHLOROETHYLENE (TCE) - CONFIRMED VINYL CHLORIDE - CONFIRMED CUMENE (ISOPROPYLBENZENE) - CONFIRMED<B&NBSP;< FONT> POTENTIAL MEDIA AFFECTED INDOOR AIR, OTHER GROUNDWATER AFFECTED (USES OTHER THAN DRINKING WATER), SEDIMENTS, SOIL, SOIL VAPOR Source: http://www.envirostor.dtsc.ca.gov/public/p...bal_id=38370044

Texas Tech University Vietnam Symposium I have posted Kurt Priessman’s presentation that he will deliver in person at Texas Tech at: http://www.2ndbattalion94thartillery.com/C...rtTexastech.htm I have also posted my presentation which I will have Kurt hand deliver CD’s of my formal submittal presentation along with the .pdf files of evidence and studies to be placed in archives at: http://www.2ndbattalion94thartillery.com/Chas/TT.htm It is a shame I cannot go, as I understand Dr. David Butler of the IOM is going to be there and I would certainly enjoy the chance to challenge him on his bullshit testimony to the congress in 2000. Of how he, as the AO committee leader and those within the IOM that were to determine our legal fate in death and disability in service connection, had no damn idea of what level they were conducting their so called science to even recommend an association. In fact, he refused to even proffer an example of a typical level of association under oath. I understand he will be addressing future grants for the IOM to piss away on studies that by their own admissions have no earthly idea as to what level of association they are trying to find. Certainly it is not documented anywhere that the stakeholders; dead, dying, and disabled Veterans and their widows can see and address as to the legality of such assumptions or direction by VA and the Executive Branch who wanted and so stated such facts no (zero) associations found. Only that VA tells them apparently to study to the death of all affected Veterans. Certainly, this scenario of Dr. Butler reminds me of what I found in the Ranch Hand transcripts (not the government redacted published lies) when some scientists within the study were protesting the protocol changes to a very narrow research of the dioxin, TCDD only and only for skin contact. One scientist said: “Christ, we had people walking and swimming in the stuff on the DMZ.†Including Agent White with picloram, nitrosamines, hexachlorobenzene, and Agent Blue (arsenic acid)…. I would add cooking in it, drinking it, storing food in the drums to keep out the rats, and boiling water in the non-decontaminated drums themselves for drinking and other such issues. The answer by the new leader of this committee when this was brought up was: “Let me just say one thing. I mean, I think that last point you made is important; that this is not so much a comment on the report, but an opportunity for other research --- potential opportunity.†Veterans are dying and becoming disabled with no warning and with no compensation from toxic chemical damages by our government and we now have this lead Ranch Hand scientist discussing “future employment opportunities†by not telling the whole story of our toxic chemical herbicides (plural) legacy. This is not what I would conclude as a recruitment tool but certainly a reason for anyone entering the military a reason to pause as to whether they want to be treated this way by our government. And yes the government/DoD/VA/IOM has done the same thing with the Gulf War boys and girls finding stress in a 90 hour war caused all the autoimmune disabling diseases, cancers, deaths, birth defects, disabilities, etc. A 90-hour war that for most of that military was nothing but a desert training exercise. Both era Veterans, disabled children whose children might also feel the sting of government cover-ups for at least three generations, and widows written off by our government/DoD/VA/IOM not because of the Nation’s enemy but the Veterans enemy – The United States Government. And yes the nation can afford it – if we can spend 3.5 billion every 90 hours in Iraq and spend over four years training and retraining and retraining their folks to do their own battles then we can afford to take care of our own. Christ during Vietnam the American soldier was given 12 weeks training and sent to war to do battle. The Marines lost so many during one time frame they even went to the draft and cut down their training from 12 weeks to 8 weeks to get them into the fight and their OJT for the rest of it was in actual battle under fire. Learn or die! Therefore, this has not been about money but nothing but government collusion, collaboration, deceit, and Executive Branch tyranny against the Veteran segment of society allowed and condoned by our elected congress. Kelley

AO in Tennessee and a posting by Kurt Priessman As the Executive Branch government/DoD/VA lies are slowly proven, just that nothing but LIES. More and more data is coming out of the actual usage of these herbicides not only in the overseas environments but also stateside. Tonight on: http://www.newschannel5.com/Global/story.asp?S=7912948 One Veteran indicates he was ordered to spray the herbicides in Tennessee. TV instigative reporters from Channel 5 in Nashville. Aired tonight!!!! It is a shame our national media, print and broadcast will not expose these Executive Branch cover-ups, controlled and manipulated nonscientific studies, purely subjective pronouncements by the once prestigious Institute of Medicine and a VA legal system run and operated by the Executive Branch that is only interested in budget control; not Veterans justice. -------------------------------------------------------------------------------- Kurt Priessman The events of the last several weeks give one pause to wonder about some very wonderful and disturbing things. The 9th Circuit’s decided to allow Iraq and Afghanistan Veterans to sue the Department of Veterans Affairs only to be told by the government’s lawyers that Veterans have no right to specific kinds of health care. The 2nd Circuit Court of Appeals decided again to deny Vietnam Veterans and Vietnamese claimants the right to sue Dow Chemical and Monsanto for Agent Orange damages. I applaud the plaintiff’s plans to appeal the decision to the Supreme Court, especially since the primary reasons the Nixon Administration ended it’s use of herbicides was the United Nations adoption of the 1925 Geneva Convention protocols with inclusion of herbicides and the joint acknowledgement by the Secretaries of Health, Education and Welfare, the Interior, and the Agriculture which announced the immediate suspension of all use of 2, 4, 5-T. Crop destruction is not something used to preclude ambush; it is the use of herbicides for attacking the food supply of the enemy. It appears to us that the role of the government is to deny Veterans fundamental rights of due process and redress, particularly when and if it doesn’t permit the government the right to send us to our deaths, in combat or from lack of medical care due to the effects of combat. The Department of Veterans Affairs submitted a woefully inadequate FY 2009 Budget Request. It testified before the House Subcommittee on Disability Assistance and Memorial Affairs concerning their continued mismanagement of the claims process’s which began by waffling about just how many hundreds of thousands of claims they are really backlogged. Thousands of canisters of cremated Veterans were found stored in mortuary basements across this country and are there because the Department of Veterans Affairs denied them burial in national cemeteries. It appears to us that the role of the government is to deny Veterans the fundamental rights to dignity, justice, fair compensation, and to renege on promises written in the laws of this great land. Despite being embroiled in one case after another from every possible constituency imaginable, the Department of Veterans Affairs continued to marginalize widows and deny them basic rights of dependency and survivorship. Therefore, widows sued. I would add here that many of these cases are the exact same case with only the claim number different and the outcomes seemed to be based on yearly budget control; not factual rulings. Some being approved after 10 to 20 years, some being denied and some being remanded right back into the VA hamster wheel for more stalling until their name comes up in the Veterans or widows lottery. Their lack of congressional action just in this one issue makes no sense what so ever in the interest of reducing the backlog of claims and the widows that have been fighting since the 1990’s. (Kelley) Did the Congress of the United States, in developing laws concerning an insurance program like the Survivor’s Benefit Plan, which requires payment of premiums, intend for the Department of Veterans Affairs to adopt rules concerning offset of Section 644 Dependency and Indemnity Compensation which give widows next to nothing? The Department ruled that Veterans diagnosed with PTSD are no longer required to submit a statement of stressor. Why you may ask? Could it be the Department of Veterans Affairs knew that the Department of the Army will not diagnose PTSD for in-service military, and that the DOA will claim they do not have sufficient qualified staff to make that diagnosis? So what changed? Are we to suppose that the Department of Veterans Affairs acted with their usual beneficence? Despite awaiting a decision by the Federal Circuit Court of Appeals, the Department of Veterans Affairs has the audacity to rule that seaman of the USS Ingersoll were exposed for two days of presumption for Agent Orange. Now should anyone consider that not only does this fly in the face of the law, but also that it flies in the face of scientific evidence concerning dioxin, and logic concerning ship operations? The US Navy, believing that there was no harm possible from dioxin, washed the ship down, cleansed every piece of equipment including desalination equipment, and what? What scientific study does the Department reference in deciding that dioxin dissipates in two days when it is in the ship's food and water? Is there anyone with any common sense still out there? Is there anyone in the stratosphere of Veterans Administration elite, administrative, medical, or scientific that believes they have earned their salaries for a decision that is unbelievable at best? Every Senior Executive Schedule administrator, physician scientist, and lawyer involved in this decision should resign immediately. But the most pertinent thing to wonder is when shall the Congress of the United States stand up for Veterans and provide to us those rights we defended in countless actions of heroism and sacrifice? When will they see that by the actions in the Courts of this great country it means there is something terribly wrong and that immediate action to correct the problems caused by the Department of Veterans Affairs and the Department of Defense must be taken? My comment would be never - since Roger Clements and Teri Schivio are much more important work for our elected congress. And after all if a bridge to no where has to be built on the backs of our dead, dying, and disabled Veterans and suffering spouses then that is exactly what congress will do. (Kelley) Posted: February 24, 2008. Kurt Priessman, MSgt, USAF (Ret) BA, MBA, CPM Vet Advocate/Researcher - http://tmai18.spaces.live.com -------------------------------------------------------------------------------- I would also add here that Kurt has uncovered MACV directing spraying of the southern part of the DMZ but also the northern part of the DMZ starting in the spring of 67. Those of us that were there saw this but it was never recorded on the Ranch Hand missions. This area parallel to QL9 certainly was in range of Carroll, Rockpile, Cam Lo, Dong Ha, Ca Lu, and Khe Sanh. All of those listed were found to be target areas of Ranch Hand missions of AO, AW, and AB with 10's of thousands of gallons used. It will be interesting to see on the 10th of March if IOM even addresses this issue or will they once again just take the DoD lies and create more lies that supposedly then have some sort of independent integrity, which is false. Thanks heavens for the gals and guys we have in the professional military now but I would not give any recommendation to anyone’s child they serve this nation – not any longer and until congress takes action. Apple pie and all that crap no longer exist in this nation with the treatment of Veterans and their families. The history lessons you had in high school about this government and justice for all are false! However, lets not forget that many that want to get out at this time cannot due to stop orders. Recently I had one 4th ID combat officer tell me it looks like not only the Vietnam Veterans are being swept under the carpet and left to die or become disabled with no help from government created issues but also the Gulf War Veterans. I agreed and said that is about it in 40 words or less. Also Kurt has found this Alvin Young collection of AO issues. When I read the part where this so called contracted scientists stated that AO would have dissipated before it hit the ground I thought to myself. This moron has never stood under a plane dispensing herbicides and then told the residue was bug spray and to rub it all over you. Or when a retired Colonel on the Disability Commission talked of his men getting out their ponchos to keep the wet spray from getting on them. Nothing was dissipated from these aerial spraying operations except this guys brain seems to be greatly dissipated. Kelley http://www.2ndbattalion94thartillery.com:8...as/kurtpost.htm

8.02. PROGRAM DESCRIPTION a. The Achievement of a Vocational Goal Is Not Currently Reasonably Feasible. To establish that it is not currently reasonably feasible for a veteran to achieve a vocational goal, a CP (counseling psychologist) must find that the veteran's disabilities currently affect his or her employability to either of the following extents: (1) The veteran cannot participate in a program of vocationally oriented training and services; or (2) The veteran is able to successfully pursue vocational training, but it would be highly improbable for the veteran to obtain and retain employment consistent with his or her abilities, aptitudes, and interests. b. Reasons for Authorizing a Program of IL Services. The VR&C (Vocational Rehabilitation and Counseling) Division may authorize a program of IL services for eligible veterans for whom achievement of a vocational goal is not currently reasonably feasible. This program of rehabilitation services may be furnished to help the veteran to (1) Function more independently in his or her family and community without the assistance of others or with a reduced level of assistance from others; (2) Become reasonably feasible for an extended evaluation; or (3) Become reasonably feasible for a vocational rehabilitation program. c. Independent Living and Independence in Daily Living. Independence in daily living means the ability of a veteran, either without the services of others or with a reduced level of those services, to live and function within the veteran's family and community. Operationally, independent living is synonymous with independence in daily living. 8-1 M28-1, Part II July 22, 1992 Change 5 d. Program of IL Services and Assistance. A program of IL services and assistance may include the following benefits: (1) The services provided in 38 CFR 21.35(d), including the counseling, diagnostic, medical, social, psychological, and educational services which the CP determines the veteran needs to achieve maximum independence in daily living; (2) The subsistence allowance and other monetary assistance authorized by 38 CFR 21.260, 21.262, 21.266, and 21.270; and (3) The special rehabilitation services under 38 CFR 21.150, 21.152, 21.154, 21.155, and 21.156. e. Barriers to Independent Living. The goal of an IL program is to increase the veteran's options, resulting in an improved quality of life. options may be limited by skill deficits or by physical, environmental, or psychological factors. For example, some veterans may be able to overcome certain cognitive limitations through training intended to improve problem-solving. Some independent living program participants may need to learn how to manage personal care attendants, use adaptive equipment, and shop for necessities. For others, technological devices such as motorized wheelchairs or vehicle modifications may facilitate independent living. Supportive services, e.g., attendant care and health maintenance programs, may ameliorate the physical factors which increase the veteran's dependence on others. Architectural modifications and advocacy to promote disabled persons, rights to barrier-free access may reduce environmental problems. Peer and professional counseling may decrease psychological hindrances to independence. A disabled veteran's anxiety about discharge from an institution may diminish through interaction with other disabled persons who are successfully adjusting to community living. f. Independent Living Services and the Rehabilitation Process. The goal of the IL program is not necessarily that the disabled veteran be able to live alone in the community with no supportive services. Rather, the goal is for that individual to have the skills necessary to choose an acceptable life-style and then be able to manage it with as little reliance on others as possible. in some instances, however, the veteran may require continuing services beyond completion of the IL program to maintain the level of independence achieved during the program. (See par. 8.05b below for limitations on these long-term services.) 8.03. ELIGIBILITY FOR PARTICIPATION To be eligible for a program of IL services, VA must determine that a. The veteran meets the basic eligibility and entitlement criteria for participation in a rehabilitation program; 8-2 July 22, 1992 M28-1, Part II Change 5 b. Achievement of a vocational goal is not currently reasonably feasible; c. The veteran has IL needs; and d. The achievement of an IL goal is currently feasible; that is, VR&C staff members expect the IL services proposed will enable the veteran to live independently in his or her family and community or with reduced dependence upon the services of others. 8.04 SCOPE OF SERVICES VA may provide a discrete service or a comprehensive program of services necessary to achieve maximum independence in daily living. As part of an IL program, the only vocational courses which VA may provide are those incidental to achieving intermediate IL objectives. Some of the IL services which VA may authorize are listed below: a. Training in activities of daily living; b. Training in IL skills; c. Attendant care during a period of transition (see par. 8.05b below); d. Transportation when special arrangements are required due to the disabling condition; e. Peer counseling; f. Evaluation or training in an IL program; g. Housing (group, transitional, or housing specifically designed to meet the needs of disabled persons); h. Advocacy; and i. other services which 38 CFR 21.160 authorizes. 8.05 DURATION AND LIMITATION OF SERVICES A program of IL services will not exceed the period necessary to restore independence in daily living. The duration of a program will not exceed 24 calendar months except as indicated in subparagraphs a and b below. a. Extension for 6 Months. The CP may approve an extension of a program of IL services for up to 6 months if the additional period is necessary and should result in an increase in independence. The CP must carefully document in the veteran's CER (Counseling/Evaluation/Rehabilitation) folder specifically how the additional services should lead to the desired results. No program may exceed 30 months. 8-3 M28-1, Part II July 22, 1992 Change 5 b. Limitation of Selected Services. Some IL needs identified during the initial phase of program planning for a veteran may require services following completion of the program and, in some cases, for the rest of the veteran's life. For example, the veteran might have a life-long need for a personal care attendant and for transportation assistance. Since the time a veteran can participate in the program is limited, program planning must focus on ways to meet these continuous needs following IL program participation. Vocational rehabilitation program funding for long-term needs is limited to the IL program period. During IL program participation the case manager will attempt to secure sources which will continue the assistance beyond the completion of the program. In no instance, however, may the VR&C Division provide these services beyond the maximum 30 months for an IL program. 8.06 MONETARY ASSISTANCE VA will pay subsistence allowance to a veteran in the IL program under 38 CFR 21.260. a. Basis for Subsistence. Measure participation on a clock-hour basis. Pay subsistence allowance based on the number of clock hours spent in training directly related to the acquisition of IL skills-such as money management, personal care attendant management, and household maintenance. To measure the rate of pursuit, follow the instructions in 38 CFR 21.310(d). (1) Reduced Work Tolerance. In view of the severity of the conditions of IL program participants, the CP must determine whether the veteran is entitled under reduced work tolerance (38 CFR 21.312) to a higher rate of subsistence allowance than VA would otherwise pay for a given level of participation. (2) Limitations on Traditional Medical Therapies. Participation in traditional medical therapies (e.g., occupational therapy, psychotherapy, and physical therapy) will not typically be counted as training time although the case manager will document participation on the veteran's VA Form 28-8872, Rehabilitation Plan. 8.08. PROCUREMENT OF SERVICES a. Authorization of Services and Supplies. The case manager will authorize the services, incidental goods, and supplies necessary for the veteran to accomplish the goals of an IL program. For these authorizations, the case manager will follow the policies and procedures in part III, chapters 2 and 6. If the case manager anticipates that program charges will require the approval of the Director, Vocational Rehabilitation Service, the regional office should follow the procedures in part II, chapter 3 to make a specific request to obtain approval of costs. b. Approved Service Providers. Normally VR&C Divisions will use VA facilities to provide IL services to veterans participating in the program. If the VR&C Division cannot make timely, effective, and cost-efficient arrangements for VA facilities to provide these services, then the VR&C Division may follow the procedures described below and use other public, private nonprofit, and for-profit facilities. (1) Use of VA Facilities. VA medical facilities are likely to be the best resources for VR&C Divisions to obtain authorized services as either part or all of an IILP. If these services are not available through VA medical facilities or the VR&C Division cannot make appropriate arrangements to timely use these facilities, the CP will document this in the veteran's record: 8.10 ROLE OF THE COUNSELING PSYCHOLOGIST a. Identification of Veterans. The CP must review each case in which a vocational goal is not currently reasonably feasible to determine if a program of IL services may be furnished for one of the reasons in subparagraph 8.02b above. if an IL program is feasible, the CP and the veteran must then develop a program of IL services that addresses the veteran's needs. If a VRS will act as case manager, the VRS will also take part in the plan development (see subpar. 8.12b(1) for detailed instructions on who will act as case manager for IL programs). b. Provision of IL Services When a Vocational Goal Is Feasible. When establishing a veteran's entitlement to services under chapter 31, the CP must document in the CER folder why the achievement of a vocational goal is not currently reasonably feasible. If vocational rehabilitation is currently reasonably feasible, but the veteran is prevented from participating in a traditional vocational rehabilitation program due to deficient IL skills, the CP should integrate the needed IL services into an IWRP (individualized written rehabilitation plan). The case manager will arrange for these services as a preliminary part of the plan or concurrently with educational or vocational services. c. Determination of Feasibility for Program of IL Services. In evaluating clients for inclusion in the program of IL services, the CP must determine that it is reasonable to expect an increase in the veteran's level of independent functioning if the veteran receives these services. (1) Documentation of the IL feasibility determination must be clearly evident in the record of each veteran for whom an IL program is provided. (2) Outside consultants and the VRP (Vocational Rehabilitation Panel) are recommended for use as the providers of data to support the IL feasibility determination (see subpar. 8.08c above for details concerning the use of an outside consultant, and par. 8.11 below for use of VRP). (3) When using an outside consultant or the VRP, the CP must assure that either resource has the expertise to address the needs of the veteran under consideration. d. Denial of IL Services. If the CP determines that the achievement of a vocational goal is not currently reasonably feasible and the CP does not approve a program of IL services, the CP must obtain the VR&C Officer's concurrence in the decision (21 CFR 21.53(f)). If the VR&C Officer does not concur, the CP must work with the VRS case manager and the veteran to develop a plan of IL services. Change 7 c. Veteran's Involvement (1) IILP Development. The CP will solicit the veteran's cooperation in negotiating and agreeing to the terms of the IILP. When the CP and the veteran have developed, agreed to, and documented the plan's substantive terms, the CP and the veteran will sign the plan to indicate mutual understanding and acceptance of the terms. Unless a VRS will assume case management responsibilities, there will be only two signatures on the IILP. The veteran will receive a copy of the signed plan. (2) Disagreement About Terms of IILP. If the CP and veteran cannot agree on the terms of the plan, the CP will request that the VR&C Officer review the proposed plan. The VR&C Officer will resolve the disagreement and ensure that plan development continues. (3) Rights of Review and Appeal. The veteran or his or her representative may request administrative review of a proposed original or amended rehabilitation plan (see pt. I, par. 3.05). Within 1 year of written notification of the CP's decision regarding the veteran's plan, the veteran or his or her representative may appeal the terms of the proposed plan to BVA (Board of Veterans Appeals) by filing a notice of disagreement (see pt. I, ch. 10). VR&C staff members will inform the veteran that any administrative review must take place prior to appealing the decision to BVA. Once the veteran files a notice of disagreement, the VR&C Officer must immediately stop any administrative review in progress and begin appellate processing. 8-12 March 24, 1993 M28-1, Part II Change 7 b. Medical and Physical Therapy Assessment. Standard medical history and physical examination by appropriate medical or physical restoration specialists should include complete assessments of: (1) Overall physical health; (2) Ability to regulate and manage own health; (3) Musculoskeletal and body movement; (4) Range of motion; (5) Posture; (6) Muscle strength; (7) Functional balance; (8) Functional mobility; and (9) Gait. c. Neurological Assessment. Following brain trauma, the neurological assessment should identify an individual's cognitive, emotional, social, and behavioral assets and liabilities. A comprehensive assessment should address the person's: (1) Attention and concentration; (2) Learning and memory; (3) Recent memory; (4) Remote memory; (5) Language; (6) Speech; (7) Visual-spatial abilities; (8) Fine-motor abilities; (9) Higher-order and executive cognitive abilities; (10) Emotional adjustment; and (11) Chemical abuse and dependency.

DAV Service Bulletin for November 1996, Part II VA REVISES RATING SCHEDULE FOR MENTAL DISORDERS The VA published its final rules, establishing new rating criteria for mental disorders, on October 8, 1996. 61 Fed. Reg. 52695-702. The new rules are effective November 7, 1996, and make very significant changes in how veterans with mental disorders will have their disabilities rated. There are no longer two sets of rating criteria, one for psychoses and one for anxiety disorders or neuroses. All service-connected mental disorders will now be evaluated under one general rating formula for mental disorders. A copy of the relevant Federal Register pages is attached. Any veteran with a pending claim for either service connection or an increased rating for an already service-connected mental disorder is entitled to have his or her claim rated under either the old or new criteria, whichever is more beneficial to that particular veteran. Karnas v. Derwinski, 1 Vet.App. 308, 313 (1991). The new regulation is as important for the accompanying supplemental information as it is for the new rating criteria. Much of this material is VAs interpretation of the regulation and may be binding on both the VA and the Court of Veterans Appeals. For example, the Court has indicated that a veteran may not have a disability within the meaning of the law unless that condition is included in the rating schedule. However, the VA stated that even though certain sleep and sexual disorders are not provided for in the rating schedule: Any that are determined to be service-connected can be evaluated under other and unspecified neurosis (DC 9410) or other appropriate analogous condition and be evaluated under the general rating formula for mental disorders. 61 Fed. Reg. 52695. VA psychiatric examinations frequently describe the severity of service-connected posttraumatic stress disorder (PTSD) in terms of nightmares, flashbacks, intrusive memories, and startle response. The VA makes clear in its notice that while these symptoms are used for diagnosing PTSD, they may not form the basis for rating service-connected PTSD. 61 Fed. Reg. 52697. Among the most important interpretations of VA regulations is the VA acknowledgment that disability resulting from a personality disorder may be rated, even though not service connected, where an acquired mental condition is superimposed on the personality disorder. • When it is not possible to separate the effects of the conditions, VA regulations at 38 CFR 3.102, which require that reasonable doubt on any issue be resolved in the claimants favor, clearly dictate that such signs and symptoms be attributed to the service-connected condition 61 Fed. Reg. 52698. There are many other statements made by the VA in the material accompanying the new rating criteria for mental disorders. I strongly recommend that all NSOs read the notice several times. Supervisors are encouraged to review this information with all NSOs so that important points are identified and shared by everyone in the office. KENNETH D. WOLFE National Service Director

Sleep Apnoea & Hypertension: Physiological bases for a causal relation http://ep.physoc.org/cgi/content/full/92/1/67 Respiratory Diseases, Miscellaneous (PVD, Neoplasms, Bacterial Infections, Mycotic Lung Disease, Sarcoidosis, and Sleep Apnea) http://www.vba.va.gov/bln/21/Benefits/exams/disexm49.htm

-------------------------------------------------------------------------------- NATIONAL INSTITUTES OF HEALTH National Heart, Lung, and Blood Institute -------------------------------------------------------------------------------- EMBARGOED FOR RELEASE Tuesday, April 11, 2000 4:00 p.m. EST Contact: NHLBI Communications Office (301) 496-4236 NHLBI Study Shows Association Between Sleep Apnea and Hypertension People with sleep apnea are at special risk for hypertension, according to a study funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Data from the NHLBI's "Sleep Heart Health Study" (SHHS), which are reported in the April 12, 2000 issue of the Journal of the American Medical Association, show that middle-aged and older adults with sleep apnea have a 45 percent greater risk of hypertension than people without the condition. Hypertension, or high blood pressure, is a major risk factor for cardiovascular disease. According to NHLBI Director Dr. Claude Lenfant, "This is the first study large enough to examine the relationship between sleep apnea and hypertension, independent of other cardiovascular risk factors. It is extremely important, since hypertension is a major risk factor for cardiovascular disease, which is the leading cause of death in the U.S. today." "Although these results must be verified, they offer hope that we may be able to reduce cardiovascular mortality in hypertensives by more aggressively diagnosing the apnea," he added. Approximately 12 million Americans have sleep apnea, a breathing disorder characterized by brief interruptions of breathing during sleep (up to 20-30 breathing pauses per hour, each lasting at least 10 seconds). These breathing pauses are almost always accompanied by loud snoring. The most common treatment is continuous positive airway pressure (CPAP), a procedure involving use of a face mask which forces air through the nasal passages. Behavioral changes, especially weight loss, are usually recommended as well. The SHHS involved more than 6,000 adults, ages 40 and over, who were participating in other NHLBI cohort studies of cardiovascular and respiratory disease between 1995-1998. Sleep apnea was assessed through at-home polysomnography, a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. Following NHLBI guidelines, hypertension was defined as blood pressure of at least 140/90 mm Hg. The study showed that the risk of hypertension increased with the severity of the apnea in all participants, regardless of age, sex, race, or weight. The risk was seen even at moderate levels of sleep apnea. The centers participating in the study were: Boston University, Boston, MA; Cornell University, New York, NY; Johns Hopkins University, Baltimore, MD; New York University, New York, NY; University Hospital-Rainbow Babies & Children's Hospital, Cleveland, OH; University of Arizona College of Medicine, Tucson, AZ; University of California at Davis, CA; University of Minnesota, Minneapolis, MN; University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Washington, Seattle, WA; and University of Wisconsin, Madison, WI. For additional information, call the NHLBI Communications Office, (301) 496-4236. NHLBI press releases, fact sheets, and other materials on sleep are available online at www.nhlbi.nih.gov/about/ncsdr. -------------------------------------------------------------------------------- SOURCE: http://www.nhlbi.nih.gov/new/press/apr11-00.htm

Independent Living Services? try this link.......... http://www.index.va.gov/search/va/va_searc...Living+Services

http://www.ehs.cornell.edu/ Article Acute respiratory symptoms in workers exposed to vanadium-rich fuel-oil ash Mark A. Woodin, ScD, MS 1 2, Youcheng Liu, MD, ScD, MPH 1, Donna Neuberg, ScD 3, Russ Hauser, MD, ScD, MPH 1, Thomas J. Smith, PhD, MPH 1, David C. Christiani, MD, MPH 1 2 4 * 1Department of Environmental Health (Occupational Health Program), Harvard School of Public Health, Boston, MA 02115 2Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115 3Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115 4Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114 email: David C. Christiani (dchris@hohp.harvard.edu) *Correspondence to David C. Christiani, Harvard School of Public Health, Department of Environmental Health, 665 Huntington Avenue, Boston, MA 02115. Funded by: NIEHS; Grant Number: ES05947, ES07069, ES00002 NIOSH; Grant Number: OH02421, CCU109979 Keywords vanadium; PM10; occupational epidemiology; occupational lung disease; boilermakers; industrial hygiene Abstract Background Occupational exposure to fuel-oil ash, with its high vanadium content, may cause respiratory illness. It is unclear, however, what early acute health effects may occur on the pathway from normal to compromised respiratory function. Methods Using a repeated measures design, we studied prospectively 18 boilermakers overhauling an oil-fired boiler and 11 utility worker controls. Subjects completed a respiratory symptom diary five times per day by using a 0-3 scale where 0=symptom not present, 1=mild symptom, 2=moderate symptom, and 3=severe symptom. Daily symptom severity was calculated by using the highest reported score each day for upper and lower respiratory symptoms. Daily symptom frequency was calculated by summing all upper or lower airway symptom reports, then dividing by number of reporting times. Respiratory symptom frequency and severity were analyzed for dose-response relationships with estimated vanadium and PM10 doses to the lung and upper airway by using robust regression. Results During the overhaul, 72% of boilermakers reported lower airway symptoms, and 67% reported upper airway symptoms. These percentages were 27 and 36 for controls. Boilermakers had more frequent and more severe upper and lower respiratory symptoms compared to utility workers, and this difference was greatest during interior boiler work. A statistically significant dose-response pattern for frequency and severity of both upper and lower respiratory symptoms was seen with vanadium and PM10 in the three lower exposure quartiles. However, there was a reversal in the dose-response trend in the highest exposure quartile, reflecting a possible healthy worker effect. Conclusions Boilermakers experience more frequent and more severe respiratory symptoms than utility workers. This is most statistically significant during boiler work and is associated with increasing dose estimates of lung and nasal vanadium and PM10. Am. J. Ind. Med. 37:353-363, 2000. © 2000 Wiley-Liss, Inc.

Post-traumatic Headaches: Subtypes and Behavioral Treatments Thomas Bennett Chronic, recurrent headache commonly follows head injury, and interestingly, it is seen more often in individuals who have experienced minor head trauma than in those more seriously injured. I will describe subtypes and behavioral treatments of the post-traumatic headache. One must realize, however, that headache is only one of a number of symptoms that commonly follow head injury. While it may be the symptom that results in a patient seeking medical treatment following brain or head injury, it may on the other hand be only the "tip of the iceberg". Many patients complaining only of post-traumatic headache are found, under close neuropsychological evaluation, to be concurrently suffering from verbal and communicative disorders, deficits in information processing and reaction time, memory difficulties, problems with perception, and impaired concept formation and general reasoning ability (Alves, Colohan, O'Leary, Rimel, & Jane, 1986). Post-traumatic headaches should also be considered within the context of post-traumatic symptoms in general which are often collectively called the "post concussion syndrome". At this point it may be helpful to briefly consider the "post concussion syndrome" in general because many of the statements that I could make about post-traumatic headaches apply to other post-traumatic symptoms as well. Post-Traumatic Symptoms The basis of post-traumatic symptoms in individuals who have sustained minor head injury (loss of consciousness of 20 minutes or less and post-traumatic amnesia of 24 hours or less) has been debated for over 2OO years. The common use of the term "post concussion syndrome" to describe the symptoms of these patients has a psychological flavor to it. It was (and still is in less informed circles) typical for physicians and psychologists to ascribe symptoms for which there was no obvious organic basis (no hematoma, no penetration of the dura, no contusion of the brain) to neurotic processes or malingering. The modern view of post-traumatic symptoms is that they do indeed have a biological or organic basis. It is now accepted that even mild concussion usually entails some structural damage to the brain (Jennett & Teasdale, 1981). This is not to say that emotional factors do not play an important role in post-traumatic symptoms because it is generally believed that emotional factors can both exacerbate and prolong post-traumatic symptoms that are the result of biological factors. This conclusion underscores the need to employ both biological and psychological interventions in treating patients with post-traumatic symptoms. With respect to malingering, let me point out that its incidence has been vastly overestimated. Symptoms are deliberately exaggerated in a smaller proportion of patients than was previously thought to be the case (Boll, 1982; Rimel, Giordani, Barth, Boll, & Jane, 1981). Neither insurance claims nor pending litigation is a significant factor influencing return to work or social recovery (Irving, 1972; Oddy, Humphrey & Uttley, 1978). A number of symptoms have been identified to follow minor head injury. However, it is not accurate to describe these symptoms as a syndrome as was common practice when using the term "post concussion syndrome". While a given patient may exhibit one, two, three, or less commonly, more of these symptoms, it is rare to see a patient experience all of them (Alves et al., 1986). Post-traumatic symptoms commonly reported after minor head injury include headaches; dizziness; impaired concentration; memory problems; sensory problems including diminished hearing, olfaction, and taste; diplopia; tinnitus; hypersensitivity to noise; insomnia; fatigue; irritability; anxiety and depression. The mechanisms maintaining these symptoms are not always obvious, but some meaningful statements can be made. The problems with dizziness and auditory difficulties are undoubtedly related to concussion of the balance and central auditory processing functions of the inner ear. Decreased olfactory sensitivity is related to strain injury of the axons of the olfactory tract as they enter the brain. I suspect that reports of decreased taste sensitivity do not reflect a decrement in that specific modality, but rather they reflect a loss of gustatory sensitivity secondary to diminished olfactory sensitivity. Hypersensitivity to noise and hyperirritability probably at least partially reflect general diminished inhibitory or gating (filtering out) processes in the brain. Insomnia is a common sequel after head injury; in general, initiation, maintenance, and cycling mechanisms do not operate as efficiently as they should after head injury, presumably because of neural disruption resulting from rotational forces exerted on the brain stem at the time of injury. Loss of concentration and memory problems may be reflective of diminished information processing ability in general. Gronwall and Wrightson (1974) tested information processing ability using the Paced Auditory Serial Addition Test (PASAT). They found that head injured patients who performed abnormally on this test at 35 days post-injury still complained of post-traumatic symptoms; the disappearance of these symptoms correlated nicely with restoration of normal performance on the PASAT. Irritability, anxiety, and depression can all be contributed to by organic factors, but typically, they are more dependent on psychological processes. Coping with head injury produces feelings of loss of self-control and feelings of helplessness and hopelessness. Finding that you can no longer perform efficiently at home, school, or on the job is very stressful, and it can aggravate other post-traumatic symptoms as well. The nature of and basis for post-traumatic headache is more difficult to explain. There appear to be many possible causes for persisting headache after head injury. Some of these include musculoskeletal trauma to the neck, head, and jaw regions, pain in scalp, scars, neuralgia of occipital or supraorbital nerves, precipitation of migraine in predisposed individuals, and occasional serious intracranial complications. Post-traumatic headaches are a significant health problem when one realizes that close to half of all patients discharged from the hospital after minor head injury report persistent headache (e.g., Alves et al., 1986). Subtypes of Post-Traumatic Headaches The vast majority of patients who experience persistent post-traumatic headaches have no intracranial abnormalities to explain their headache pain (Dalessio, 1980). Electroencephalographic (EEG) abnormalities are not correlated with occurrence of post-traumatic headache, but the presence of scalp lacerations is positively correlated (Scherokman & Massey, 1983). At least four or five types of post-traumatic headaches have been categorized including, 1) steady pressure with cap-like distribution, 2) circumscribed superficial tenderness around the impact site, 3) episodic aching or throbbing pain which is typically unilateral, and 4) episodic, unilateral frontotemporal pain with ipsilateral mydriasis and hyperhidrosis. Recently, I have seen more and more cases where patients report unilateral or bilateral pain in the temple region or just superior to it and I will comment on this as a fifth type of post-traumatic head pain. Type 1: Steady Pressure with Cap-like Distribution Type 1 headaches are the most common and persistent variety of headaches that occur after head injury. Patients will often have this type of headache concurrently with one or more of the other types. As indicated, these headaches are described as a steady pressure, often with a cap-like distribution, but more commonly in a circumscribed area elsewhere than the site of the injury. There is usually a deep tenderness present in the neck or shoulder region, and headache can often be reproduced by manual pressure on these tender areas. The intensity of the associated pain is described as being from "mild to very severe". The attacks of pain can recur for many years. Occurring intermittently, the attacks can vary from several hours to as long as ten days duration (Dalessio, 1980). Type 1 headaches are usually made worse by effort stress, coughing, stooping or turning the head. As a result the patient may be functionally incapacitated for engaging in physical activity related to work or recreation. During periods of severe headache of this sort, patients may experience spinning sensations, dizziness, and photophobia (Dalessio, 1980). Finally, these headaches are associated with persistent and sustained muscle contraction in the head, neck, upper back, and shoulders. This can be easily demonstrated through electromyographic (EMG) studies that show excessive levels of muscle contraction in these patients. Medically, these headaches are treated with muscle relaxants, analgesics, amiltryptaline, heat, and massage. They often prove to be resistant to treatments. Type 2: Circumscribed Tenderness Around Impact Site Most patients with Type 2 headaches suffer from Type 1 headaches as well. Type 2 patients have a circumscribed, relatively superficial tenderness of the scalp at the site of the original injury which is often, but not always, associated with a visible or palpable scar (Scherokman & Massey, 1983). In most patients who experience this type of pain, there is spontaneous aching pain at the original site of impact; in some cases, headache pain only occurs when some pressure, such as a hat or a brush, is applied to the site (Dalessio, 1980). Typically, this type of post-traumatic headache pain is described as being "moderate", and usually it resolves within a year after the original injury. It appears to be related to contusion and injury to the scalp vasculature. Type 3: Episodic Aching or Throbbing Pain, Usually Unilateral Type 3 post-traumatic headaches are described as aching, often throbbing pain, usually unilateral in onset. They occur in attacks and are most commonly reported to occur in the temporal regions. They are also sometimes frontal, occipital, or postauricular. The attacks may be of short duration, and they may represent an intensification of symptoms for patients who also experience a background of Type 1 headache. Reported pain associated with Type 3 headaches varies from "mild to severe". The intensity of the pain is increased by effort, coughing, bending, or lying down. Post-traumatic headaches of the Type 3 variety, while usually unilateral in onset often become generalized. They often begin in the morning or are present upon awakening, and they may continue all day. Nausea, vomiting, and anorexia may accompany them. Dalessio (1980) reports that these headaches are not relieved by massage or head but ice bags, cold compresses, and codeine will provide relief. Ergotamine tartrate eliminated this type of pain but did not diminish Type 1 components resulting from excessive muscle contraction. Type 3 headaches are vascular in nature, and they are more commonly seen in patients with a migraine history, even if migraines have been rare or infrequent in the past. This type of headache disorder is related to recurrent painful distention of cranial arteries. For many patients, it represents the precipitation of a serious vascular headache (migraine) disorder in a person already at risk. Type 4: Episodic, Unilateral Frontotemporal Pain With Ipsilateral Mydriasis and Hyperhidrosis Vijayan (1977) has described a type of headache syndrome associated with anterior neck injuries secondary to cervical whiplash (also see Khurana & Nirankari, 1986). In these patients, unilateral, frontotemporal vasodilating headaches are experienced episodically. What makes them unique is that they are accompanied by ipsilateral mydriasis (excessive dilation of the pupil) and facial hyperhidrosis (excessive sweating). When the pain subsides, the patient is left with ipsilateral ptosis (drooping of the upper eyelid) and miosis (excessive constriction of the pupil). In Vijayan's series, patients experienced between two and 12 of these headaches per month. Type 4 headaches are related to damage to the third-order sympathetic neuron in the neck; they reflect localized sympathetic nervous system dysfunction. Patients with these headaches were helped when treated with the beta adrenergic blocking agent, propranolol, in doses of 20-60 mg per day (Vijayan, 1977); they did not respond to ergotamine. Type 5: Pain in Temple or Superior Temple Region A fifth type of headache syndrome, which also typically is accompanied by Type 1 headaches, is an intermittent recurrent relatively steady pain in the region of the temples or just above. The pain may be unilateral or bilateral, and when it is bilateral, it may be described as a band extending from temple to temple. It is also typically accompanied by jaw popping during chewing, leaving no doubt that it is related to temporomandibular joint (TMJ) dysfunction or injury. Many people in our society clench their teeth at night (bruxism) in response to stress. An automobile accident that results in a person striking the windshield or dashboard can easily exacerbate ongoing temporomandibular joint degeneration or significantly displace or injure a healthy joint. High resolution computerized tomography has been shown to be vastly superior to conventional radiography in detecting TMJ degeneration in post-traumatic headache patients (Tilds, Miller, & Guidice, 1986). The increasing availability of magnetic resonance imaging will enhance the detection of these difficulties further. Treatment of TMJ syndrome, whether post-traumatic or not, may require a multidisciplinary approach including orthodontic and surgical treatments, splint therapy, physical therapy, and biofeedback. In summary, at least five distinct headache syndromes can be described in post-traumatic headache victims. With the exception of Type 4, which reflects sympathetic nerve damage, these headaches reflect musculoskeletal and vascular dysfunction that is essentially the same as that seen in chronic headache patients who have not experienced trauma. As with typical chronic headache patients, the head pain experienced by head trauma victims comes in many combinations. As indicated, patients with Types 2, 3, and 5 headaches will often complain of Type 1 headaches as well, and some patients will exhibit symptoms consistent with several subtypes concurrently. A multimodality approach using behavioral treatment interventions will be described next. The use of behavioral treatments for patients with post-traumatic headaches has been discussed in case studies by several investigators (e.g., Daly & Wulff, 1987; Duckro, Tait, Margolis, & Silvermintz, 1985; Muse, 1986). In Behavioral Treatments of Post-Traumatic Headaches, Packard (1979) asked directly, "What does the headache patient want?" and then outlined the stated needs of patients along with physician estimates of those needs. Generally speaking, physicians ranked medication higher than did the patients. The patients gave their highest rankings to the need for information about the causes of their headaches and to the need for relief from pain. The patients' responses thus indicated that education must be an integral part of any headache treatment program. Behavioral treatment of post-traumatic headaches must thus use a multifaceted approach and should include education about headaches and medications for them, physiologic therapies such as physical therapy, therapeutic massage and biofeedback, and cognitive-behavioral therapies aimed at helping the patient acquire pain management skills. Education Let us forever bury the idea that post-traumatic headaches, or headaches in general, are simply psychiatric problems. Clearly, stress can produce or exacerbate headache syndromes, but headaches are best understood by considering both psychological and physiological factors. Their interaction can be understood by an explanation to the patient with post-traumatic headaches. The Vicious Cycle A major failure of the traditional organic-psychological dichotomy is to downplay the interaction among emotional factors, the autonomic nervous system, and elevated levels of muscle tension on head pain levels. Muscle tension levels are commonly elevated in the head, neck, shoulders, and upper back regions after trauma, and this is often not evaluated in diagnostic studies. The muscle contraction can cause additional pain. Similarly, it is clearly the case that emotional arousal is frequently present in these patients. Emotional arousal increases discharge in the sympathetic nervous system. Prolonged excessive discharge in the sympathetic system will in turn exacerbate pain levels by increasing perception of the intensity of stimuli related to pain. Unfortunately, these physical and emotional factors can create a "vicious cycle" in which pain becomes a stressor, eliciting emotional (anger, frustration) and physical (increased muscle tension) factors which then produce more pain (Zimmerman, 1981). The longer this sort of cycle persists, the more difficult it is to break. Diagramming the cycle, explaining it to the patient and then giving homework exercises to disrupt it have been very effective in helping the post-traumatic headache patient break this cycle. This type of exercise is most beneficial if the patient learns techniques to intervene at multiple points in the cycle. When patients have learned about the physiological factors contributing to their headaches and how emotional factors can interact with physical factors to set up a "vicious cycle", they are ready to accept the fact that their pain has both biological and psychological aspects. They can then be assured that their presence in the psychologist's office is not because their physician believes their headaches are "just in their minds". Treatments Medication I find that few patients understand the role of medication in their treatment. It is clear that medications (i.e., analgesics, those which reduce muscle spasms and overall level of muscle contraction, those that reduce emotional arousal, and antidepressants) can be useful in selected patients. The psychiatric medications may or may not produce pain relief because of their psychiatric effects. Benzodiazepines may help because of their muscle relaxant properties; antidepressants may help because they promote serotonin activity in the brain which in turn decreases pain sensations. Patients need to be informed of why they are taking certain medications. One must be careful in using antidepressants, particularly amitryptaline, in treating individuals with post-traumatic headaches. The anticholinergic side effects of these drugs can exacerbate post-traumatic symptoms related to head injury including dizziness, diminished concentration, and memory problems. Patients also typically have a misconception about how effective their medications should be. They often believe that analgesics should eliminate the pain completely. I find that this is an example of a "fix me doc syndrome" that impedes the progress of many patients. Instead of holding the belief that "improvement is outside of their own control" (Barnat, 1986), post-traumatic headache patients need to learn that a certain amount of discomfort will often persist; it is something that must be lived with. If a medication provides no relief, then it is a failure, but medications that provide only partial relief have not necessarily failed. Biofeedback Physiological therapies, including physical therapy, therapeutic massage, and biofeedback, can be effective treatments for post-traumatic headaches. I will only discuss the use of biofeedback therapy in this paper, but let me emphasize that we regularly refer post-traumatic headache patients to certified massage therapists and/or physical therapists as part of their treatment program. These procedures are all complimentary to one another. Biofeedback is a procedure by which a biological signal (for example, skin temperature, muscle tension, heart rate, brain waves) is converted to an easily detected signal, such as a light or a tone, and "fed back" to a patient so that she or he can exert conscious control over that function. Thus, a person might learn to detect and subsequently lower excessive levels of muscle tension in his or her forehead, neck, shoulders, and jaw, or a person might learn to increase the recorded temperature of her or his finger tips. (Cold hands signal excessive sympathetic nervous system discharge and resulting vasoconstriction; they are a sign of stress and a common characteristic of migraineurs.) Biofeedback is not a cure-all, and this treatment is most effective when incorporated into a comprehensive treatment program. Nevertheless, biofeedback treatment has been used successfully for two decades to treat a variety of psychophysiological disorders including muscle contraction and vascular headaches, hypertension, gastrointestinal disorders, pain syndromes, anxiety syndromes, abnormal heartbeats, sleep disorders, and many neurological syndromes including movement disorders and epilepsy. It is also employed in neuromuscular rehabilitation following peripheral or central nervous system damage (Bennett, 1987). I have found it to be of significant benefit for the post-traumatic headache patient, particularly when combined with stress management training. As I indicated in an earlier article (Bennett, 1988), biofeedback training can have both obvious and subtle benefits for these patients. One obvious benefit would be to teach the patient with excessive levels of muscle tension to relax chronically tensed muscles and to be more sensitive to muscle tension levels. This is accomplished through electromyographic (EMG or muscle tension) training. Temperature training in biofeedback can be used to increase vasodilation (decrease sympathetic activity) and thereby decrease the likelihood of vascular headaches. We typically use a combination of these procedures, as both contribute to stress management and relaxation training. All post-traumatic headache patients can benefit from such training. EMG biofeedback is particularly applicable to patients experiencing Type 1 and Type 5 headaches, and temperature training is especially relevant for patients with Type 3 headaches. A more subtle benefit of biofeedback is to teach the patient that he or she can have some control over an aspect of their life (for example, "I can relax my muscles and decrease the severity of my headaches"). The head injured person often has a recent history of failure and frustration, and feelings of "loss of control" or "helplessness" may predominate. By learning to have more control over something as basic as level of muscle tension or skin temperature, the patient can learn that "what I do can really makes a difference". This helps the person to overcome the "fix me doc" syndrome and places him or her in more control of their future in general. Thus, the feelings of failure, loss of control, and helplessness can be attenuated. Cognitive-Behavioral Therapies The usefulness of cognitive-behavioral therapies in pain management and headache treatment programs is well established. A particularly effective use of these principles in the treatment of chronic headache patients has been described by Bakal (1982), whose general program is quite helpful for patients with post-traumatic headaches. I recommend it highly. Two important features of this program are attention diversion and thought management. These methods assist the patient in decreasing the intensity of the pain and in minimizing negative thoughts and dysphoric affect that increase headache severity. In introducing the use of attention diversion and thought management, it is important to explain to the patient that headache pain consists of both sensory and reactive components. The sensory component consists of sensations of pain that are largely determined by changes in the muscles and veins of the head. The reactive (or cognitive) component consists of the thoughts and feelings that accompany headache episodes. There are, in turn, two important aspects of the reactive component. The first is the amount of attention that is directed toward the headache. The second is our interpretation of thoughts regarding, and feelings about, the pain experience. Negative or catastrophic cognitions exacerbate pain by increasing activation of the sympathetic nervous system. The patient being taught attention diversion learns that we normally only focus on one thing at a time, and we are free to attend to whatever we want. Thus, we can influence what we are attending to by shifting our attention from one aspect of our environment to another (internal or external). Finally, it is difficult if not impossible, to stop focusing on one's pain unless one shifts attention to something else. With this general framework in mind, the patient is provided with a number of attention diversion strategies to learn. They are initially practiced during headache-free periods and later applied to times of significant headache discomfort. Turk (1978) provides a variety of attention-diversion techniques, including imagery production, strategies that are relatively easy to master and quite effective in interrupting and/or decreasing the intensity of a headache attack. Thought management deals with helping the patient control negative and/or catastrophic headache-related thoughts and feelings. By now, the patient is quite aware of the role that distressing thoughts play in their headache disorder. He or she is encouraged to understand that distressing cognitions not only increase the pain experienced, but also they interfere with the ability to cope effectively with the headache pain. These thought patterns can be identified and modified. The patient learns that the process of "negative talking", can be reversed, and training is given in how to accomplish this. First the patient is told to be alert to those times when he or she is experiencing distressing feelings and thoughts. Second, the patient learns to use these distressing thoughts as a signal to start making positive self-statements. Third, the patient learns to actively substitute the distressing cognitions with positive, coping-oriented statements (Bakal, 1982). In order to demonstrate this process, the patient is provided with a list of positive statements (Turk, 1979) to be used during different stages of the headache episode. He or she is encouraged to develop his or her own statements as well. Again, this intervention is over-practiced during times when headaches are not present before being put into practice. Conclusions Post-traumatic headache is the most frequent complaint made by victims of minor head injury and is thus of major importance in head trauma rehabilitation. Post-traumatic headaches can be severe and persistent. As a result they can produce a major disruption in the patient's life. Their economic impact is significant in that they can prevent return to work in individuals who are otherwise recovered. Post-traumatic headaches reflect an interaction among organic and emotional factors. For this reason, they are best treated via a multimodality approach that considers all of these factors. For many individuals, participation in such a program results in a complete remission of their symptoms. For others, the end of the program represents an improvement in their symptoms and the beginning of a long-term process of self-managing their headache pain. Most patients arrive at the point where their headaches no longer interfere with their lives. This represents a significant improvement over their prior incapacitation dependency on a variety of medications. In head injury recovery, this is one sign that the victim can once more be in control of her or his future. REFERENCES Alves, E.M., Colohan, A.R.T., O'Leary, T.J., Rimel, R.W. & Jane, J.A. (1986). Understanding post-traumatic symptoms after minor head injury. Journal of Head Injury Rehabilitation, 1, 1-12. Bakal, D.A. (1982). The psychobiology of chronic headache. New York: Springer Publishing Company. Barnat, M.R. (1986). Post-traumatic headache patients II: Special problems, perceptions, and service needs. Headache, 26, 332-338. Bennett, T.L. (1988). Neuropsychological rehabilitation in the private practice setting. Cognitive Rehabilitation, 6(l), 1215. Bennett, T.L. (1987). Neuropsychological aspects of complex partial seizures: Diagnostic and treatment issues. The International Journal of Clinical Neuropsychology, 9, 37-45. Boll. T.J. (1982). Behavioral sequelae of head injury. In P.R. Cooper (Ed.) Head Injury. Baltimore: Williams and Wilkins. Dalessio, D.J. (1980). Post-traumatic headache. In D.J. Dalessio (Ed.) Wolff’s headache and other head pain, 4th ed. New York: Oxford. Daly, E. & Wulff, J. (1987). Treatment of post-traumatic headache. British Journal of Medical Psychology, 60, 85-88. University Press, 3324-3381. Duckro, P.N., Tait, R., Margolis, R.B. & Silvermintz, S. (1985). Behavioral treatment of headache following occupational trauma. Headache, 25, 328-331. Gronwall, D. & Wrightson, P. (1974). Delayed recovery of intellectual function after minor head injury. Lancet, 2, 605-609. Irving, J.G. (1972). Impact of insurance coverage on convalescence and rehabilitation of head injured patients. Connecticut Medicine, 36, 385-391. Jennett, B. & Teasdale, G. (1981). Management of head injuries. Philadelphia, D.A. Davis. Khurana, R.K. & Nirankari, V.S. (1986). Bilateral sympathetic dysfunction in post-traumatic headaches. Headache, 26, 117-121. Muse, M. (1986). Stress-related, post-traumatic chronic pain syndrome: Behavioral treatment approach. Pain, 25, 389-394. Oddy, M., Humphrey, M. & Uttley, D. (1978). Subjective impairment and social recovery after closed head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 41, 611-616. Packard, R. (1979). What does the headache patient want? Headache, 19, 370-374. Rimel, R.W., Giordani, B., Barth, J.T., Boll, T.J. & Jane, J.A. (1981). Disability caused by minor head injury. Neurosurgery, 9. Scherokman, B. & Massey, W. (1983). Post-traumatic headache. Neurologic Clinics, (2), 457-463. Tilds, B.N., Miller, P.R. & Guidice, M.A. (1986). The diagnostic value of high resolution computerized tomography in post traumatic head pain patients. Headache, 26, 117-121. Turk, D.C. (1978). Cognitive behavioral techniques in the management of pain. In J.P. Foreyt & D.P. Rathjen (Eds.) Cognitive behavior therapy: Research and application. New York: Plenum Publishing Company. Vijayan, N. (1977). A new post-traumatic headache syndrome: Clinical and therapeutic observations. Headache, 17,19-22. Zimmerman, M. (1981). Physiological mechanisms of pain and pain therapy. Triangle, 20, 7-17. This article originally appeared in The Journal of Cognitive Rehabilitation, Volume 6 Issue 2, March/April 1988.

ARTICLES Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis Allan C. Gelber, MD, MPH, PhD; Marc C. Hochberg, MD, MPH; Lucy A. Mead, ScM; Nae-Yuh Wang, MS, PhD; Fredrick M. Wigley, MD; and Michael J. Klag, MD, MPH Pages 321-328 Background: Knee and hip injuries have been linked with osteoarthritis in cross-sectional and case-control studies, but few prospective studies have examined the relation between injuries in young adults and risk for later osteoarthritis. Objective: To prospectively examine the relation between joint injury and incident knee and hip osteoarthritis. Design: Prospective cohort study. Setting: Johns Hopkins Precursors Study. Participants: 1321 former medical students. Measurements: Injury status at cohort entry was recorded when the mean age of participants was 22 years. Injury during follow-up and incident osteoarthritis were determined by using self-administered questionnaires. Osteoarthritis was confirmed by symptoms and radiographic findings. Results: Over a median follow-up of 36 years, 141 participants reported joint injuries (knee alone [ n = 111], hip alone [ n = 16], or knee and hip [ n = 14]) and 96 developed osteoarthritis (knee alone [ n = 64], hip alone [ n = 27], or knee and hip [ n = 5]). The cumulative incidence of knee osteoarthritis by 65 years of age was 13.9% in participants who had a knee injury during adolescence and young adulthood and 6.0% in those who did not (P = 0.0045) (relative risk, 2.95 [95% CI, 1.35 to 6.45]). Joint injury at cohort entry or during follow-up substantially increased the risk for subsequent osteoarthritis at that site (relative risk, 5.17 [CI, 3.07 to 8.71] and 3.50 [CI, 0.84 to 14.69] for knee and hip, respectively). Results were similar for persons with osteoarthritis confirmed by radiographs and symptoms. Conclusions: Young adults with knee injuries are at considerably increased risk for osteoarthritis later in life and should be targeted in the primary prevention of osteoarthritis. Ann Intern Med. 2000;133:321-328. Osteoarthritis is a major contributor to functional impairment and reduced independence in older adults (1-4). It is the leading cause of arthritis in the United States, affecting an estimated 21 million persons (5), and has substantial economic impact (6, 7). History of an injury to a joint, particularly at the knee and hip, is associated with an increased risk for osteoarthritis in cross-sectional and case-control studies (8-11). Such studies, however, may overestimate this relation because persons with symptomatic osteoarthritis may be more likely to recall a past injury or to interpret early symptoms of osteoarthritis as indicative of joint injury. A prospective cohort study can address this weakness by determining exposure status before the outcome develops. To date, prospective studies have examined the relation between history of joint injury and osteoarthritis in middle-aged persons and senior citizens (12, 13), but not in young adults. However, many athletic injuries occur in high school and college. In addition, joint trauma may be a more common cause of osteoarthritis than has been previously recognized (14). We performed a prospective cohort study of 1321 young adults to examine the risk for knee and hip osteoarthritis associated with joint injury during young adult life. Methods Study Participants The Johns Hopkins Precursors Study was designed by the late Caroline Bedell Thomas, MD, to identify precursors of the aging process (15). A total of 1337 medical students, members of the graduating classes of 1948 through 1964 at the Johns Hopkins University School of Medicine in Baltimore, Maryland, enrolled in the study. The cohort was 91% male and 97% white; the mean age was 22 years. At entry, participants underwent a standard history and examination, including assessment of musculoskeletal disorders, history of trauma, level of physical activity, and measurement of weight and height. Body mass index was calculated as weight in kilograms divided by height in meters squared. In addition, participants were asked to categorize their level of physical training during the past month as "none," "little," "moderate," or "much," as described elsewhere (16). Since graduation, participants have been followed prospectively with annual self-administered questionnaires to detect incident disease and to update risk factor status over time. At the time that baseline data were collected, it was not customary to obtain informed consent. After establishment of the Joint Committee on Clinical Investigation at Johns Hopkins, the follow-up protocol was reviewed and approved. Assessment of Injury Injury was defined as a report of trauma to the knee or hip joint, including internal derangement and fracture. During the baseline assessment, knee and hip injuries that occurred before graduation from medical school and the year of their occurrence were recorded. Postgraduation injuries were assessed by annual morbidity questionnaires. During every 5-year follow-up period, at least 86% of the living participants responded at least once to the questionnaires. Injuries were assigned diagnosis codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (17). Diagnoses included torn meniscus (code 836.2); torn knee ligament (code 844.9); tibial fracture (code 823.8); femoral fracture (code 821.01); fibular fracture (code 823.81); patellar fracture (code 822); broken leg, site not otherwise specified (code 827.0); knee injury, not otherwise specified (code 959.7); gunshot wound (code 891); hemarthrosis (code 844.9); shin splints (code 844.9); and hip dislocation (code 836.5). Incidence of Osteoarthritis The methods used to determine osteoarthritis incidence in this cohort have been described elsewhere (18). Briefly, all participants were mailed annual morbidity questionnaires. Before 1985, respondents were queried about the development of "physical and musculoskeletal disorders." Since 1985, follow-up morbidity questionnaires have contained the specific question, "Have you ever had arthritis?" and have asked those who respond affirmatively to "provide the type of arthritis, year of onset, and treatment received." An event of osteoarthritis was defined as the self-report of osteoarthritis or degenerative arthritis in response to the questionnaire. The incidence date was determined by the reported year of osteoarthritis onset. Two rheumatologists reviewed each report of osteoarthritis, assigned ICD-9-CM codes (17) to the most specific arthritis site reported by the respondent, and excluded inflammatory arthritides. For this analysis, only osteoarthritis at the knee (code 715.96) and hip (code 715.95) were included as outcomes. In 1995, all surviving participants who had previously reported osteoarthritis were mailed a more detailed questionnaire. They were asked, "Have you had pain in or around the knee, including back of the knee, on most days for at least 1 month?" and "Have you had pain in or around either hip joint, including the buttock, groin, and side of upper thigh, on most days for at least 1 month?" These symptom-related questions were used to screen for knee and hip osteoarthritis, respectively, in the National Health and Nutrition Examination Survey (NHANES) (19). Respondents were also asked whether they had undergone radiographic evaluation of their knees and hips and whether radiography revealed osteophytes, joint space narrowing, subchondral cysts, or bony sclerosis (the radiographic hallmarks of osteoarthritis) (20). Statistical Analysis The association between baseline characteristics and injury status was assessed by using the Student t-test for continuous variables and the chi-square test for categorical variables. These data are presented both for the entire cohort and separately by sex. Injury was the independent variable in the survival analysis; age was the time variable. Knee and hip osteoarthritis were examined as separate outcomes. The relation of a joint injury at baseline to the incidence of osteoarthritis was examined by using Kaplan-Meier analysis (21). The log-rank statistic was used to test whether the cumulative incidence of osteoarthritis differed according to injury status at cohort entry (22). In addition, Cox proportional hazards analysis was used to estimate the independent risk for osteoarthritis associated with a joint injury. Cox models were constructed for injury status at cohort entry and over follow-up, modeled as a time-dependent covariate. We adjusted for age at graduation, sex, body mass index, and level of physical activity, each of which was determined at baseline, to evaluate for possible confounding. In this cohort, body mass index at enrollment was more predictive of future osteoarthritis than average or most recent body mass index during follow-up (18). These analyses were performed for all reported events of knee and hip osteoarthritis and for cases confirmed by both characteristic symptoms and radiographic findings. Hazard ratios are reported as relative risks with 95% CIs. Statistical significance was defined as an level equal to 0.05 using a two-tailed test. We conducted a sensitivity analysis to assess the potential effect of an omitted covariate on the association between joint injury and subsequent osteoarthritis. Role of the Funding Sources The funding sources did not have a role in the collection, analysis, or interpretation of the data or in the decision to submit the study for publication. Results At graduation from medical school, the average age of the 1216 men and 121 women in the cohort was 26 years. Our analysis is based on events reported through 30 November 1995 and represents a median follow-up of 36 years. Information at baseline or during follow-up was available for 1321 participants, who form the basis of our longitudinal analysis. At the end of follow-up in 1995, the mean age of the cohort SD was 61.4 8.9 years. Overall, 141 participants had a joint injury (knee alone [ n = 111], hip alone [ n = 16], or injuries at both sites [ n = 14]) before or after graduation. Table 1 shows the baseline characteristics of the cohort according to injury status at the end of follow-up. Proportions of men and women with joint injury were similar (P > 0.2, chi-square test). Participants were generally lean, 49% were physically active, and 54% smoked cigarettes. Men who had a joint injury were heavier at baseline than men who were injury-free, but both groups of men were similar in age, level of physical activity, and smoking status. Women with injury were, on average, 2 years older at baseline than those without injury. At baseline, 47 men (3.9%) reported a knee injury and 12 men (1.0%) reported a hip injury. The mean age at which the injuries occurred was 16 years. Knee injuries included 10 tibial fractures, 3 fibular fractures, 4 femoral fractures, 2 patellar fractures, and 9 otherwise unspecified leg fractures. In addition, 8 men incurred trauma resulting in torn knee cartilage, 2 had torn knee ligaments, 2 had knee injuries resulting from gunshot wounds, 1 had traumatic hemarthrosis, 1 had joint dislocation, 1 had shin splints, and 4 had otherwise unspecified knee injuries. Of men with a knee injury, 4 reported that they were injured while playing football, 2 each reported that they were injured while playing basketball or participating in athletics, and 1 each reported that he was injured while horseback riding, bicycling, skiing, playing volleyball, wrestling, playing baseball, or playing tennis. Knee trauma also resulted from motor vehicle accidents (n = 3) and falls (n = 2). At baseline, 4 of the 121 women (3.3%) had a history of knee injuries and 1 (0.8%) had a history of hip injuries. Sixty-two men and 7 women developed knee osteoarthritis, and 27 men and 5 women developed hip osteoarthritis. The mean SD ages at onset of knee and hip osteoarthritis were 57 8 years and 59 6 years, respectively. The cumulative incidence of knee osteoarthritis by 65 years of age was 6.3% and the cumulative incidence of hip osteoarthritis was 2.9%. Fifty-two of 60 male participants (87%) who had reported knee osteoarthritis and were alive in 1995 returned the detailed osteoarthritis questionnaire. Of these 52 men, 43 (83%) had current symptoms, signs (including crepitus or tenderness at the joint margin), or radiographic features of knee osteoarthritis; 6 (12%) had undergone knee replacement surgery. Besides joint replacement, 20 additional men with knee osteoarthritis (38%) had other surgical procedures, including arthroscopic meniscectomy and osteotomy. Similarly, 24 of 26 male participants (92%) who were alive in 1995 and had reported hip osteoarthritis returned the detailed questionnaire. Of these 24 men, 19 (79%) had current symptoms (including pain with flexion or internal rotation at the hip) or radiographic features of hip osteoarthritis; 10 (42%) had undergone hip replacement surgery. Fifty percent of the participants were currently using aspirin or other nonsteroidal anti-inflammatory drugs as medical therapy for their osteoarthritis. Compared with the remainder of the cohort, participants with osteoarthritis exhibited significantly greater limitations in their activities of daily living, including climbing stairs, bending, kneeling and stooping, and walking more than 1 mile (data not shown). We first examined the relation between injuries in young adult life (before graduation) and subsequent development of osteoarthritis. The cumulative incidence of knee osteoarthritis by 65 years of age was 13.9% among participants with a history of knee injury at baseline and 6.0% among those without (P = 0.0045, log-rank test) (Figure ). The average time to clinically apparent osteoarthritis in participants with a knee injury at baseline was 22 13 years. These early knee injuries were associated with a nearly threefold increase (relative risk, 2.95 [CI, 1.35 to 6.45]) in risk for future symptomatic knee osteoarthritis. In contrast, none of the 13 men and women with a hip injury before graduation later developed hip osteoarthritis. Next, we examined the association between joint injury at baseline or during follow-up and development of osteoarthritis. After graduation, an additional 68 men and 6 women incurred a new knee injury and 14 men and 3 women incurred a new hip injury, yielding a total of 125 persons with knee injuries and 30 persons with hip injuries throughout the study period. The cumulative incidence of knee and hip injury by 65 years of age was 11.0% and 2.2%, respectively. Knee injury occurred at a mean age of 36 years, and hip injury occurred at a mean age of 37 years. Six of the 125 participants with knee injury developed osteoarthritis concurrent with or before the injury. Of the remaining 119 participants, 20 developed osteoarthritis after the injury occurred (7.5 events per 1000 person-years of follow-up) (Table 2 ). In contrast, the incidence of knee osteoarthritis among 1202 participants without knee injury was 1.2 events per 1000 person-years of follow-up. The relation between a previous hip injury and incidence of hip osteoarthritis during follow-up was similar to that observed for knee osteoarthritis. Two of the 30 participants with hip injury developed osteoarthritis before the injury occurred. Of the remaining 28 participants, 2 who were injured after graduation later developed hip osteoarthritis (3.2 events per 1000 person-years) (Table 2 ). In contrast, 30 of 1293 participants without previous hip injury developed incident hip osteoarthritis (0.7 event per 1000 person-years). The association between a previous injury (incurred throughout the study period) and future osteoarthritis was further examined by modeling injury as a time-dependent covariate. Knee injury, at baseline or during follow-up, substantially increased the risk for subsequent knee osteoarthritis (relative risk, 5.17 [CI, 3.07 to 8.71]) (Table 3 ). This increase in risk for knee osteoarthritis persisted after adjustment for age, sex, body mass index, and level of physical activity at baseline. When the analysis was repeated and confined to persons with symptomatic and radiographic evidence of osteoarthritis, the point estimate of the risk associated with previous knee injury was greater than for all cases. Time-dependent hip injury was associated with a threefold increase in risk for future hip osteoarthritis (relative risk, 3.50 [CI, 0.84 to 14.69]) (Table 3 ). Because relatively few participants developed hip osteoarthritis fewer than 50% of those who developed knee osteoarthritis the confidence intervals surrounding the risk estimates were wide. When the model was adjusted for physical activity, the risk estimate nearly doubled and was of borderline statistical significance. In exploratory analyses to investigate the influence of physical activity on this association, the risk for hip osteoarthritis associated with time-dependent hip injury varied by physical activity status. The relative risk for osteoarthritis associated with hip injury was 9.72 (CI, 1.12 to 84.45) in the group that was physically active at baseline and 4.92 (CI, 0.63 to 38.38) in the group that was not. Because the study included few cases of hip osteoarthritis, the confidence intervals around these estimates were wide. A sensitivity analysis was conducted to determine how severe a potential missing confounder would have to be to affect the results. We found that the risk for knee osteoarthritis associated with joint injury decreased only modestly with a confounder (omitted covariate) that was related to the exposure (knee injury) with an odds ratio greater than 2.5 and to the outcome (knee osteoarthritis) with a relative risk greater than 3. Discussion In this cohort study of former medical students who were enrolled in their twenties, joint injury was related to a substantial increased risk for future knee osteoarthritis. In addition, injury at the knee and hip joints during follow-up resulted in a greater incidence of later osteoarthritis at that joint. Our findings also indicate that the risk for knee osteoarthritis associated with previous injury is not explained by confounding due to heavier body weight or higher level of physical activity in young adulthood. Cross-sectional studies have shown that a history of joint injury is related to knee and hip osteoarthritis (23, 24). For example, a history of knee fracture, severe knee sprain, or swelling in NHANES participants was associated with prevalent knee osteoarthritis (odds ratio, 16.3 at the right knee and 10.9 at the left knee) (8). A similarly strong association was observed in a population-based case-control study in Bristol, United Kingdom (25). In addition, Finnish former soccer players and weight lifters with knee osteoarthritis were more likely to have a history of knee injury than former athletes without osteoarthritis (26). With regard to hip osteoarthritis, prevalence data from NHANES yielded age-adjusted odds ratios of 24.2 for history of hip trauma among men and 4.17 for history of hip trauma among women (9). Greater risk for hip osteoarthritis in persons with a history of lower-limb injury was also observed in Finnish and English population-based case-control studies (10, 11). These studies, however, have several limitations. When the exposure (injury) and outcome (osteoarthritis) are assessed at the same point in time, it is difficult to discern which occurred first. Injury may result from an unsteady, mechanically impaired knee and may not predate the development of osteoarthritis. In addition, the knee pain and impaired function caused by existing osteoarthritis may influence recollection of previous injury or lead to misinterpretation of early symptoms of osteoarthritis as indicative of an injury, resulting in an overestimation of risk. Prospective studies, in which risk factor status is ascertained before subsequent development of the outcome, are not vulnerable to these biases. Data from the Framingham Osteoarthritis Study, in which a history of knee injury was assessed at a mean age of 71 years and again 8 years later, yielded few reports of injury and inconsistent results that were not statistically significant (13). Our analyses compared the incidence of knee and hip osteoarthritis in a cohort of young adults who were not selected on the basis of collegiate or professional athletic status. This longitudinal cohort study extends previous reports by using prospectively collected data and is not susceptible to the previously discussed biases. Knee injury sustained at a mean age of 16 years was associated with an increased lifetime incidence of subsequent knee osteoarthritis. Our study has several limitations. It included only a small number of women because the cohort was assembled from 1948 to 1964, when women made up only 10% of entering medical school classes. Because of this small number, we could not meaningfully analyze sex-specific risk in women. Our results are strictly applicable only to physicians and may not be generalizable to persons in other occupations. However, if the frequency of joint injury is greater in other populations and is associated with a similar lifetime risk for future osteoarthritis, our data may underestimate the burden of osteoarthritis associated with joint injury in the general population. Information on family history and other possible risk factors for osteoarthritis was not incorporated into the study protocol when this cohort was initiated; therefore, we were unable to consider all potential confounders. In addition, relatively few persons had knee and hip osteoarthritis, which limited the statistical power and yielded wide CIs. The risk could also have been overestimated if persons with a joint injury were more apt to recognize early symptoms and seek radiographic evaluation. The Precursors Study participants, however, are known to be highly accurate in their self-report of chronic diseases, including cardiovascular disease (27) and gout (28). Although radiographs were not obtained on all incident events, approximately 80% of participants with self-reported osteoarthritis responded affirmatively to symptom-based screening questions (29) or reported having radiography that demonstrated the hallmarks of osteoarthritis (20). The association between injury and knee osteoarthritis was as strong or stronger when confirmed cases were used as the outcome. Further support for the validity of self-reported osteoarthritis comes from a study of community residents in Australia. In this study, osteoarthritis was confirmed 81% of the time after examination by trained metrologists (30) using the American College of Rheumatology criteria (31). The joint is a complex organ, made up of periarticular and subchondral bone, articular cartilage, synovial membrane, joint capsule, and periarticular musculature. Deleterious effects of trauma that compromise the structural integrity of one or more of these joint constituents are implicated in the development of osteoarthritis (32-34). Harmful forces inflicted on a joint during an injury lead to cartilage breakdown, trabecular microfracture, and bone remodeling (35, 36). It is noteworthy that knee osteoarthritis is induced in animal models by transection of the anterior cruciate ligament or by injury to the meniscus (37, 38). Joint injury may also adversely affect muscle tissue as a direct result of the injury or indirectly through disuse atrophy during convalescence. Moreover, weakness of the quadriceps muscle is related to both prevalent and incident knee osteoarthritis (39, 40). Novel drug treatments for osteoarthritis are currently being developed (41). Some of these drugs are understood to have a chondroprotective effect, including inhibition of degradative metalloproteinases. Such agents may stabilize or reverse the course of an early osteoarthritic joint. Persons with a risk factor linked to the development of osteoarthritis are suitable participants for such investigational therapy (42). Our findings strongly demonstrate that adolescents and young adults with traumatic injury to the knee joint, as well as persons with knee and hip injuries incurred during middle age, are at substantially increased risk for osteoarthritis at the same joint later in life. Such persons constitute a high-risk group and are an ideal population to target for primary prevention of osteoarthritis. Physicians who encounter a young patient with a knee or hip injury should consider recommending joint-stabilizing braces and temporary modification of high-impact exercise to minimize further damage. In addition, physicians should advocate use of proper sports equipment under safe conditions to prevent joint injuries and decrease their long-term sequelae. Author and Article Information From Johns Hopkins University, University of Maryland, and Veterans Affairs Medical Center, Baltimore, Maryland. Presented in part at the 60th National Scientific Meeting of the American College of Rheumatology, Orlando, Florida, 19-22 October 1996. Acknowledgment: The authors thank the members of the Precursors Study, whose dedicated participation over 47 years has made this work possible. Grant Support: In part by grants from the National Institutes of Health (AG-01760, KO8 AR-01939) and a Postdoctoral Fellowship award from the Arthritis Foundation. Requests for Single Reprints: Allan C. Gelber, MD, MPH, PhD, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205. Requests To Purchase Bulk Reprints (minimum, 100 copies): Barbara Hudson, Reprints Coordinator; phone, 215-351-2657; e-mail, mailto:bhudson@mail.acponline.org. Current Author Addresses: Dr. Gelber: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205. Dr. Hochberg: University of Maryland School of Medicine, 10 South Pine Street, MSTF 8-34, Baltimore, MD 21201. Ms. Mead and Dr. Wang: The Precursors Study, 2024 East Monument Street, Suite 2-200, Baltimore, MD 21205. Dr. Wigley: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7300, Baltimore, MD 21205. Dr. Klag: Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205. Author Contributions: Conception and design: A.C. Gelber, M.C. Hochberg, L.A. Mead, M.J. Klag. Analysis and interpretation of the data: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag. Drafting of the article: A.C. Gelber, M.C. Hochberg, M.J. Klag. Critical revision of the article for important intellectual content: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag. Final approval of the article: A.C. Gelber, M.C. Hochberg, L.A. Mead, N. Wang, F.M. Wigley, M.J. Klag. Provision of study materials or patients: L.A. Mead, M.J. Klag. Statistical expertise: L.A. Mead, N. Wang. Obtaining of funding: A.C. Gelber, M.J. Klag. Administrative, technical, or logistic support: M.J. Klag. Collection and assembly of data: A.C. Gelber, M.C. Hochberg, L.A. Mead, M.J. Klag. References 1. Creamer P, Hochberg MC. Osteoarthritis. Lancet. 1997;350:503-8. | PubMed | 2. Yelin EH, Felts WR. A summary of the impact of musculoskeletal conditions in the United States. Arthritis Rheum. 1990;33:750-5. | PubMed | 3. Cunningham LS, Kelsey JL. 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Lancet. 1972;1:519-22. | PubMed | 36. Sowers M, Lachance L, Jamadar D, Hochberg MC, Hollis B, Crutchfield M, et al. The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women. Arthritis Rheum. 1999;42:483-9. | PubMed | 37. Altman RD, Kates J, Chun LE, Dean DD, Eyre D. Preliminary observations of chondral abrasion in a canine model. Ann Rheum Dis. 1992;51:1056-62. | PubMed | 38. Little C, Smith S, Ghosh P, Bellenger C. Histomorphological and immunohistochemical evaluation of joint changes in a model of osteoarthritis induced by lateral meniscectomy in sheep. J Rheumatol. 1997;24:2199-209. | PubMed | 39. Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997;127:97-104. | PubMed | 40. Slemenda C, Heilman DK, Brandt KD, Katz BP, Mazzuca SA, Braunstein EM, et al. 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Title Causation, incidence, and costs of traumatic brain injury in the U.S. military medical system. Author Ommaya AK; Ommaya AK; Dannenberg AL; Salazar AM Address Defense and Veterans Head Injury Program, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. Source J Trauma, 40(2):211-7 1996 Feb Abstract Hospital discharge records from military facilities and private facilities reimbursed by Civilian Health and Medical Program of the Uniformed Services for fiscal year 1992 were reviewed to identify head injury admissions. Incidence rates, case fatality rates, causes of head injuries, and direct cost for hospital admissions were computed in this well-defined population. For fiscal year 1992, there were 5,568 hospitalized cases of noncombat head injury in the military medical system. The age-adjusted head injury rates for ages 15-44 years are higher in active-duty individuals compared with other beneficiaries (1.6 times greater for men and 2.5 times greater for women). The total cost for hospitalization in this population was $43 million. Private facility rehabilitation accounted for 26% of all private facility costs but only 6% of head injury cases. Firearms and motor vehicle crashes caused the most severe injuries for cases admitted to military facilities. Motor vehicle crashes, falls, and fighting accounted for 80% of the total military facility cost for head injuries. Military active-duty individuals are at increased risk for noncombat head injury. Prevention of head injury in military settings should focus on motor vehicle crashes, fist fights (assault), and falls. Language Eng Unique Identifier 96231945 MESH Headings Accidental Falls ; Accidents, Traffic ; Adolescence ; Adult ; Age Factors ; Brain Injuries CL/EC/*EP/ET ; Comparative Study ; Female ; Hospitals, Military EC ; Human ; Incidence ; Injury Severity Score ; Length of Stay ; Male ; Military Personnel * ; Retrospective Studies ; Sex Factors ; Support, U.S. Gov't, P.H.S. ; United States EP Publication Type JOURNAL ARTICLE ISSN 0022-5282 Country of Publication UNITED STATES

From the National Center for PTSD Traumatic Stress and Motor Vehicle Accidents A National Center for PTSD Fact Sheet By Todd Buckley, Ph.D. Introduction Motor vehicle accidents are coming under more study as a common cause of traumatic stress. In one large study, accidents were shown to be the most frequent traumatic event experienced by males (25%) and the second most frequent event experienced by females (13%) in the United States. Over 100 billion dollars are spent every year in direct care of the damage caused by personal injury auto accidents. An additional and often overlooked burden of severe MVAs is the emotional distress that is endured by survivors of such accidents. Mental health difficulties such as posttraumatic stress, depression, and anxiety, can all be problems experienced by survivors of severe MVAs. This fact sheet addresses important issues related to MVAs including: how many people experience a serious MVA, how many people develop MVA-related Posttraumatic Stress Disorder (PTSD) and other psychological reactions, what are the risk factors for MVA-related PTSD, and what is the treatment for MVA-related PTSD? How many people experience a serious motor vehicle accident (MVA)? An unfortunate consequence of the high volume of commuter/personal travel in our country is the number of accidents that result in personal injury and fatalities. In any given year, approximately 1% of the US population will be injured in a motor vehicle accident (MVA). Thus, MVAs account for over 3 million injuries to the American public on an annual basis and are one of the most common traumas individuals experience. How many people develop MVA-related PTSD and other psychological reactions? Research from individuals seeking treatment and those in the general population suggests that the majority of individuals who survive a serious MVA do not develop mental health problems that warrant professional treatment. However, a substantial minority of MVA survivors suffer from mental health problems, the most common of which are: Posttraumatic Stress Disorder (PTSD), Major Depression, and Anxiety Disorders. In studies of people in the general population, approximately 9% of MVA survivors develop PTSD. Rates are significantly higher in samples of MVA survivors seeking treatment. Studies show that between 14% and 100% of MVA survivors seeking treatment have PTSD, with an average of 60% across studies. In addition to their PTSD, between 3% and 53% of treatment seeking MVA survivors have a mood disorder such as Major Depression. Finally, in one large study of MVA survivors seeking treatment, 27% had an anxiety disorder in addition to their PTSD and 15% reported a driving phobia. What are the risk factors for MVA-related PTSD? Recent research efforts have started to identify variables that have predictive value when trying to determine who might experience PTSD after a serious accident. The use of such research allows for early identification of individuals at risk for long-term mental health problems secondary to their accident. The research focusing on identifying "at risk" individuals has been directed at three sets of variables: characteristics about the individual that were present prior to the MVA, accident-related variables, and post-accident variables. Pre-accident variables such as poor coping to previous traumatic events, presence of a pre-accident mental health problem (e.g., depression), and poor social support have all been linked to the development of PTSD following severe MVAs. With respect to accident-related variables, the amount of physical injury, potential life-threat, and loss of significant others have been predictive of the development of mental health problems such as PTSD. That is, as the amount of physical injury and fear of dying increase, the greater the chance of developing PTSD. Post-accident variables that are predictive of PTSD following MVAs are: rate of physical recovery from injury, social support from friends and family, and active re-engagement in both work and social activities. To the extent that physical limitations will allow, survivors of MVAs should be encouraged to maintain as much of their pre-accident lifestyle as possible, with as much support from family and friends as can reasonably be expected. Such coping strategies appear to be linked with positive mental health outcomes. What is the treatment for MVA-Related PTSD? One aspect of MVA-related PTSD that is different from many other traumas is the increased likelihood of being injured or developing a chronic pain condition following the trauma. As a result, many people who have been in a MVA present first to their primary care physicians for treatment and do not consider psychological treatment for some time. Unfortunately, studies have shown that approximately half of the people who develop MVA-related PTSD continue to have symptoms for greater than six months or a year without treatment. Therefore, it is important to identify the symptoms early on and seek appropriate psychological treatment. There are a number of different treatment approaches that have proven effective for the MVA-related PTSD. Treatments include behavior therapy, cognitive therapy, and medications. In addition, it may be useful to work with a chronic pain specialist to help manage the pain caused from being injured. Sometimes these treatments are provided in conjunction with one another. Readers who are interested in more extensive information regarding treatment and provider contacts will find the following websites useful: American Psychological Association (www.apa.org), Association for Advancement of Behavior Therapy (www.aabt.org), The International Society for Traumatic Stress Studies (www.istss.org), and the American Psychiatric Association (www.psych.org). Additional Information A full exposition of the personal and accident-related characteristics that are associated with poor mental health outcomes after MVAs can be found in an excellent book, After the Crash, by Blanchard and Hickling (1997). This book also covers a comprehensive approach to treatment for clinicians working with severe accident survivors. This book and other extensive readings in this area of research can be found in the references provided at the end of this fact sheet. SUGGESTED READING ON PSYCHOSOCIAL RESEARCH AND MOTOR VEHICLE ACCIDENTS Blanchard, E.B., & Hickling, E.J. (1997). After the crash. Washington DC: American Psychological Association. Blanchard, E.B., Hickling, E.J., Barton, K.A., Taylor, A.E., Loos, W.R., & Jones-Alexander, J. (1996). One-year prospective follow-up of motor vehicle accident victims. Behaviour Research and Therapy, 34, 775-786. Blanchard, E.B., Hickling, E.J., Forneris, C.A., Taylor, A.E., Buckley, T.C., Loos, W.R., & Jaccard, J. (1997). Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims. Journal of Traumatic Stress, 10, 215-234. Blanchard, E.B., Hickling, E.J., Taylor, A.E., & Loos, W.R. (1995). Psychiatric morbidity associated with motor vehicle accidents. Journal of Nervous and Mental Disease, 183, 495-504. Bryant, R.A., & Harvey, A.G. (1995). Avoidant coping style and posttraumatic stress following motor vehicle accidents. Behaviour Research and Therapy, 33, 631-635. Buckley, T.C., Blanchard, E.B., & Hickling, E.J. (1996). A prospective examination of delayed onset PTSD secondary to motor vehicle accidents. Journal of Abnormal Psychology, 105, 617-625. Ehlers, A., Mayou, R.A., & Bryant, B. (1998). Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Journal of Abnormal Psychology, 107, 508-519. Kuch, K., Cox, B.J., & Evans, R.J. (1996). Posttraumatic stress disorder and motor vehicle accidents: A multidisciplinary overview. Canadian Journal of Psychiatry, 41, 429-434. Taylor, S., & Koch, W.J. (1995). Anxiety disorders due to motor vehicle accidents: Nature and treatment. Clinical Psychology Review, 15, 721-738. LINKS TO INFORMATION ABOUT MOTOR VEHICLE ACCIDENTS AND AUTO SAFETY AAA Foundation for Traffic Safety www.aaafts.org Advocates for Highway and Auto Safety www.saferoads.org DWI Statistics http://www.nh-dwi.com/caip-206.htm National Highway Traffic Safety Administration http://www.nhtsa.dot.gov/ LINKS TO INFORMATION ABOUT TREATMENT OF MENTAL HEALTH PROBLEMS American Psychological Association www.apa.org Association for Advancement of Behavior Therapy www.aabt.org The International Society for Traumatic Stress Studies www.istss.org American Psychiatric Association www.psych.org Top | Format for printing The information on this Web site is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider. For more information telephone us at (802) 296-5132 or send email to ncptsd@ncptsd.org. This page was last updated on June 12, 2000. All information contained on these pages is in the public domain unless explicit notice is given to the contrary, and may be copied and distributed without restriction.

Hello Greg, Welcome to Hadit.com this examination sheet will explain what is supposed to take place. Make sure you take any current or past medical records you find relitive and discuss with the examiner, what service connects you. If your filing for sinus, COPD due to environmental exposures; say dioxins, fuels, fuel ash, deck grinding, painting, Asbestos, stationary and marine boiler work, it would be good to take a couple of medical treatises. Ask the Dr to make a comment on them in relation to your medical history of "symptoms" and occupational service in the military. Allan ###################################################################### Nose, Sinus, Larynx, and Pharynx Examination Nose, Sinus, Larynx, and Pharynx Name: SSN: Date of Exam: C-number: Place of Exam: A. Review of Medical Records: B. Medical History (Including Prior Treatment and Subjective Complaints): Location and nature of the injury or disease. Treatment - type (e.g., surgery, medication, oxygen, respirator, etc.) frequency, duration, response, and side effects. Subjective Complaints Comment on presence or absence of each of the following: Interference with breathing through nose. Purulent discharge. If speech impairment (ability to communicate by speech, ability to speak above a whisper, etc.). For chronic sinusitis, indicate whether pain, headaches, purulent discharge or crusting are present. Describe frequency of episodes. Number of incapacitating episodes per year (defined as requiring bedrest and treatment by a physician) necessitating prolonged (lasting 4-6 weeks) antibiotic treatment. Number of non-incapacitating episodes per year. Other symptoms reported. Effects of condition on occupational functioning and activities of daily living. History of neoplasm. Date of diagnosis, diagnosis. Benign or malignant. Type and dates of treatment. Last date of treatment. C. Physical Examination (Objective Findings): Perform complete examination of area affected by disease and/or injury. Report all findings. Additionally, comment on presence or absence of each of the following: For allergic and vasomotor rhinitis, indicate whether nasal polyps are present. For bacterial rhinitis: Indicate whether there is evidence of permanent hypertrophy of turbinates, granulomatous disease including rhinoscleroma. When there is obstruction (partial or complete) of one or both nostrils, indicate percent of obstruction for each. Is there septal deviation? Is there tissue loss, scarring or deformity of the nose? Sinusitis - Describe tenderness, purulent discharge, or crusting and sinus (es) affected. For disease or injury affecting the soft palate, is there nasal regurgitation or speech impairment? For larynx: Describe current appearance of larynx. Indicate whether there has been a laryngectomy, partial or total. For pharynx: Describe any residuals of injury or disease. D. Diagnostic and Clinical Tests: If there is stenosis of larynx, order FEV-1 with flow-volume loop. If there is facial disfigurement, order color photographs. Include results of all diagnostic and clinical tests conducted in the examination report. E. Diagnosis: Comment on whether the disease primarily involves or originates from the nose, sinus, larynx, or pharynx. Signature: Date: http://www.vba.va.gov/bln/21/Benefits/exams/disexm41.htm

RSG, C-file is your claims file. If you have not requested a copy of this, do it now. It contains everything the VA has on you. Service medical records(SMR's), evidence, duty stations, C&P's, comunications between VARO & VAMC, etc. I have more symptoms and diagnoses. Just tired of thinking about them. Berta, It was a VAMC Dr that first diagnosed MS back in 94'. I saw him for general care. A private Dr agreed & I started recieving Social Security for MS from 1993. I recieved VA Pension for it in 97' maybe. I pushed and pushed the neurologist for years to provide a diagnose other than, Neumuscular Disorder of Unknown Cause. Finally in 2004 a neurologist diagnosed brain injury. A year later in 2005, Dr Bash diagnosed Multiple Sclerosis as directly related to service in the Navy. The VA had no problem with the diagnoses of MS as long as I stayed on Pension. As soon as I filed for service connection, I no longer had it. DM? Ocasionally, my glucose is elevated. My liver enzymes are generally elevated. If I don't watch my diet, sugar intake and eat a little something serveral times a day, I will come real close to passing out. Comes on very sudden. No they say I don't have it.

RSG, these are mine. Multiple Sclerosis TBI Ischemia Cognitive defects Fibromyalgia Hypothyroidism Hypercholesterolemia Hyperlipidemia Hypertention Sinus Brady Cardia Osteoarthritis Difficulty swallowing Chronic sinus infections Chronic Pneumonia/Bronchitis Chronic shortness of breath COAD Chronic Obstructive Airway Disease Bronchial wall thickening Chest pain Ataxia Ocular Inflammation Chronic Pain Disorders neuralgia/neuritis Chronic Headaches Chronic Depression Chronic Bipolar disorder Multiple body tics and jerks Cervical, thoracic and lumbar DJD/DDD Tendon lock GERD Stomach muscle cramps Nausea Skin disorders Numbness in hands/feet Feet swell another size or two some times Pain when I breathe Low body temp: 95-97 Hot and cold flashes

Seems like if we weren't replacing it or polishing it, we were chipping, grinding and painting it Boats. Pete, One of these times I think i'll stop breathing and never start again. I'm not sure Navy is counted as military, when it comes to toxic exposures and granting awards for disease or illness as a result.

68mustang, If they have, I haven't found it yet. After medical holding, my first & only ship was going through a major overhaul at Hunterspoint drydock. When I first came aboard the USS Twining, I was assigned to the deck crew, grinding off the deck skid. When the deck was mostly finished, I was changed to "B" division and put to work on steem lines, valves, tubes and fire boxes. A nice cool out of the way place to work. Those WWII vessels were full of toxins. My duties as a "Boilerman" exposed me to toxic levels of Vanadium Pentoxide(fuel oil ash), Manganese, Asbestos, fuels, radiation, lead paints and whatever was in that grinding dust, and If I'm right about the Twining being used in "Project Shad" testing just off the coast of San Fransisco, that would tell me they knew how I would end up when I got out. Allan

warning! May be offensive to some due to one picture of nudity The Story of Treasure Island http://treasureislandfestival.com/island.php There is one part that is mentioned about hostilities to wards military personnel by bay area residents. I don't remember reading about this before. I lived it, just don't remember reading anything about it, except this one jerk that said we all lied about the hostile treatment. Any service member coming and going out of San Francisco or Oakland after 1968, got the treatment first hand. There were many of us that took beatings and some died before the Navy made it mandatory shore leave or liberty with a buddy. Many of us chose to stay on base, where it was safe. And how safe was it? We lived on this base. Took showers in it, washed our clothes, worked and trained on it and the SF people act like they're waiting for a new species to emerge from it, due to the toxins, "still" left behind.

RSG, this might help us both. Toxic Acres The fill below Treasure Island is filled with dangerous toxins left by the Navy By Ron Russell Published: May 24, 2006 http://www.sfweekly.com/2006-05-24/news/toxic-acres/ Allan

Jaz, I'm praying I can live long enough to see these crooks behind bars, where they belong. I'm taking my meds, getting more mentally healthy and gaining strength through prayer. I sent in the IMO from Dr bash in early Feb,05, and twenty days later the AMC sends for IMO from some contract Dr in Chicago. In March 2006, this jerk refers to the radiology and examination results of a 1997 C&P Exam with Opinion. But mentions,"nothing" of the fully favorable VA Opinion with it. He does state that my 1997 chest xrays, again showed no rib fractures or contusion for the 1968 chest trauma. That comment was his expert opinion for the Issue: residuals of "Blunt Chest Trauma". I wish I could check this Dr out. His IMO is a rubber stamp of a previous SSOC. I have four IMO's from Dr bash they completely blew off as incompetent. They even ignore the VA C&P Exam/opinion in my records. Don't they usually take VA examiners over any outside Dr? Their supposed to give the "benefit" of the doubt or "reasonable" doubt to private Dr's and IMO's, as long as they hold credentials to provide such an opinion. I have six favorable opinions. Where's the benefit or reasonable doubt applied here? Didn't think they could simply dismiss Dr Bash's IMO's. But apparently they can. At least they have in my case. Submitting an IMO will not help no matter who it's from or who pays for it, if they simply ignor it like the favorable VA C&P's. It doesn't matter if it's $2000, $6000 or $20,000 worth of imo's, if all they have to do is give it "no" weight, question their ability to perform and pay one of their whores to say what they want. The simple "fact" is Berta, the VA will not recognize any C&P exam or IMO, except the ones they choose. Nothing different by changing from C&P's to IMO's. To me, IMO's won't help with the DVA. To another vet, maybe it works. If they did it to me, they will treat the rest of us the same eventually is how I'm looking at this. After getting a newly assigned VAMC Dr last summer, he was telling me that what I did by getting an IMO outside of the VA was criminal. Thats just how the AMC has treated me since I turned them in, with their decisions. "While they sleep, work and play, I will spend my life searching to put them away."

http://www1.va.gov/vasafety/docs/IL_10-99-004.htm IL 10-99-004 In Reply Refer To: 13 March 5, 1999 UNDER SECRETARY FOR HEALTH'S INFORMATION LETTER RESPIRATORY DISEASES IN FORMER NAVY DECK GRINDERS 1. This letter calls attention to a concern that some veterans, who served as deck grinders on aircraft carriers in the Navy during the 1970s through the 1990s, may have unrecognized, misdiagnosed occupational lung disease. Reevaluation of a Navy veteran who had been involved in grinding antiskid materials on aircraft carrier decks resulted in a change of diagnosis from sarcoidosis to pneumoconiosis. This case led to a study by staff of the National Institute of Occupational Safety and Health (NIOSH) which found an increased risk for diagnosis of sarcoidosis, especially for African-Americans, associated with service on aircraft carriers. Conversely, another paper reported a decreased risk for a diagnosis of sarcoidoisis in Navy veterans who had served only on "clean ships." 2. Navy veterans who are concerned about possible misdiagnosis of pneumoconiosis as pulmonary sarcoidosis or who have other pulmonary problems possibly related to hazardous exposures in service are being invited to enroll to receive Department of Veterans Affairs (VA) health care. It is recommended that VA facilities provide the following services to veterans who may have occupational lung disease: a. Performance of a Detailed Occupational History. This should include a list of all occupations during Navy service and the duration of each. Any shipboard service and type of ship, such as aircraft carrier, should be identified. Any potentially hazardous exposures should be described. Periods of service performing deck grinding should be specifically noted. All other occupations prior to and after service with the duration of each also should be listed. b. Performance of a Detailed Medical History (1) This should include special attention to respiratory symptoms, diagnosis of respiratory diseases and/or sarcoidosis, and treatment for respiratory conditions during the following 4 time periods: (a) Before service, (b) In service prior to the start of any deck grinding or other potentially hazardous exposure, © In service following the start of any deck grinding or other potentially hazardous exposure, and (d) After service. (2) Attention also should be given to smoking, current respiratory symptoms (e.g., cough, sputum, hemoptypsis, wheezing, dyspnea on exertion, fever, night sweats, weight gain or loss, anorexia, asthmatic attacks), current treatment including medications, need for supplemental oxygen and indication, periods of incapacitation, pulmonary malignancy, and review of previous chest X-rays, biopsy findings and special studies such as Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI). c. Performance of a Detailed Physical Examination. Special attention should be given to findings of cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, congestive heart failure, respiratory failure, and pulmonary and/or extrapulmonary sarcoidosis. d. Performance of Diagnostic and Clinical Tests. Tests could include pulmonary function tests before and after bronchodilation (unless performed within 6 months previously), chest X-ray (unless performed within 1 year previously) (NOTE: Chest X-rays may be sent to be re-read by a certified B-reader, if desired; if a B-reader is not available locally, you may contact the VA Office of Public Health and Environmental Hazards for assistance in identifying one), baseline screening tests (e.g., complete blood count, blood chemistries including calcium) and angiotensin converting enzyme (ACE) levels. Subspecialty consultations and other tests should be obtained if clinically indicated (e.g., referral to a pulmonary specialist, biopsies, CT and MRI studies). NOTE: If there are questions about biopsy findings, review by the Armed Forces Institute of Pathology may be helpful. 3. Veterans should be advised to contact a VA Benefits Counselor or the appropriate VA Regional Office (telephone 1-800-827-1000) if they have questions about or wish to file a compensation claim. 4. This information letter needs to be distributed to all Ambulatory Care physicians. 5. Questions may be directed to the Office of Public Health and Environmental Hazards at 202-273-8575, or if assistance is needed to identify a B-reader. NOTE: Consultations with the VA Program Director for Pulmonary Diseases or occupational health specialists may be arranged if necessary. 6. References a. "Sarcoidosis Among U.S. Navy Enlisted Men, 1965-1993," Mortality and Morbidity Weekly Report (MMWR), Vol. 46, Number 23, June 13, 1997, pp 539-543. b. Jajosky, P., "Sarcoidosis Diagnoses Among U.S. Military Personnel: Trends and Ship Assignment Associations," American Journal of Preventive Medicine, Volume 14, Number 3, 1998, pp. 176-183. S/ by Thomas Garthwaite, M.D. for Kenneth W. Kizer, M.D., M.P.H. Under Secretary for Health DISTRIBUTION: CO: E-mailed 3/5/99 FLD: VISN, MA, DO, OC, OCRO, and 200 – FAX 3/5/99 EX: Boxes 104, 88, 63, 60, 54, 52, 47, and 44 – FAX 3/5/99

Hello RSG, I was in medical holding a couple months on TI in 68', then assigned to Post Office for light duty. Went through two major overhauls at Hunters Point ship yard. Trained often at the damage control center. I wish I could remember what squadron the USS Twining was assigned to in the 7th fleet. Any way, TI was home port. When in port, we trained, trained reserves. I've learned that drums of radioactive disc's to make nuke weapons, were buried underneath the island, after one of the arms reduction agreements, post WWII. I knew there was something about the beer at the NCO club that gave it an off taste. Heres a few more links i'll toss in. PUBLIC HEALTH ASSESSMENT NAVAL STATION TREASURE ISLAND HUNTERS POINT ANNEXSAN FRANCISCO COUNTY, CALIFORNIA ENVIRONMENTAL CONTAMINATION AND OTHER HAZARDS http://www.atsdr.cdc.gov/HAC/PHA/treasure/tre_p2.html Federal Facilities Site Information NPL (National Priority List) Sites Region 9's, Pacific Southwest, Federal Facility National Priority Superfund List http://www.epa.gov/region09/waste/sfund/fe...acsiteinfo.html U.S. Nuclear Accidents 16 May 1969 The U.S.S. Guitarro, a $50 million nuclear submarine undergoing final fitting in San Francisco Bay, sank to the bottom as water poured into a forward compartment. A House Armed Services subcommittee later found the Navy guilty of "inexcusable carelessness" in connection with the event. http://www.lutins.org/nukes.html#subs

fwd also airs earlier Monday, February 18, 2008, at 08P , EST Also airs, Sun Feb 24, 4 PM & Mon Feb 25, 4 PM EST -------------------------------------------------------------------------------- From: VeteranIssues@yahoogroups.com [mailto:VeteranIssues@yahoogroups.com] On Behalf Of Colonel Dan Sent: Monday, February 18, 2008 12:58 PM To: Veteran Issues by Colonel Dan Subject: [VeteranIssues] FW: Inside the Vietnam War - National Geographic Channe, Feb 18, evening Monday, February 18, 2008, at 11P Also airs, Sun Feb 25, Mon Feb 25 Inside the Vietnam War takes you inside covert operations, gives you a seat at the military strategy table and lets you witness the emotional toll of war through the eyes of the soldiers and the pilots who undertook dozens of death-defying missions. Woven together with testimonials from more than 50 Vietnam veterans, archival audio and video footage, and never-before-seen photos, the special features the harrowing firsthand http://channel.nationalgeographic.com/chan...y/20080218.html -------------------------------------------------------------------------------- From: seabee40 [mailto:seabee40@comcast.net] Sent: Monday, February 18, 2008 11:21 AM To: colonel-dan@sbcglobal.net Subject: Inside the Vietnam War - National Geographic Channel I thought maybe some guys on your email list might be interested in this, we don't get the National Geographic channel, so I won't be able to watch it ------------------------------------------------------------------------------------------------------- Subject: Inside the Vietnam War - National Geographic Channel On president's Day February 18, the NGC, will play a three hours special. " inside the Vietnam War." I hope and pray that you will pass this notice on to all your friends to watch this documentary. It will help to explain the WAR to loved ones and friends. All agreed it was very well done since it is from the Capt/Private perspective - not the political level, except as politics led to battle actions. While the movie starts at the beginning with the "advisors" it really gets started with the battle of Ia Drang Valley. They interviewed then LTC Hall Moore [LTG] about the battle. Spectacular footage and maybe some of todays troops can learn some things. Good focus on TET which I happened to participate in and thence on to the final stages. One word of warning, if a loved can not stand looking at battle casualties in the raw, maybe they should not watch. T he documentary is real war where real people are getting wounded and killed. This documentary as with the personal knowledge that I have is that the American military forces never lost a battle in the Vietnam War!!! not one! Further I swear to all who may read this and as documented in this movie, The VC and the NVA were totally defeated after TET! There were NO VC left. WE could have declared victory and left, but as every Vietnam Vet knows the American public turned on us and the WAR. General Giap got it right the American Public will tire of the WAR and we will win it - EVEN though we can not defeat the Americans militarily. We Vietnam Vets have vowed this will never happen again and we will NEVER allow Vets to retun home un-welcomed. http://channel.nationalgeographic.com/chan...y/20080218.html "Keep on, Keepin' on" Dan Cedusky, Champaign IL "Colonel Dan" See my web site at: http://www.angelfire.com/il2/VeteranIssues/

From: Sp5kelley2nd94th@aol.com [mailto:Sp5kelley2nd94th@aol.com] Sent: Sunday, February 17, 2008 10:25 AM To: undisclosed-recipients: Subject: VAC VA Process Committee review response VAC VA Process Committee review response http://www.2ndbattalion94thartillery.com/C...etingreview.htm Kelley VAC Subcommittee Disability Claims Process Oversight Meeting February 14, 2008 Instead of a subcommittee hearing, this was the perfect example of Veterans Affairs being nothing but a fill in committee. On the 14th this oversight meeting should have been listed as a micro-miniature subcommittee as there appeared to be, two members there and sometimes down to one holding oversight meetings on the claims process system. Assuming there is one - other than reject, deny, and stall. Compare that to the Roger Clements congressional “standing room only hearing” and we can clearly see where the congressional importance is as well as the nation in all the talk shows and news shows. Moreover, it isn’t the Veterans or how they are treated for doing nothing wrong or even suspected of any wrongdoing as the subject matter. The most important subject that affects the most Veterans and their families regarding how claims are handled and adjudicated and why there is a backlog of over 600,000 claims and growing was discussed at way to high of a level for the most part. A backlog that has been the subject at least since the 1980’s and still it cannot be and has not been resolved nor even the real rational as to why it cannot be solved even been identified. Excuses and so-called fixes are about gone and used up; although several have been revisited. Now, VA just makes up things and they are allowed to make statements with no challenges. A quorum of two subcommittee members in oversight heard the testimony of four panels of experts (see http://veterans.house.gov/hearings/hearing.aspx?NewsID=189) Three of the panels it was hard to tell the difference between the VA speaking and the panel members. One panel had a legal background and some had worked for the VA prior to being associated with this panel. Our submitted statements for the record to reduce 200,000 claims in six months as you can see in panel five did not make the grade. While Kurt Pressman’s testimony, one of our guys did make it in. I think you will find the submitted statements by the Harvard Professor Linda Bilmes interesting as to how the civilian world processes claims in comparison to the VA; handling 30 million claims a year and pays 98% of them within 60 days. I think you will also find it interesting that the VSO’s, especially the VFW, made a direct point that they did not support the recommendations by the Harvard professor and her analogy and recommendations. Bet that makes you wonder why you are paying dues to these folks and their organizations. Just maybe there is a conflict of interest there, as VA can politically lobby (threaten) the VSO’s to support this or that or not support this or that; but in turn, VSO cannot return the favor. Also makes me wonder why congress even puts any credence at all, in what they say or present as representatives (?) of stakeholders; but yet they still do. I was also miffed at VVA not being there or submitting for the record. One can only say, with the longevity of this issue of decades that within the government the ultimate reasons it has not been solved; is because the government does not want to solve the problem due to yearly budget control to mask the cost of war, cover the mistakes made by DoD in herbicides and Gulf War issues (etc), and the White House philosophy of only support what you have to keep enlistment. Those that served in the past, the White House memo by the Reagan/Bush White House to all federal agencies not to associate death and disability to the usage of DoD herbicides should have read = We “the Presidents,” as their commander’s and chief have chosen not to fund or identify our government damaged Veterans…just let them die off and become disabled with no compensations or award of service connection compensations or recognition of dying for the nation…their damaged offspring and widows that are left, can fend for themsleves. Some highlights that I recall: · The amount of abandoned VA claims was simply mind-boggling. This was attributed to many reasons. One of which was the complexity of the process and the lack of real professional legal guidance. I was hoping they would give the delta between Veterans claims and Widows claims that were abandon as the subject came up. That did not happen. Nor was it stated the number only represented Veterans claims and was not inclusive to the widows that finally just give up. · The analogy of the little fellow pushing the rock up the hill then only to find once at the top it rolled backed down and he had to start all over pushing the rock back up again was compared to the VA system of claims processing. My analogy would have been Veterans or widows A-Z push up the ball. The balls name is one of the many disorders that should be classified as presumptive. So, lets call the ball Esophageal Cancer. Each one in turn tries to roll the ball up the hill called VA. After five years some are BVA approved, some are denied, and some are remanded. Yet, the ball was the same only with different A-Z pushing. The exact same ball; and some make it, some take longer, some never do make it, and some just give up. As each A-Z gets to the perches on the hill and continues after each perch, the incline of the hill (VA) gets government controlled increased thus making it harder and harder to climb the hill. · The amount of overturned VA claims on one side stated that 80% of VA denials were BVA overturned. Of course, VA denied this and said that they only had 20% of their claim decisions overturned. This is where the crux of our submitted recommendations was rooted. Even at 20-40% of the claims being eventually overturned, one must realize the amount of claims we are talking about. These claims would be in the range of 2 – 10 year claim resolution down to a maximum of six months to approve. Considering that many of these are simply duplicates of the exact same claim with different Veterans or widows rolling the rock uphill. If one is approved even if it was approved in, the context “it is just as likely as not” was herbicide, gulf war, or service in an area, etc attributable then all such claims should be approved. An error has been found and the flow down back to the VA should be that all such claims that are similar should be approved. An example of this was given in our proposal of such cases as esophageal cancers that BVA found at least as likely as not associated to service in Vietnam and herbicides. · Of course, the subject was brought up that VA in some cases just ignores BVA pronounced and mandated actions on a claim. On the other hand, as we have found in the past they sit for five years while VA sits on them with no action at all. · One of my pet topics was the fact VA says they determine claims within 6 months or so. VA seems to have a hard time figuring out what day of the week it is within 6 months. Arguing over whether it should be 160 days or 145 days is pointless. The reason why? This seems to be when you get the first denial or request for more data – resolution or determination of the claim has just begun not some - we are done within 6 months therefore give us credit. Presumptive cancer disorders are not approved in 6 months that require little if any real thinking or decisions. Remembering the civilian counter point of 30 million claims in one year and resolved in 98% of the cases within 60 days gives one reason to question why the government keeps paying VA for non-performance. I think most of us know why. As you may recall Nicholson recanted under oath before the committee that all parts of the claim must be resolved and that was one reason for the delay of years for the Veteran receiving anything with regard to financial support. Yet, one of the lead VA guys testified under oath that VA in some cases such as amputees that VA fund that immediately and worry about the loss of hearing and such as that later. Now that is directly opposed to the excuses made previously. That I would like to see a real honest report on as to how many VA is treating this way without an act of congress. I would also point out that an amputee recovering is probably not going to die while there are many issues that the Veteran is going to die from and still cannot get this kind of service this VA fellow was discussing under the same scenarios of award the known and associated now and figure out the other later. While Nicholson got out of this VA mess, I think he inherited nothing but a cluster foul up. The only thing he said while in office that made any sense to me was, Veterans should not have to fight for earned benefits. Yet, we know they did then and still do. The one issue that chapped my butt and always has. Somehow, in context of Veterans Entitlements was brought up. Entitlements are something the government gives away based on something that does not involve any earning of such entitlements. In other words, the government receives nothing in exchange, as the red grows even larger with more and more entitlement programs > leaning evermore towards a socialistic society. Veterans Benefits the nation received something in exchange called freedom and a constitution that still stands. While everyone must agree that, those receiving these benefits based on honorable service and in many cases valorous service under the most despicable of all circumstances one citizen can ask of another citizen is hardly in the context of an entitlement. In addition, it is clear that those receiving these “earned benefits” are not privy to the constitutional guarantees that our constitution demands of our lawmakers and elected officials for all citizens. Now we find that our lawmakers even mandate these guarantees to the illegal as well as the terrorist bent on destroying the constitution that those removed by our lawmakers from these constitutional rights have defended. Something not right with this way of thinking? You bet!!! One politician in our history stated centuries ago in the form of; “when the government creates the Veteran the citizen is not laid aside.” Yet, it has been down hill since then with more and more rights being stripped away. A hallmark of inverse action so eloquently stated by our first President was in the form of the Feres Doctrine and its nefarious usage by both DoD and VA and the Executive Branch. Somehow our congress agreed with this stripping of the marquee sign on the Supreme Court = Equal Justice for All. For Veterans, this is nothing but a joke; a sick congressional joke. It probably should be revised to say; Equal Justice for All (except for Veterans and their families) this no longer applies to those that served in accordance with the wishes of the nations elected politicians. In that vane and with comparisons of the legal rights of many different segments of society where Veterans do not have those same rights one of the panel suggested that Veterans must be guaranteed “The Veterans Bill of Rights.” Exhibit C: THE VETERANS BILL OF RIGHTS Preamble: It is the intent of Congress to honor the service and personal sacrifices of veterans and their families by ensuring that they have fair and timely access to all the benefits to which they are entitled, including death and disability compensation, medical care, educational assistance, job training, housing and pensions (“VA Benefits”). To this end, 1. Congress recognizes that all veterans have and have always had a Fifth Amendment property interest in the receipt of all VA Benefits. 2. Veterans shall have an unfettered access to retain attorneys at their own expense, and the Fee Prohibition in 38 U.S.C. § 5904©(l) shall be abolished. 3. Veterans should have full rights to judicial review in Article III courts, and the Court of Appeals for Veterans Claims should be abolished, with a transition plan for implementation. 4. Veterans shall have the right to subpoena documents or records from all federal agencies, and all federal agencies shall treat veterans’ document or record requests expeditiously and shall produce all responsive documents within 60 days. 5. Veterans shall have the right to call any VA employees as witnesses at any regional office hearings related to veterans’ benefits, including treating physicians or other medical personnel and anyone else who has made any determination in connection with a claim. 6. Congress shall take all necessary measures to insure that the VA delivers on its commitments to provide health care to veterans, and the VA’s practice of denying care to veterans it classifies as having a low priority is disapproved. 7. The VA shall adopt remedies and procedures to timely address cases of alleged denial of or unreasonable delays in providing health care, including notice, an opportunity to call witnesses, and a hearing to any veteran contesting such denial, as well as an expedited procedure in cases of emergency. 8. The VA shall award interest at the federal rate on all retroactive awards of any form of death or disability compensation or pension. 9. Congress shall guarantee and appropriate all funds necessary to provide all veterans benefits in accordance with the VA’s budgets. The above is the minimum of rights that should be guaranteed. To even have to consider this should give most folks and those in congress a moment to pause and think… – What have we done to our Veterans and families? Yet, this will not happen and those that are prospective military personnel should be told before they sign on the dotted line. After they serve they are indeed no longer real citizens but the personal property of the Executive Branch and those in congress that support this stripping of their constitutional rights and to be treated as those politicians in power deem is appropriate…now matter how nonsensical it is and would and could not apply ever to any other segment of society as long as our constitution stands. When I say the minimum, many issues must be added to this Bill of Rights as specific issues: X. Any and all process and procedures use in pronouncing associated disorders to a form of exposures or service in a geographical area “shall be” open, transparent, defined in measurable scientific data points that can be addressed by the real constitutional courts and the stakeholders. · WITH REGARD TO X, any and all government-contracted personnel and heads of such contracts on both sides “shall be” available for testimony under oath and provide the methodology used to determine such associations on behalf of the government and its contracted work. · WITH REGARD TO X, VA “shall provide” where in the now mandated and defined decision matrix at what level the congressional mandated propaganda of the 1984 Benefit of the Doubt rule is applied. · Until X is resolved (and the CONGRESSIONAL actions suggested below), VA nor BVA “shall not deny” any case based on any statements made by the Secretary of VA (judge) or findings by the contracted IOM (jury). The case shall be resolved by the merits of the evidence… not statements of findings of exclusion by others that are subject to bias and perjury with an undefined level of decision processes that can no longer be purely subjective. XX. VA “shall not” ignore those findings that were found associated to civilians around the world from similar exposures that somehow VA has determined does not apply to Veterans. XXX. VA “shall not” ignore the published findings of laws of chemistry for civilians around the world and then conclude these proven and sacred laws do not apply to Veterans. While these next two are cynical in presentation, it shows how unscientific many of these VA and IOM decisions and statements are nothing but subjective scientific garbage based on budgets; not facts. · Since the Secretary of the VA has pronounced time limits, on certain presumptive disorders, VA and IOM “shall present” the actual causation and etiology of such disorders and how a time limit is appropriate in the manifestation. (Obviously, the VA and the IOM must know the actual causation and the processes in that process in order to limit the time after exposures that mandated such decrees by science. Moreover, I am quite sure there are hundreds of thousands of medical doctors around the world that would be interested in what seems to be outside of their intellectual prowess and only privy to the VA and IOM. · Since the Secretary of the VA has pronounced time limits of medical resolution of created disorders, on certain presumptive disorders, VA and IOM “shall present” the actual causation and etiology of such disorders and how a time limit of complete resolution is appropriate. (Obviously, the VA and the IOM must know the actual causation and the processes in that process in order to limit the actual resolution of created medical disorders after exposures that mandated such decrees by science. Moreover, I am quite sure there are hundreds of thousands of medical doctors around the world that would be interested in what seems to be outside of their intellectual prowess and only privy to the VA and IOM. Especially since in many of these disorder medical science is waiting for the answers as to how to treat these disorders that seemed to be a VA and IOM secret… so the pain and suffering of both civilians as well as Veterans will go away and their associated disorders will resolve itself. Congressional mandated actions: Congress, not just the VAC, should immediately call for hearings to the validity of Ranch Hand Study Data used by both VA and BVA in denial. This must include IOM using these flawed statistics and flawed findings to recommend no associations to VA. This would be to determine has there been government interference, has there been a constitutional injustice, and those within the agencies and contracted agencies that have not been forthcoming, for whatever reason, be identified for possible collusion. In addition, an explanation of how so many studies can find increased risk of incidence or significant correlation and yet VA and IOM deny such associations based on what. I would remind the congress that they met for similar issues on a weekend and with the President flying back from Texas on such constitutional rights issues regarding a single citizen. That being Teri Schiavo. It seems the one citizen is more important than the millions when it comes to constitutional rights. But then again with Veterans, their citizenship status is laid aside by congress. For published fatal flaws in Ranch Hand see: http://www.2ndbattalion94thartillery.com/C...ediaReports.htm Almost half of the “non-exposed comparison group” was actually exposed, creating nothing but flawed useless data that was published from 1982 on…used in VA and IOM denials and also cited by BVA in their denials then and up to including the present. ------------------------------------- In addition, see Oversight Congressional transcripts of meeting on Ranch Hand dated March 15, 2000 HEARING before the SUBCOMMITTEE ON NATIONAL SECURITY, VETERANS AFFAIRS, AND INTERNATIONAL RELATIONS of the COMMITTEE ON GOVERNMENT REFORM HOUSE OF REPRESENTATIVES Serial No. 106-163 Participating scientists under oath of charges of: · Use of command influence · Changing concluding medical findings that were already cleared for publication · Serious protocol violations; to include the usage of another executive branch federal agency directives of the office of the Surgeon General in those protocol violations · Changing of Exposure Index as data mounted against the government · Medical issues found associated at a 50% level of increase or higher not brought forward · Study integrity was sorely lacking · Data was not being used properly · Veterans not given a fair assessment of their health status ------------------------------------- Also, see questionable testimony of Dr. David Butler (Senior Program Officer, Veterans and Agent Orange Reports, Institute of Medicine, National Academy of Sciences Also, see questionable testimony of Dr. Susan Mather, Chief Public Health and Environmental Hazards Officer, Department of Veterans Affairs Also, see questionable testimony of Ronald Coene, Executive Secretary, Ranch Hand Advisory Committee, Food and Drug Administration ------------------------------------- Congress shall investigate in oversight why it is other government agencies find many issues associated and yet VA and IOM seem to find these scientific facts not associated. Congress shall investigate in oversight why it is other government agencies find many issues associated and yet VA and IOM seem to find these scientific facts not associated when it deals with Veterans. Does congress now concur with VA and IOM; that Army fatigues and Marine utilities double as some sort of toxic chemical environmental hazard protective clothing? Congress shall investigate in oversight why it is when government scientists (EPA and CDC for example) with actual integrity come forward they are demoted or suspended. Examples Dr. Cate Jenkins at the EPA and toxicologist Christopher De Rosa at the Centers for Disease Control. For the latest in cover-ups see http://www.2ndbattalion94thartillery.com/C...oxiccoverup.htm Quote from that recent article: “There were deficits in immune function, which is significant because some of the chemicals, such as PCBs do affect the immune system and suppress the immune system.” Many studies have shown Veterans exposed as well as civilians develop immune system issues or what is called “a compromised immune system.” This also included many international studies. Yet, exposed Veterans clearly developing the multitude of symptoms some disabling and some not and systemic organ damages are denied by IOM and VA even when medical testing proves their immune system has been compromised. Testing that validates exactly what the studies brought forward. Does congress think this is some sort of spectacular here to fore unknown massive coincidence? It seems so. This also includes our EPA concluded long ago that the amount needed for this compromised immune system requires a much lesser dosage then for a cancer. At least in the short-term response for some cancers, not all. Also once this happens the outcomes are as many disorders that are listed in the medical books. Yet, if congress looks at our hit parade of cancer killers already associated you will not find one association to only a compromised immune system that can also kill and disable. How is that possible? Certainly there are more outcomes in a compromised immune system than VA can count using their fingers and toes. Including that EPA has concluded that not only do these toxic chemical create an ineffective immune system but also an attacking immune system at the same time; the worst of the medical scenarios. A chronic proinflammatory response and yet an immune system degraded to the point of little if any tumor protection is available. No congress, diabetes type II is considered a disease of old age and not immune system associated as in type I. Although with the massive amount of type II early in life for Veterans and civilians alike now … this might be a mischaracterization. Contrary to seemingly congressional belief the chemical companies, using fraudulent studies, do not have more right to produce 50 years of toxic chemicals than citizens do to not live in a toxic chemical environment destroying whole towns and the people in them in the process. (Times Beach, MO and Love Canal, NY.) Anyone at the VA or the NAS/IOM or the CDC or the congress or congressional staffers wanting to debate me on these issues either separately or all at one time, given that any intestinal fortitude is present, please contact me. Charles Kelley ............................................................................... "Keep on, Keepin' on" Dan Cedusky, Champaign IL "Colonel Dan" See my web site at: http://www.angelfire.com/il2/VeteranIssues/