NATIONAL ACADEMIES COMMITTEE AGENT ORANGE AND HEALTH

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1 NATIONAL ACADEMIES COMMITTEE AGENT ORANGE AND HEALTH Peter D. Rumm MD, MPH, Director, Pre-9/11 Era Environmental Health Program Post Deployment Health Service, Office of Patient Care Services Veterans Health Administration 1

2 Overview 1. Introduction to Veterans Affairs and Veterans Health Administration 2. Brief background on legal ground 3. Charge to the Committee 2

3 About VA Mission: Core Values: Integrity, Commitment, Advocacy, Respect & Excellence Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile & Integrated 3

4 VA s Administrations The Veterans Health Administration (VHA) is one of the three major administrations of the Department of Veterans Affairs. Veterans Health Administration (VHA) National Cemetery Administration (NCA) Veterans Benefits Administration (VBA) 4

5 VA Vital Statistics 8.97 Million VA Health Care System Enrollees* 6.74 Million Unique Patients Treated* 6.28 Million VA Supervised & Administered Life Insurance Policies** 4.21 Million Veterans Receiving VA Disability Compensation** 2.45 Million Active VA Home Loan Participants** 1.02 Million VA Education Beneficiaries* 3.40 Million VA Maintained Gravesites* 338,491 Full Time VA Employees* 294,650 Veterans Receiving VA Pension** *As of FY 2015 **As of 12/31/15 5

6 VA Health Care Overview Department of Veterans Affairs 2016

7 VHA s Mission and Vision Mission: Honor America s Veterans by providing exceptional health care that improves their health and well-being. Vision: VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient-centered and evidence-based. This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement. It will emphasize prevention and population health and contribute to the Nation s well-being through education, research and service in national emergencies. 7

8 Hospital System to Health System In 1996, VA began the creation of Veterans Integrated Service Networks (VISNs) to transform VA Health Care from a Hospital System to a Health System. VHA currently has 21 VISNs. 151 Medical Centers 985 Outpatient Clinics 820 Community-Based 151 Hospital-Based 8 Mobile 6 Independent 300 Vet Centers 70 Mobile Vet Centers 103 Domiciliary Residential Rehabilitation Programs 135 Community Living Centers Source: FY End-of-Year Pocket Card 8

9 FY 2015 End-of-Year Totals Enrollees 8.97 Million Unique Patients Treated 6.74 Million Outpatient Visits 95.2 Million Outpatient Surgeries 325,000 Inpatient Admissions 699,100 Lab Tests (Inpatient & Outpatient) Million Prescriptions Dispensed (30-Day Equivalent) Million Prosthetic Services Performed 19.1 Million Source : FY 15 4th Qtr VHA Pocket Card 9

10 VA s Health Care Expertise VA is one of the largest civilian employers in the federal government and one of the largest health care employers in the world. 288,000+ Total VHA Employees 177,000+ Clinical Employees 88,000+ Veteran Employees 10

11 Leaders in Medical Research The groundbreaking achievements of VA researchers 60% of whom also provide direct patient care have resulted in 3 Nobel Prizes, 6 Lasker Awards and numerous other distinctions. 11

12 Preparing the Nation s Health Professionals for Tomorrow VA is the largest provider of health care training in the United States and maintains more than 5,000 individual affiliation agreements at more than 1,800 educational institutions. Every year, clinical traineeships and fellowships are provided to more than 117,000 students in more than 40 professions. 12

13 My HealtheVet A personal My HealtheVet account provides Veterans with 24/7 online access to a variety of tools to manage their health care. Communicate with Participating Patient Aligned Care Team Members View Appointments and Health Information Refill and Track Prescriptions Download and Share Personal Health Record 13

14 Million Veteran Program (MVP) VA is partnering with Veterans to learn more about how genes affect health by establishing a program where Veterans can volunteer to link their DNA with their health information. VA s goal is to collect blood samples and health information from one million Veteran volunteers Since launching the program, more than 200,000 Veterans have enrolled Data collected from MVP will be stored anonymously for research on diseases like diabetes and cancer, and militaryrelated illnesses, such as post-traumatic stress disorder 14

15 Today s Veterans 55% of all Veterans are 60 years old or older M M M M M Million 15

16 Institute of Medicine (IOM) There have been ten updated reports looking at associations with disease plus special reports on the Blue Water Navy and C-123 issues. Renamed the Health and Medicine Division (HMD) part of the National Academies. 16

17 By Statute This is the eleventh updated study in a series of studies on Agent Orange exposures and human health effects. The study is mandated by Congressional legislation (P.L and P.L ). 17

18 Charge to the Committee A new committee established by the National Academy of Sciences (NAS) will conduct a review and update of scientific evidence regarding statistical associations between diseases and exposure to dioxin and other chemical compounds in herbicides used in Vietnam. This statutorily mandated review will build upon and update information developed by previous NAS committees in their report Veterans and Agent Orange (1994), which has had biennial updates to include the most recent report, Veterans and Agent Orange: Update The Eleventh Biennial Update will focus on scientific studies and other information developed since the release of those earlier reports. The new committee will also brief the Department of Veterans Affairs (VA) and other interested stakeholders, including the U.S. Congress. 18

19 Charge to Committee Cont. Public Law 102-4, The Agent Orange Act of 1991, extended by Public Law , direct the Secretary of Veterans Affairs to contract with the NAS to conduct a comprehensive review of scientific and medical literature on health effects from exposure to Agent Orange and to conduct biennial updates. The statute directs each new NAS committee to determine, to the extent that scientific data permit, meaningful determinations: Whether there is a statistical association between the specific diseases and herbicide use, taking into account the strength of the scientific evidence and the appropriateness of the methods used to detect the association; The increased risk of disease among individuals exposed to herbicides during service in Vietnam; and Whether there is a plausible biologic mechanism or other evidence of a causal relationship between herbicide exposure and a disease. 19

20 Charge to Committee Cont. In evaluating the long-term health effects of herbicide exposure among Vietnam War Veterans, the committee should look broadly for relevant information. Information sources to pursue could include, but are not limited to: Published peer-reviewed literature related to herbicide exposure among the Vietnam War Veteran population; Published peer-reviewed literature related to herbicide exposure among similar populations, such as Allied military personnel; and, Published peer-reviewed literature related to herbicides in other populations. 20

21 Charge to the Committee Cont. In addition to summarizing the available scientific and medical literature regarding the multi-system response to herbicide exposures and subsequent acute and long-term health consequences on Vietnam War Veterans, the National Academies will assess the current research available on possible generational health effects that may be the result of exposures to these chemicals including the biologic plausibility or potential for an exposure to lead to an increased risk of birth defects or other adverse conditions in the descendants of male Veterans and will address myeloproliferative neoplasms (MPN) as part of its consideration of the literature concerning leukemias and related diseases. The report will offer findings, conclusions, and recommendations as appropriate. 21

22 Questions? Thank you for serving on this important committee PDHS Contacts Peter D. Rumm, MD, MPH Director, Pre-9/11 Era Environmental Health Program, Post Deployment Health Service (PDHS) Ralph L. Erickson MD DrPH Chief Consultant, PDHS - 22

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