Review of the Health Effects in Vietnam Veterans of Exposure to Herbicides
Eleventh Biennial Update, Meeting 4, November 30, 2017
Under VA law, MGUS is a “disability” (because it is a disease)
International Classification of Diseases (ICD-10) Code D47.2
Not merely a lab finding, MGUS reduces life expectancy
Like the subclinical form of the Agent Orange (AO) presumptive disease, hypothyroidism, MGUS may be asymptomatic and noncompensable
Like other AO presumptive diseases, the prevalence of MGUS increases with age, e.g., type 2 diabetes, ischemic heart disease, and prostate cancer
MGUS is a precursor to the following AO presumptive diseases:
Multiple myeloma (MM is preceded by MGUS 100% of the time)
Non-Hodgkin’s lymphoma (WM is often preceded by IgM subtype of MGUS)
AL amyloidosis (AL is preceded by MGUS 100% of the time)
MGUS may precede chronic lymphocytic leukemia (CLL is another AO disease)
Operation Ranch Hand findings establish a positive association and increased risk
Show exposure to Agent Orange more than doubles the risk of MGUS
Suggest higher dioxin levels in blood fat increases MGUS risk
Show that even comparison Veterans had been exposed to dioxin
Support previous findings of pesticides/herbicides increasing MGUS risk
Support MGUS as having a key role in the pathway to multiple myeloma
Support an association between Agent Orange exposure and multiple myeloma
MGUS is associated with chronic immune system stimulation/dysregulation
Dioxin stored in the bodies of Veterans increases MGUS risk
Infections increase MGUS risk
Autoimmune diseases increase MGUS risk
Inflammation increases MGUS risk
A reasonable doubt about service connection is resolved in favor of the claimant
Monitoring for MGUS progression and MGUS complications
Typically MGUS is diagnosed incidentally
Lifelong monitoring after MGUS diagnosis is the standard of care
Can give an early warning of diseases like asymptomatic AL amyloidosis
Associated with longer survival in multiple myeloma
Allows better management of potential complications of MGUS, e.g., kidney damage, infections, neuropathy, blood clots
High BMI is associated with increased risk of progression, MM
Dioxin half-life in humans is 7.6 years; increases with body fat and age
VA can waive copayments for MGUS-related care of dioxin-exposed Veterans
Offering MGUS screening to Veterans exposed to dioxin?
Most MGUS does not progress to cancer
Would help Veterans quantify their risks of progression and take action
A MGUS diagnosis may cause anxiety
VA to decide how to balance these issues
Evidence supporting the above statements is attached.