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Use and effects of chemical agents on Australian personnel in Vietnam - Royal Commission (Hon. Mr Justice P. Evatt) - Final report, dated 31 July 1985 - Report - Volume 2 - Toxicology and general health


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The Parliament of the Commonwealth of Australia

ROYAL COMMISSION ON THE USE AND EFFECTS OF CHEMICAL AGENTS ON AUSTRALIAN PERSONNEL IN VIETNAM

Commissioner: The Hon. Mr Justice P. Evatt, DSC, LLB

Final Report—July 1985

Volume 2: Toxicology and General Health

Presented 22 August 1985 Ordered to be printed 19 September 1985

Parliamentary Paper No. 289/1985

i*e m. .

ROYAL COMMISSION ON THE USE AND EFFECTS OF CHEMICAL AGENTS ON AUSTRALIAN PERSONNEL IN VIETNAM

Commissioner: The Hon. Mr Justice Phillip Evatt DSC. LLB.

A Judge of the Federal Court of Australia

FINAL REPORT

July 1985

VOLUME 2

Australian Government Publishing Service Canberra 1985

© Commonwealth of Australia 1985

ISBN 0 644 04339 3 Set of Volumes ISBN 0 644 04341 5 Report Volume Two

Printed by Canberra Publishing and Printing Co., Fyshwick, A.C.T.

ROYAL COMMISSION ON TH E USE AND E FFEC TS OF CHEMICAL AGENTS ON AUSTRALIAN PERSONNEL IN VIETNAM

Commissioner: The Hon. Mr Justice Phillip Evatt DSC

Secretary: Mr B.D. Meade

31 July 1985

G.P.O. Box 4842 Sydney, N.S.W. 2001 Telephone: (02) 239 6222

Your Excellency,

In accordance with Letters Patent issued to me on 13 May 1983, 27 June 1984, 3 August 1984 and 23 April 1985, I have the honour to present to you the Final Report of my inquiry.

I believe that the Report complies with those Letters Patent and that my task is therefore completed.

Yours sincerely

JUSTICE PHILLIP EVATT Royal Commissioner

His Excellency the Right Honourable Sir Ninian Stephen, A.K., G.C.M.G., G.C.V.O., K.B.E. Governor-General and Commander-in-chief Government House CANBERRA A.C.T. 2600

TABLE OF CONTENTS

VOLUME 2

CHAPTER V

TOXICOLOGY AND SAFE DOSES

1. DEFINITION 1

2. PROCESSES LEADING TO TOXICITY 6

(a) Entry 7

(b) Delivery 8

(c) Primary Targets 9

(d) Secondary Changes due to Modification of Primary Target 9

(e) Toxicity 10

3. TYPES OF TOXICITY 10

4. EXPOSURE TO SEVERAL CHEMICALS 12

5. SAFETY EVALUATION AND RISK ASSESSMENT 13

6. AGENT ORANGE - EVIDENCE OF NOEL AND TOXICITY 6.1 Human Evidence 19

2.4.5-T 20

2,4-D 20

TCDD 21

6.2 Animal Evidence and Extrapolation to Man 23

7. THE ESTABLISHMENT OF CONSERVATIVE SAFE DOSE LEVELS IN MAN 25

7.1 Comparison of Demonstrated Safe Dose Levels of the Constituents of Agent Orange with Exposure to Direct Spraying in Vietnam 26

8. THE SYMPTOMS OF TOXIC EXPOSURE TO THE CONSTITUENTS OF AGENT ORANGE 8.1 The symptoms of Toxic Exposure 31

8.1.2 Symptoms Observed Among Australian Personnel Serving in SVN 33

8.3 Comparison of Theoretical Worst-Case Exposure in SVN and Exposures Following Industrial and Environmental Incidents 34 ENDNOTES 37

v

TABLE OF CONTENTS

VOLUME 2

CHAPTER VI

HEALTH EFFECTS - GENERAL

1. INTRODUCTION 1

2. THE MORBIDITY STUDY PROPOSAL 2.1 Commission's Request for Study and Government's Refusal 3

2.2 Correspondence Requesting Proposed Morbidity Study 10

3. INDIVIDUAL VETERAN'S HEALTH COMPLAINTS - WAA's TEN BEST SHOTS 59

3.1 Evidence of Veterans Re Health Complaints and Conclusions Thereon 61

3.2 General Conclusions from the 10 Best Shots 110 4. OTHER EVIDENCE OF ADVERSE HEALTH OUTCOMES IN AUSTRALIAN VIETNAM VETERANS FROM OTHER SOURCES 4.1 AVHS Mortality Study 114

4.2 Particular Causes of Death - Pointers to General Health Effects 117

4.3 Informal Sessions 127

4.3.1 Alcohol Use 131

4.3.2 Smoking 132

4.3.3 Veterans in Prison 132

4.4 The Team 136

4.4.1 Introduction 136

4.4.2 "The Team" in Vietnam 139

4.4.3 Command Methods of the AATTV 141

4.4.4 Submission of the AATTV 142

4.5 Psychological Symptoms Found Amongst Australian Vietnam Veterans 144

4.6 other Morbidity Evidence Vietnam Veterans, Non-Australian 147

4.6.1 Ranch Hand I 148

4.6.2 Ranch Hand 11 150

5. WAA's Case - ALLEGED NEUROTOXIC AND OTHER EFFECTS 162

5.1 Van Tiggelen's Theory 166

6. INDUSTRIAL AND ACCIDENTAL EXPOSURES 172

7. CONCLUSIONS 174

ENDNOTES 176

vi

TABLE OF CONTENTS - REPORT

VOLUME 1 - INTRODUCTION and EXPOSURE

Prologue

I II III IV

Introduction Standard of Proof Ascertainment of Claims Exposure

VOLUME 2 - TOXICOLOGY and GENERAL HEALTH

V VI

Toxicology and Safe Doses Health Effects General

VOLUME 3 - BIRTH ANOMALIES

VII Health Effects, Reproductive Outcomes and Birth Anomalies

VOLUME 4 - CANCER

VIII Health Effects, Cancer

VOLUME 5 - MENTAL WELL-BEING

IX Health Effects, Mental

VOLUME 6 - MORTALITY CLASS ACTION W A A and SECTION 47

X XI XII XIII

Mortality Class Action Status of W A A Interim Report and S.47

VOLUME 7 - BENEFITS and TREATMENT

XIV Benefits and Treatment

VOLUME 8 - CONCLUSIONS. RECOMMENDATIONS and EPILOGUE

XV Conclusions and Recommendations Epilogue

VOLUME 9 - EXHIBIT LISTS AND BIBLIOGRAPHY

vii

TOXICOLOGY AND SAFE DOSES

1. DEFINITION 1

2. PROCESSES LEADING TO TOXICITY 6

(a) Entry 7

(b) Delivery 8

(c) Primary Targets 9

(d) Secondary Changes due to Modification of Primary Target 9

(e) Toxicity 10

3. TYPES OF TOXICITY 10

4. EXPOSURE TO SEVERAL CHEMICALS 12

5. SAFETY EVALUATION AND RISK ASSESSMENT 13

6. AGENT ORANGE - EVIDENCE OF NOEL AND TOXICITY 6.1 Human Evidence 19

2,4,5-T 20

2,4-D 20

TCDD 21

6.2 Animal Evidence and Extrapolation to Man 23

7. THE ESTABLISHMENT OF CONSERVATIVE SAFE DOSE LEVELS IN MAN 25

7.1 Comparison of Demonstrated Safe Dose Levels of the Constituents of Agent Orange with Exposure to Direct Spraying in Vietnam 26

8. THE SYMPTOMS OF TOXIC EXPOSURE TO THE CONSTITUENTS OF AGENT ORANGE 8.1 The symptoms of Toxic Exposure 31

8.1.2 Symptoms Observed Among Australian Personnel Serving in SVN 33

8.3 Comparison of Theoretical Worst-Case Exposure in SVN and Exposures Following Industrial and Environmental Incidents 34 37

CHAPTER V

ENDNOTES

CHAPTER V

TOXICOLOGY AND SAFE DOSES

1. DEFINITION

Toxicology is the qualitative and especially the

quantitative study of the injurious effects of chemical

and physical agents, as observed in alterations of

structure and response in living systems.1

Although there is no aspect of toxicology that does not

overlap with other disciplines, it contributes in

particular to clinical medicine, legal medicine,

occupational medicine and hygiene, veterinary medicine,

experimental pathology and perhaps most importantly for

present purposes to safety evaluation.

The science is an ancient one dating back to the Ebers

papyrus, perhaps man's earliest medical record (circa 1500

BC) . This document which contains more than 800 recipes

includes many recognised poisons including hemlock, opium, 2

belladonna and even substances akin to digitalis.

Hippocrates of the famous oath introduced rational

medicine about 400 BC and he wrote instructions which

V-l

might well be considered primitive principles of

toxicology.

The ancient Greeks developed the art and the state

disposed of the trouble-making Socrates by use of a poison.

Demosthenes who took the poison hidden in his pin was a

volunteer as was Cleopatra in exposing her bosom to the

asp.

By the fourth century BC in Rome poisoning seemed to have

taken on epidemic characteristics and the first law

against poisoning. Lex Cornelia, was issued by Sulla in 82

BC. This law later became a regulatory statute directed

at careless dispensers of drugs.

The law did not help Claudius who was poisoned by

Aggripina to make Nero emperor of Rome. In similar style

Nero disposed of Britannicus, Claudius' natural son.

The Council of Ten of Venice in their records display the

political use of poisons in large measure. The Borgias

are probably the most famous of poisoners but Catherine de

Medici was also a formidable practitioner of the art of

applied toxicology!

V-2

In the age of enlightenment a most significant figure in

the history of science and medicine. Paracelsus

(1493-1541). formulated many then revolutionary views

which remain an integral part of the present structure of

toxicology. He promoted focus on the toxicon, the toxic

agent, as a chemical entity and held as corollaries that:

(i) Experimentation is essential to an examination of

responses to chemicals;

(ii) One should make a distinction between the

therapeutic and toxic properties of chemicals;

(iii) These properties are sometimes but not always

indistinguishable except by dose; and

(iv) One can ascertain the degree of specificity of

chemicals in respect of their therapeutic or

toxic effects.

He also first voiced the maxim which is absolutely

fundamental to the science of toxicology and which must

underlie any discussion or consideration of it, "Dosis

sola facit venenum".

V- 3

Toxicology is therefore concerned first and foremost with

dose.

Next, it is concerned with modes of ingestion of the

toxin, by inha la tion, by swallowing, or by transference

through the skin.

Then, it is concerned with the target organs or systems

and the body's response to the ingestion of the toxic

substance, (e.g ., the metabolism of the toxin by actions

of the liver and its enzymes upon the toxin). The body's

methods of excreting the toxin and indeed all other

methods of coping or attempting to cope with the attack of

the toxin on the target organ or systems is the next

matter for study.

Lastly, toxicology is concerned with outcome.

This short introduction is not the place for a detailed

analysis of toxicology but the Commission has made itself

familiar with the standard texts of toxicology and taken

the advice of and consulted with eminent toxicologists

both in Australia and abroad.

There are however three concepts that are vitally

important to an understanding of the Commission's approach

V-4

to the toxicological or health effects aspects of its

Inquiry. These are the concepts of dose. threshold and

no-effect level.

In his written statement Dr Frank Dost said:

It is fundamental that all chemicals are toxic; whether they produce toxicity in the laboratory or affect humans in the workplace or in the

general environment depends entirely on how much chemical enters the body (the dose). If the dose is high enough, an effect will result. The issue is not whether the chemical is capable of

intoxication, but whether a given use pattern may result in sufficient exposure to constitute an unacceptable hazard.3

Dr Ian Munro in his written statement said:

It is also a generally accepted principle in toxicology that a threshold dose of a chemical must be achieved before any toxic effect can be measured. Therefore, while high doses of a

chemical may induce toxic effects, lower doses may be administered for the life time of an

animal without inducing any observable toxicity. This phenomenon is explainable on the basis that low doses of most chemicals are readily

detoxified and excreted by animals and man producing no hazardous or lasting effects.4

Dr W. Norman Aldridge, Secretary-General of the

International Union of Toxicology and Director of WHO's

Collaborating Laboratory for the Safety and Use of

Pesticides for Vector Control. dealt with the same topics

as follows:

V- 5

Dose is clearly very important and often

suggestions are made that a particular event occurs due to exposure when the dose which could conceivably have been received by the animal is below that necessary to cause the event. So dosage is a very important parameter and it is almost an obligatory requirement to do what we call a dose response curve, in other words to define the dose often in terms of what is given

to the animal and, even better, what gets into the animal .... there is a threshold below which nothing will happen.5

In that context one must remember that all chemical

substances including water, table salt and mother's milk

have a dose level at and above which those exposed to it

will suffer toxic effects.

Other important aspects of toxicology are as follows:

2. PROCESSES LEADING TO TOXICITY

The processes leading to toxicity may be sub-divided into

several stages:

(a) Entry of the chemicals into the organism;

A graph with dose on one axis, effect on the other producing a curve which represents effects at

particular dose levels and the dose-response

relationship.

V-6

(b) Processes which affect the delivery of the chemical to

its site of action;

(c) The reaction of the chemical at the primary site(s)

which lead on to secondary changes some of which lead

to the signs and/or symptoms of toxicity;

(d) Secondary Changes;

(e) Toxicity.

(a) Entry:

Entry of a chemical can be by many routes; for example

by mouth, skin, lung or injection. The mix of a

pesticide will greatly influence the proportion of the

applied dose which will penetrate the organism. For

example absorption of DDT by the gastro-intestinal

tract is rapid when the DDT is dissolved in oil but

extremely slow from a suspension in water in which it

is very sparingly soluble. For the insecticides which

are the concern of this Inguiry, the main routes of

entry will be via the lung by inhaled droplets and

through the skin.

V-7

(b) Delivery:

Once a chemical gains entry it is transported round

the organism and it may become unevenly distributed by

binding to proteins, storage in tissues etc. It also

becomes available for chemical attack by a variety of

enzymic systems which normally lead to a decrease in

toxicity (detoxification). These processes often lead

to the conversion of the chemical to more

water-soluble compounds which are rapidly excreted.

Sometimes, however, these enzymic processes lead to

the conversion of the applied chemical into a compound

which is more toxic (bioactivation). These enzymic

processes are mainly concentrated in the liver but

also in other tissues, and in evolutionary terms, have

probably developed as a response to the many toxic

chemicals to which man has been normally exposed - in

food, air, etc., and which have enabled him to

detoxify them.

(c) Primary Targets:

It is a general hypothesis that a toxic event results

from an interaction of the chemical with a particular

target (macromolecule, membrane, etc) which may be

V-8

present in one or many tissues. The insecticides

which are the concern of this Inquiry have been

designed to interact with the nervous system of

insects - they can also influence the nervous system

of mammals, including man. The primary targets with

which they react have been established and in some

cases the detailed chemistry of the reaction has been

worked out.

(d) Secondary Changes due to modification of Primary

Target:

These can be many in the nervous system due to its

anatomical and cellular complexity. Measurement of

some of these changes may be the first conclusive sign

that a chemical has gained entry and is sometimes the

ideal way (biological monitoring) to establish the

received dose (in contrast to measurement of the

concentration in the environment in which the organism

exists).

(e) Toxicity:

The processes involved in the production of toxicity

following entry of a chemical are increasingly

V-9

becoming defined in chemical terms. This knowledge

allows us to be more rational about the risk of

exposure to certain doses and means we are not so

reliant on the empirical toxicity testing procedures

in animals. Indeed when there are large differences

in the toxicity of a chemical to various species of

animal it is this more detailed knowledge of chemical

mechanisms of toxicity which allow us to be more

certain about the risks of exposure of man.

3. TYPES OF TOXICITY

Toxicity is usually divided into acute and chronic types.

Acute toxicity is that which appears shortly after one or

a few doses and if death does not occur, recovery is

complete. Chronic toxicity is a long lasting deleterious

alteration in the function of an organism. These

definitions must be distinguished from those describing

the administration of the chemical, ie acute and chronic

exposure. For example, it is quite possible to obtain the

same toxic response by acute exposure and by long

term administration of the chemical. This will only apply

V-10

when the chemical accumulates in the organism and its

biological half-life is long.

Examples are known of the following:

1. Acute toxicity - rapid development of symptoms

followed by complete recovery;

2. Acute toxicity with rapid development of symptoms

(e.g. convulsions. coma) themselves leading to

secondary changes which may be long-lasting;

3. Chronic toxicity caused by prolonged exposure which is

the same as that produced by acute exposure;

4. Chronic toxicity for which prolonged exposure is

required and which cannot be produced by acute

exposure;

5. Chronic toxicity produced by a single acute exposure;

6. Changes in sensitivity produced by several exposures

to a chemical leading to immunological reactions.

The biological half-life of a substance for a species is that period of time during which half of the dose of the substance is eliminated or rendered inactive.

V-ll

Measurements of toxicity (e.g. LD-50) are not precise like

physical constants such as boiling point etc and may vary

between different laboratories for a variety of reasons

even though the animals are from the same strain.

Measurement of what a chemical does in the animal to cause

toxicity in relation to the concentration of the chemical

at the site of action is much more precise.

4. EXPOSURE TO SEVERAL CHEMICALS

We are all exposed to a very large number of chemicals

each in small amounts (food additives, natural products in

foods, pesticides, air pollution, etc) without noticable

effects on health. Examples are known when the toxicity

of two chemicals are:

1. Additive;

2. Potentiate the toxicity of one of them;

3. Are antagonistic and reduce the toxicity of one

or both compounds.

While these effects are known and understood in specific

cases, interactions between chemicals so as to increase

toxicity or to produce a new form of toxicity must be rare.

V-12

5. SAFETY EVALUATION AND RISK ASSESSMENT

Safety evaluation and risk assessment involve the

assessment of potential risks of chemicals to the human

population based upon the results of animal

investigations. These procedures involve both qualitative

and quantitative assessment of risks. The basic

principles underlying this exercise have been enunciated

by WHO.

In essence, three activities are involved here. First,

the assessment of the relevance of animal findings in the

human context. Second, extrapolation of animal data to

the human population and third, assessment of human risk

taking into account the nature, level, frequency and

duration of human exposure along with the estimated risk

from animal studies.

The question of relevance is best dealt with by example.

Many chemicals when administered to animals at very high

doses in the diet may drastically reduce food consumption

leading to apparent signs of toxicity and behavioural

distress. It is thus incumbent upon the investigator to

determine whether this is a true toxic effect or whether

the chemical simply has rendered the diet so unpalatable

V-13

that the animal refuses to eat. This alteration in normal

food consumption may predispose to pathological and

biochemical changes in the liver, kidneys, brain or other

vital organs and in some cases lead to death due to

starvation or nutrient deprivation. This, of course, is

not toxicity.

Similar findings also have been noted in more subtle

toxicities such as carcinogenesis when the feeding of

large amounts of chemicals leads to the production of,

say, bladder stones, a predisposing factor in bladder

cancer in animals. Similarly, chronic administration of

toxic levels of chemicals may induce hepatic toxicity

leading to repeated tissue degeneration and regeneration

which likewise predisposes to liver cancer in certain

strains of animals.

Observations such as these are clearly irrelevant in the

human population particularly those exposed to trace

quantities of chemicals either in the form of air borne or

food borne residues.

In these and similar instances it is largely a matter of

scientific judgment whether the observed effects in

animals are pertinent to the human population.

V - 14

On the other hand, chemicals that induce specific forms of

toxicity and demonstrate this property over a wide range

of doses in a reproducible manner and which do not, at

least in the initial stages of toxicity, profoundly

influence survival, or lead to gross alterations in

physiology that are incompatible with life, are a real

concern. Examples of such chemicals include

methylmercury, the dioxins and naturally-occurring

toxicants such as aflatoxin. Human risk assessment of

such substances obviously needs to take into account the

probability of human toxicity even when exposure is low.

The extrapolation of animal toxicity to the human setting

must take cognisance of the limitations and nature of

animal tests. Animal tests are designed to maximize the

potential of producing a toxicological response and

therefore present a worst case analysis. This is done

purposely so as to reduce the probability of not detecting

dose-effect and dose-response relationships. Large groups

of animals are therefore exposed to a range of chemical

concentrations in their diet, air or drinking water over

the duration of the test. It should be noted that minimum

criteria for the design and conduct of tests acceptable

for human risk assessment have been laid down (by e.g.

WHO) and that those not validated as appropriate for human

risk assessment are of questionable value for this purpose.

V - 15

The extrapolation of animal data to humans begins with

elaboration of the dose-response curve which describes in

quantitative terms the relationship between the applied

dose and the incidence and/or severity of effects

induced. Properly designed tests will have included at

least one dose which does not induce any observable

toxicity within the statistical limitations and power of

the test.

This lowest "no-effect" dose is known as the "no-observed

effect level" (NOEL) a term which is accepted

internationally. The lowest effective dose may also be

described as the "threshold dose" or the dose at which

effects are first observed.

It is the accepted practice in toxicology to translate the

NOEL to a maximum acceptable exposure for humans exposed

in a similar manner as were the animals used for the

test. Two procedures are generally accepted for this

purpose, one being the use of safety factors and a second

being the use of mathematical (statistical) procedures for

risk assessment. The former procedure involves dividing

the NOEL by an arbitrary safety factor such as 100 to 5000

to obtain an acceptable human exposure level.

V-16

The selection of the appropriate safety factors takes into

account the statistical limitations of animal tests, the

nature of the dose-response curve, the expected

differences in susceptibility between animals and humans

and variability (genetic differences) in the human

population. The size of the safety factor will depend

also upon the nature and degree of toxicity and as

previously stated involves expert scientific judgment.

Mathematical procedures are largely reserved for the

extrapolation of carcinogenesis data from animals to man

because of uncertainty in establishing NOELs. These

procedures, by and large, dispense with the threshold

concept which is not generally accepted in carcinogenesis

and are used to establish the statistical probability of

tumour induction at very low doses, doses to which humans

may be exposed.

The final aspect of risk assessment involves the

evaluation of human risk given the nature, degree, level,

frequency and duration of human exposure. In

carcinogenesis testing animals are exposed to high doses

of the chemical in question daily for their entire

lifetime while in most instances humans may be exposed

intermittently or possibly only once or twice during a

lifetime to much lower doses. It is well established that

V-17

cancer induction, particularly at low doses, requires very

long-term exposure, usually 20-30 years or more to elicit

effects in humans. Brief or intermittent exposures may be

of no consequence because:

(a) inadequate target tissue levels are reached to

produce toxicity, or

(b) ongoing tissue repair processes counteract any

induced damage.

Likewise, effects on reproductive processes carried

through the genetic material of the male will require that

toxic tissue levels be present at the time of impregnation

and/or that genetic impairments be induced and not

repaired prior to impregnation. Low level exposure of the

male reproductive system to chemicals at a time far

removed from the time of impregnation would not be

expected to produce birth defects. Thus, risk estimates

predicted solely on the basis of animal tests may

overestimate human risk, particularly when the frequency

and duration of exposure is less than that imposed by the

figures of animal test methods.

V-18

6. AGENT ORANGE - EVIDENCE OF NOEL AND TOXICITY

6.1. Human Evidence

For obvious reasons. experimental evidence of true

no-effect levels in humans for the constituents of Agent

Orange (or any other chemical) is limited. However, there

is valuable material from which doses which cause no

effect can be stated. Because the true threshold or

no-effect level in humans cannot be determined

experimentally as it can be determined in animals. the

material only enables a conclusion to be drawn that

certain doses constitute less than a threshold dose. The

threshold must lie above, and may lie far above„ the doses

which have been administered without effect.

2.4.5-T

It seems clear that the toxic threshold for a single oral

dose of 2.4,5-T lies above a dose of 5 mg/kg body weight.

In studies designed to study absorption and excretion

single doses of that size were administered to volunteers

by both Gehring6 and Kohli7 without any untoward

effects being detected in any of the subjects. That dose

may be compared with the no-effect level proposed by Dr

V-19

Munro8 of between 3 mg and 10 mg/kg body weight daily

for life.

2,4-P

9 10

Similarly, Sauerhoff and Kohli administered single

oral doses of 5 mg/kg to subjects in studies designed to

examine the absorption and excretion of 2,4-D in man, and

detected no untoward effect in any of the subjects. Dr

E.J. Krauss is said to have reported that an adult male

had taken daily by mouth (for reasons unstated) 500 mg of

purified 2,4-D after the midday or evening meals during a

period of 21 days without effect11; the subject's weight

is not stated, but if a weight of 70 kg is assumed, the

daily dose was a little over 7mg/kg per day and the total

dose was 150 mg/kg.

12

Hill and Carlisle estimated on the basis of animal

experiments that a 75 kg man could tolerate a dose of 1500

mg, or 20 mg/kg. Dr Munro estimated a no-effect level in 13

man in the range of 25 mg/kg per day.

TCDD

14

In 1965-6 Kligman conducted a unique series of

experiments in which he administered TCDD dermally to

V-20

groups of volunteer prisoners from the Philadelphia

Prison, Holmesburg, PA. Doses of increasing size were

administered to 6 successive groups each of 10 subjects.

In the group receiving the highest dose in the first

series of experiments, an initial quantity of 8 ug in a

solution of chloroform ethanol was administered to each

subject dermally and covered for 24 hours with a gauze

pad. Fourteen days later he began administering in a

similar manner a total of 80 daily applications of .1 ug

so that each member of the highest-dose group received a

total cumulative dose of 16 ug. The members of each group

were subjected after the first dose and 3-4 days after the

final dose to kidney and liver function tests, they were

examined for signs of systemic illness, and their skin was

examined weekly for 6 weeks after the last dose. No

chloracne was found, and no abnormal clinical results were

measured or illness observed at any of the dose levels.

Subsequently, in a further series of tests, he

administered to 10 other subjects a daily dermal

application of 500 ug of TCDD every alternate day for one

month, so that at the end of that period a total quantity

of 7,500 ug had been applied to the skin of each of the

subjects. After this course of treatment, 8 of the 10

developed chloracne "usually beginning three to four

weeks", but although each week for 6 weeks thereafter.

V-21

urinalysis, CBC, BUN, SCOT, alkaline phosphatase and

creatine clearance tests were performed, all results were

in the normal range, and there was no evidence of toxicity

apart from chloracne among any of the subjects.

Regrettably, the experiments were subject to an enormous

dose leap from 16 ug to 7,500 ug. or, if only the first

application of each series is taken into account, from 8

ug to 500 ug. Somewhere between those levels of

administration lies the threshold for chloracne among 8 of

the 10 study subjects, although it seems that for 2 of the

subjects the threshold for chloracne was not reached and

that for the other effects the threshold was not reached

in any of the subjects even at the highest dose level. On

the other hand, Schulz induced chloracne by two 10 ug 15

applications to his forearm. This does not readily

accord with the second series of Kligman experiments but

does not detract from the conclusion that 8 ug is a safe

dermal application.

6.2. Animal Evidence and Extrapolation to Man

A substantial body of experimental evidence is available

from animal tests in respect of each of the three

constituents of Agent Orange. Much of the evidence is

summarised by Young16 and by Dr Dost.17 It relates to

V-22

many species, is directed to a wide range of effects and

involves a variety of dose regimes. It demonstrates a

broad range of sensitivity among the different species to

each of the ingredients of Agent Orange. While animal

data is of obvious importance to health authorities in

establishing, subject to a safety factor, prospective

standards for human exposure to a chemical, it is equally

obvious that it offers a doubtful basis from which to

determine retrospectively whether a particular past

exposure was sufficient to produce toxic effects in man.

All four toxicologists, Munro, Dost, Reggiani and Aldridge

consider that there is a relationship between animal

effects and humans but that it is irregular and

uncertain. This is why high safety margins are used for

, „ 18

regulatory purposes.

There are good grounds upon which to infer that man is

less sensitive to TCDD than animals. Such a view was 19

expressed by Professor Holmstedt who pointed out that

animals brought into the contaminated areas after the

Philips-Duphar and Spolana exposure incidents died, while

there were no deaths among humans. and that many horses

and other smaller animals died after exposure to the

contaminated horse arena at Missouri while the exposed

V-2 3

humans, including children who played in the contaminated

arena, suffered only transient effects. A similar view

was expressed by Dr Dost20 and by Dr Taylor.21

The animal data offers only limited assistance to the

Commission in considering the likely effects among

Australian personnel or their families of any exposure to

Agent Orange which may have occurred in Vietnam. Most

animal experiments involve high doses (often near fatal)

over a significant proportion of the life of the animal.

Vietnam, at most, involved transient short exposures for a

fraction of the human life.

7.THE ESTABLISHMENT OF CONSERVATIVE SAFE DOSE LEVELS IN MAN

The most useful data in identifying safe dose levels of

Agent Orange in man are those which are provided by the

human experimental material referred to above. They are 22

both useful and conservative. The studies of Kohli, 2 3 24

Gehring, and Sauerhoff did not involve any attempt

to determine the highest dose of 2,4-D or 2,4,5-T which

would provide no-effect: the purpose of each of the

studies was to examine absorption and excretion rates and

processes, and for present purposes each of those studies

constitutes simply a demonstration that the dose

V-24

administered (obviously chosen with the intention of

providing a wide margin for safety) in fact caused no

untoward effects in the study subjects.

2 5

In the case of Kligman's experiments the great

difference between the higher quantity administered in the

first series of experiments, and the quantities ultimately

administered, (which produced only chloracne, and then

only in 8 of the 10 subjects), indicates that the highest

dose in the first group of experiments is a very long way

below the no-effect level. For even greater conservatism

the daily doses of 0.1 ug can be disregarded and only the

initial dose of 8 ug is taken into account for present

purposes.

As already indicated, Schulz's experiment gives a contrary

indication to a conclusion that the threshold lies above

500 ug, but casts no doubt on 8 ug as a safe application.

On the foregoing basis, the following safe doses in man

(not "no-effect levels" or "thresholds") are postulated:

2,4-D 5mg/kg - ingested orally

2,4,5-T 5mg/kg - ingested orally

TCDD 8ug - applied dermally

V - 25

It is stressed that the above are, in the Commission's

view, doses that fall clearly and to a substantial but

indeterminate extent below the threshold for a toxic

response or a "no-effect" level in man.

7.1.Comparison of Demonstrated Safe Dose Levels of the

Constituents of Agent Orange with Exposure to Direct

Spraying in Vietnam

In Table 1 of Exhibit 1168B there are set out calculations

of the quantity of each constituent of Agent Orange which

would be deposited per square metre in the course of a

Ranch Hand spray mission in South Vietnam, assuming no

drift. If there was drift, the deposition would be

reduced on the main swath in accordance with the extent of

the drift: in any area outside the main swath on which

drifting herbicide fell, the concentration would be very

substantially reduced.26 Spraying would rarely have

taken place in open areas - there would have been no need

for it in such areas otherwise than for the purposes of

crop destruction. In Exhibit 1168B Table 1 calculations

are set out which indicate how the gross amounts deposited

ought to be reduced having regard to various overhead

foliage conditions, the quantities reaching the forest

floor under triple canopy forest being as little as 6% of

the gross amounts deposited.

V-26

For present purposes. however „ it is sufficient to

consider a theoretical direct exposure to spray, without

drift, and without the intervention of any overhead

foliage. No such exposure of any Australian troops has

been demonstrated on the evidence, and the exposure models 27

discussed above in Chapter TV show this to be the most

extreme exposure to which Australian troops would have

been subjected.

To reiterate, the actual dose administered to a soldier as

a result of dermal contact with spray under these

circumstances was calculated by Dr Dost.28 The

assumptions he was asked to make for the purpose of those

calculations were as follows: 1

1. Open field with no canopy protection;

2. Agent Orange sprayed at the rate of 3 gallons per acre;

3. Concentration of TCDD of 2 parts per million in the

Agent Orange;

4. The dress of the soldier consisting of battle

trousers, army boots, long-sleeved shirt with the

sleeves down and a soft rag hat, but with his hands,

face, neck and the V of his chest exposed;

5. The permeability of the exposed skin of the soldier is

the same as that of the hairless rat in the Poiger

experiments;

V-27

6. The penetration rate of human skin by TCDD to be

equated with that of TCDD dissolved in the carrier,

methanol;

7. Body weight of the soldier of 70 kg.

Dr Dos t1s view was that to calculate the actual dose

received in the relevant circumstances the gross deposit

rates per square metre had to be reduced by 2 factors of

10: first to reflect the fact that the exposed skin area

of the soldier would be approximately 0.1 sq.m., and

secondly to reflect a dermal absorption of 10% of the

quantity of chemical deposited on the skin. The first

reduction is clearly conservative in that the soldier's

exposed skin is not exposed to the spray as a horizontal

surface. and might reasonably be expected to arrest less

of the sprayed material than would settle on .1 square

metres. The second reduction factor was based on the

absorption rate determined by Dr Poiger in an experiment

with TCDD and hairless rats, and Dr Dost regarded the 29

adoption of that rate as also conservative. That 10%

is a conservative absorption rate in relation to 2,4-D in

man is demonstrated by the study by Feldmann and

3 0 -

Maibach where a dermal absorption rate of 5.8% was

indicated for 2,4-D in man.

V-28

Adopting the above approach, and the gross deposition

rates calculated in Table 1 of Exhibit 1168B, the

following comparison can be made between the actual doses

or applications absorbed (in the case of 2.4-D and

2.4.5-T) or received on the skin (in the case of TCDD) by

a person directly exposed in Vietnam and the safe doses or

applications demonstrated in the tests referred to above,

assuming the weight of the exposed person to be 70 kg:

Constituent Theoretical dose/ Safe dose/

application from application exposure dose application dose application

2.4-D 14.16mg* 350mg

2,4.5-T 14.83mg* 3 50mg

TCDD 0.5797ug** 8ug

* Gross rate per sq. metre x 0.01

** Gross rate per sq. metre x 0.1 (dermal application)

The above figures are based on dermal absorption alone,

which is realistic in the light of findings that in

corresponding circumstances the amount deposited on skin

is 20-1700 times the amount reaching the respiratory

- _ 31 tract.

On the basis of the above material it is abundantly clear

that even the most extreme theoretical exposure in Vietnam

V-29

(which is not shown to have occurred to Australian troops)

would have subjected a person so exposed to a dose of

Agent Orange well within the exposure shown on the tests

referred to above to have been safe.

8. THE SYMPTOMS OF TOXIC EXPOSURE TO THE CONSTITUENTS OF

AGENT ORANGE

8.1. The symptoms of toxic exposure

Both 2,4-D and TCDD. as a contaminant of 2,4,5-T, produce

a specific short term symptom in humans exposed to a toxic

dose of the respective chemical agent. In the case of

2,4-D, the effect is peripheral neuropathy while TCDD's

sign is chloracne.

Peripheral neuropathy as an outcome of 2,4-D intoxication

3 2 3 3

has been described by Berwick, Goldstein et al,

and Todd.34

Chloracne has been observed among some of the exposed

subjects in almost every incident involving exposure to

TCDD where toxic levels have clearly been reached.

Professor Holmstedt said of chloracne and TCDD -

V-30

Chloracne thus serves as a sensitive marker of ... exposure (to a number of chlorinated cyclic organic compounds, including TCDD). While the absence of chloracne does not absolutely negate exposure to a dose of TCDD, its absence usually

indicates that there has been no exposure to a toxic dose of the substance. I use 'toxic' as including both systemic and local effects.35

Dr Taylor expressed a similar view.36

Industrial incidents in which exposure to TCDD has

occurred with the incidence of chloracne being identified,

include the following -

Nitro USA 1949.37

Nordrhein, Westfalen F.R.G. 1948-9.38

BASF Ludwigshafen,· F.R.G. 1953.39

40

Boehringer, Hamburg F.R.G. 1954.

Diamond Alkali Newark US 1956.41

42

Rhone-Poulenc, Grenoble 1956.

Dow Midland Michigan USA 1964.43

V-31

Philips-Duphar, Netherlands 1963.

45

Spolana. Czechoslovakia 1965.

4 6

Coalite, Bolsover UK 1968.

47

UK Government Laboratories 1970.

48

Missouri US 1972.

Seveso Italy 1976.49

The condition of chloracne was described in detail by Dr

Taylor who has had extensive experience in respect of the

disease.50

8.1.2. Symptoms Observed Among Australian Personnel

Serving in SVN

44

Not only is there no evidence of either chloracne or

peripheral neuropathy being found among a significant

number of Australian personnel who served in Vietnam,

there is no evidence of one person having either sign or

symptom of those complaints. This absence either of signs

or symptoms does not of itself provide evidence absolutely

V-32

negating any relevant exposure to Agent Orange. However,

the absence of any cases of chloracne provides further

strong evidence against the possibility that relevant

exposure occurred. It is clear that, if toxic exposure to

aerially sprayed Agent Orange had occurred, then

substantial numbers would have been so exposed with

consequential signs of symptoms of the effect of such

exposure. Dr Taylor expressed the following view about

this aspect of the matter:

In a large group exposed to mixtures containing TCDD the absence of chloracne:

(a) makes it improbable that there was exposure to a toxic dose;

(b) renders it unlikely that systemic disorders will result from exposure,51-

Professor Holmstedt expressed a similar view in Exhibit

1 1 9 Θ , In the light, of these views, the absence of these

signs or symptoms (and in particular chloracne) among

Australian personnel in Vietnam provides strong evidence

that either Australian personnel were not exposed to Agent

Orange in Vietnam, or that any such exposure was not

sufficient to give rise to toxic effects.

V-3 3

8.3.Comparison of Theoretical Worst-Case Exposure in SVN

and Exposures Following Industrial and Environmental

Incidents

In several of the industrial or environmental

contamination by TCDD, evidence is available of the

quantity of TCDD per square metre deposited within the

contaminated area. Dr Reggiani prepared a table which

became Exhibit 1262 in which the available data of this

kind was set out. The table is reproduced at the end of

this section of the Report.

That table shows that the concentration of TCDD measured

at the Missouri horse arena in 1971 was 700,000 times

greater than the maximum deposit rate from a Ranch Hand 52

mission in Vietnam, namely, 5.797 ug/sq.m. Young

children played daily in the sand of the contaminated

arena for some weeks after the contamination occurred, but

the symptoms they suffered were transient notwithstanding 5 3

that many animals, similarly exposed, died.

Even the lowest concentration shown in Dr Reggiani1s

table, the ground concentration at Seveso measured on the

borderline of the area of greatest contamination, is

almost three times the amount deposited in Vietnam. In

V-34

Seveso, a substantial number of children (who may have

been exposed to much higher concentrations through direct

contact with the chemical cloud released from the ICMESA

factory) contracted chloracne. But those children suffered

54

no other adverse health effects.

Further„ concentrations of TCDD up to 15,840 ug/sq.m were

measured in vegetation at Seveso shortly after the

55

incident occurred.

A comparison of exposure levels in Dr Reggiani1s table

(Exhibit 1262) with the maximum "worst case" exposure

levels in Vietnam calculated above (0.5797 ug) displays a

dramatic discrepancy. That discrepancy is consistent with

and sits most comfortably with a finding that Australian

personnel suffered no .adverse effects from exposure to

Agent Orange in SVN.

V-35

TCDD - LEVELS OF CONTAMINATION

LOCATION SOURCE OF CONTAMINATION CONTAMINATION WEIGHT PER

WEIGHT

SAMPLING DEPTH 1 CONTAMINATION PER UNIT AREA

REFERENCE

HORSE ARENA A (Missouri) 1971 WASTE OIL 32,000 ppb 10 on 4,500,000ug/m2 (4,500 mg/m?)

Kimbrough 1977

SPOLANA Czechoslovakia Occupational 24,200 ppb 2,420,000ug/m2 (2,240 mg/m?)

Jirasek et al 1974

PHILIPS DUPHAR Amsterdam Industrial accident

10,000 ppb 100,000ug/m2

(100 mg/m?) Vos et al 1978

HORSE ARENA C (Missouri) 1974 Waste Oil 540 ppm 30 an 220,000ug/m2

(220 mg/m?)

Kimbrough 1977

COALITE Manchester

Industrial accident 400 ppb 40,000ug/m2

(40 mg/m?)

Crow, 1980

EGLIN A F B (FLORIDA) HARDSTAND 7

Agent Orange Spills 170 ppb 10 an 2,400ug/m2

(24 mg/m?)

Young 1974

CHEMIE WERKE Linz Industrial accident

140 ppb 14,000ug/m2

(14 mg/m?)

Internal document 1973

EGLIN A F B (FLORIDA) GRID ] 1974 HIGHEST VALUE

Practice Area

Application

1.5 ppb for Herbicide 10 an 210 ug/m2 Young

(0.21 mg/m?)

SEVESO BORDERLINE Pocchiari ZONE A - B accident

Industrial 0.15 ppb 7 an

(0.015 mg/m?)

15 ug/m2

1979

V-36

ENDNOTES

1. Hayes. W J . Toxicology of Pesticides, Williams & Wilkins Co.. Baltimore, 1975.

2. Casarett, L J . and Doull J ., Toxicology; The

Basic Science of Poisons. McMillan Publishing Co. Inc. N.Y.

3 . Exhibit 1268 at p 3.

4. Exhibit 1245 para 8.

5. Transcript at p 3457-9.

6 . Exhibit 74.

7 . Exhibit 118.

8. Transcript at p 2369.

9. Exhibit 176.

10. Exhibit 117.

11. Exhibit 179 at p 208.

12 . Exhibit 894 No 447.

13 . Transcript at p 2369.

14. Exhibit 1207.

15 . Holmstedt, Professor B R. at Transcript p 1945.

16 . Exhibit 906 Part IV Tables 1-12.

17. Exhibit 1268. pp 22-30, 39-40, 46-48 and 56-65.

18 . Transcript p 2389 et seq, p 2596 et seq, p 2682

et seq.

19 . Exhibit 1197 para. 1 and also at p 1914 et seq.

of the Transcript.

20. Transcript at p 2781 et seq.

21. Exhibit 1206.

22 . Exhibits 117 and 118.

V-37

23 .

24 .

25.

26 .

27.

28 .

29.

30.

31.

32.

33 .

34 . .

35 .

36 .

37.

38 .

39.

40.

41.

42.

43 .

44 .

45.

46.

47.

Exhibit 74.

Exhibit 176.

Exhibit 1207.

See Exhibit 1880. p 24 et seq.

See Ch IV - Exposure.

Transcript p 2747 et seq.

Transcript p 2748.

Exhibit 271.

See Feldmann and Maibach, Exhibit 271, p 126.

Exhibit 22.

Exhibit 77.

Exhibit 1580.

Exhibit 1197, paras 2, 4 & 5.

Exhibit 1206, Annexure A, paras 2 and 5.

Exhibit 1550.

Baader & Bauer, not an Exhibit but mentioned in Exhibit 719.

Exhibit 75.

Exhibit 720.

Exhibit 260.

Exhibit 58.

Exhibit 68.

Exhibit 1186.

Exhibit 1738.

Exhibit 130.

Exhibit 143.

V- 3 8

48 . Exhibit 1260.

49 . Exhibit 1258 .

50. Exhibit 1206 and at p 2027

Transcript.

et

51. Exhibit 1206, Annexure A.

52 . See Table 1, Exhibit 1168B.

53 . Exhibit 17, Exhibit 111, Exhibit 337

54 . Exhibit 1258.

55 . Exhibit 1258. Table II.

the

V-3 9

CHAPTER VI

HEALTH EFFECTS - GENERAL

1. INTRODUCTION 1

2. THE MORBIDITY STUDY PROPOSAL 2.1 Commission's Request for Study and Government's Refusal 3

2.2 Correspondence Requesting Proposed Morbidity Study 10

3. INDIVIDUAL VETERAN'S HEALTH COMPLAINTS -WAA'S TEN BEST SHOTS 59

3.1 Evidence of Veterans Re Health Complaints and Conclusions Thereon 61

3.2 General Conclusions from the 10 Best Shots 110 4. OTHER EVIDENCE OF ADVERSE HEALTH OUTCOMES IN AUSTRALIAN VIETNAM VETERANS FROM OTHER SOURCES

4.1 AVHS Mortality Study 114

4.2 Particular Causes of Death - Pointers to General Health Effects 117

4.3 Informal Sessions 127

4.3.1 Alcohol Use 131

4.3.2 Smoking 132

4.3.3 Veterans in Prison 132

4.4 The Team 136

4.4.1 Introduction 136

4.4.2 "The Team" in Vietnam 139

4.4.3 Command Methods of the AATTV 141

4.4.4 Submission of the AATTV 142

4.5 Psychological Symptoms Found Amongst Australian Vietnam Veterans 144

4.6 Other Morbidity Evidence Vietnam Veterans, Non-Australian 147

4.6.1 Ranch Hand I 148

4.6.2 Ranch Hand II 150

5. WAA'S Case - ALLEGED NEUROTOXIC AND OTHER EFFECTS 162

5.1 Van Tiggelen’s Theory 166

6. INDUSTRIAL AND ACCIDENTAL EXPOSURES 172

7. CONCLUSIONS 174

ENDNOTES 176

CHAPTER VI

HEALTH EFFECTS GENERAL

1. INTRODUCTION

Early in the life of the Commission it was decided that

courtroom hearings would be confined to matters where an

issue in dispute was presented either by the literature or

some submission lodged with the Commission in accordance

with the procedures which had then been laid down. Owing

to the very complex questions raised by the Terms of

Reference. it was decided to subdivide courtroom hearings

into topics and a timetable was accordingly drawn up.

Such topics were decided by having regard to consideration

such as time, cost and the convenience of the parties.

In those early days, Senior Counsel for W A A indicated

that he wished to call as witnesses a large number of

veterans evidencing adverse health effects. This did not

appear to be an efficient course. Apart from time and

cost considerations, which obviously would have been of

great magnitude, it was clear that it would be difficult,

VI-1

if not fallacious, to extrapolate from the health

situation of an individual to that of a large group.

Accordingly, four steps were taken:

(i) A system of Informal Sessions was established

which resulted in information being received

directly from more than 2,000 veterans throughout

Australia.

(ii) The Federal Government was requested to fund an

epidemiological morbidity study, the protocol for

which had been drawn up and/or perused and

approved by world-renowned scientists in this

discipline. It is now notorious that such

funding was ultimately refused.

(iii) Two weeks for courtroom hearings were set aside

to enable Mr Lonnie from Western Australia and

Counsel for W A A to call evidence from experts,

notably those who were to be the plaintiffs'

expert witnesses in the American Class Action.

(iv) Two weeks for courtroom hearings were programmed

for the calling of "Health Effects" evidence so

as to permit W A A to call a number of veterans

with typical disorders who could be considered as

being characteristic of the classes of veterans

VI-2

suffering unfortunate health consequences

allegedly related to exposure to chemical agents

in Vietnam.

In view of the emphasis placed upon Cancer. Birth Defects

and Mortality by both W A A and the media. these topics are

extensively dealt with in separate chapters. Because of

overlap, psychological consequences of service are dealt

with briefly in this section but will be fully dealt with

in a later chapter called "Mental Well-Being".

2. THE MORBIDITY STUDY PROPOSAL

2.1 Commission's Request for Study and Government's

Refusal

At an early stage of the Inquiry the Commission was of the

view that an essential ingredient for a proper

investigation of the subject matters of the Terms of

Reference was a scientifically valid epidemiological study

of the morbidity of Vietnam veterans. That view was made

after taking the advice of eminent scientists expert in

public health. in epidemiology, in toxicology and in

statistics.

VI-3

On 11 July 1983 the Commission's decision in this regard

was expressed in correspondence with the Government.

Thereafter. reasons for the decision were forcefully put

in follow-up correspondence and at face to face meetings

with Government Ministers.

After more than a year of prevar ication and delay the

Government decided that it would not fund the Study. It

has been suggested that there should be no budgetary

control of Royal Commissions by Governments.1 However,

the Commission is, and always was, of the view that the

Government's decision was within power. But, as the

correspondence shows, the decision was a bitter

disappointment to the Commission and undoubtedly has had a

real inhibiting effect in respect of the conclusions

reached by it.

Little more need be said other than to publish as part of

this Report the correspondence that passed between the

Government and the Commission on the topic.

Dealings with the various Ministers nominated by the

Government to deal with the question before 27 July 1984

were frustrating. A number of them seemed not to have

read what had been proposed, even when the Commission was

VI-4

summoned to Canberra for no other purpose than to discuss

the matter. Difficulties raised about earlier proposed

versions of such a study were regurgitated apparently

without knowledge of the Commission's considered and

lengthy responses thereto, nor appreciation of the

parameters of the difficulties therein considered.

The Commission's conclusion is that the Government's

decision was taken under the powerful influence of

bureaucrats behind the scenes and for reasons unconnected

with either the validity of the study or its feasibility

and only marginally connected with its cost.

Before the change of Government in March 1983, the

bureaucracy had opposed both a Royal Commission and a full

morbidity study. It had committed itself to opposition of

the study under Prime Minister Fraser and the reasons

given by the bureaucracy to his Ministers now reappeared

in discussions.

A factor operating upon the minds of those charged with

providing advice to the Government was that to support the

study was to commit oneself to something that might be or

be said to be inconclusive. (Indeed it is the nature of

VI-5

epidemiological studies to produce blurred edges here and

there and the proposed study would have been no exception.)

Public servants dislike advising positively, particularly

where failure is possible.

It seems likely that the primary reason for the decision

not to recommend the study was that those charged with

making it did not believe that the Australian veteran

community would accept the results of the study unless it

suited the "chemically caused" position. US Veteran

reaction after the publication of the Ranch Hand Mortality 2 Study Report provides an example, as does Veteran 3 non-acceptance of the MR I Report and rejection of Young

et al 1978.4

A second reason may have been a belief that veterans would

focus on apparent elevations of medical conditions in

spite of the lack of real statistical significance. This 5

in fact later occurred after the GDC Birth Defect Study

and the Ranch Hand Morbidity Study6 were published.

The opposition of the W A A to any study which included a

key ingredient to solution of the herbicide question (not

health questions), namely, an exposure index, was also

VI-6

clearly an important factor to those making

recommendations.

Budgetary constraint was undeniably a factor. although

perhaps a catch-all for what one does not want to do!

The first two reasons underestimate the intelligence of

veterans. Whilst in the United States, the Commission had

lengthy meetings with representatives of the American

Legion, Veterans of Foreign Wars, Disabled American

Veterans. Paralysed Veterans of America, Blinded Veterans

Association as well as with representatives of

specifically Agent Orange oriented veterans' organisations.

The Commission's informal sessions have brought it into

close contact with over 2,000 individual veterans and

family members throughout Australia.

The Commission has a clear impression that the American

studies have been accepted by the leadership of all groups

other than those which came into existence for the purpose

of supporting the Agent Orange thesis.

In Australia the overriding concern of veterans is for

some answer, from a trustworthy source, whatever that

answer may be.

VI-7

Control of such a study by the Commission would have been

acceptable to the great body of veterans and would also

have met all genuine needs for reliability and scientific

integrity.

As to W A A opposition to the study, the Minister for

Veterans' Affairs' letter to the Commission of 8 May 1984,

with its implication that because the WAA's efforts

brought about the Commission, the views of its President

on a highly technical matter had weight is astounding. As

to the misapprehension referred to in the Minister's

letter, it arose because the Minister himself had said,

"If the W A A don't support the study, you won't get it:

politically it's not on".

The Commission is aware that the W A A consulted at least

one epidemiologist. Dr Peter Dunt. He supported the study

in general and expressly because it included an exposure 7 index attempt.

His high and appropriate qualifications and eminence were

ignored in favour of the whisperings of the unqualified

John Evans.

VI-8

The reasons for continuing with the Commission in spite of

the lack of a study are clearly stated in the Commission's

letter of 6 August 1984 to the Prime Minister.

The Commission merely reiterates that having regard to

research developments in 1984 and to the evidence called

before the Commission, it has a very high degree of

confidence in the conclusions reached, notwithstanding the

lack of the study. Those conclusions will have all the

weight the status of a Royal Commissioner can give them.

The conclusions have been reached on the balance of

probabilities as the law demands. Access to the results

of the Morbidity Study which had been proposed would, in

the Commission's view, have taken the "General Health"

conclusions from the area of the balance of probabilities

into the rarer atmosphere of scientific certainty.

As to "budgetary constraint", the Vietnam War, so far as

Australia is concerned, has been variously costed but a

figure of $400,000,000 has been authoritatively given.8

The Budget provision for Defence for 1984-85 is

9

$5,820,200,000. It would provide for a study of the

health of veterans more than 500 times over.

VI-9

Note too that a reliable estimate of current expenditure

on Recruiting (NOT including salaries and accommodation)

is more than $7„000,000 per annum.10

The Government's refusal to fund the study should be

viewed in that context.

The Commission's dealings in late July - early August 1984

with Mr Kim Beazley. then the Acting Special Minister of

State. were frank, pleasant and direct. He was completely

familiar with all correspondence and documentation. His

intervention was welcome and useful.

The correspondence which passed between the Government and

the Commission on this matter is set out seriatim. For the

sake of brevity, formal parts are omitted.

2.2 Correspondence Requesting Proposed Morbidity Study

11 July 1983

To The Hon. R.J.L. Hawke. A.C., M.P.. Prime Minister, From Justice Evatt

Counsel Assisting me have spent the last six weeks investigating the methods to be adopted by the Royal Commission.

Their regular reports to me have latterly indicated that an essential ingredient for a proper investigation of the subject matter of the Terms of Reference is a

VI-10

scientifically valid epidemiological study of the morbidity of Vietnam Veterans. Without such a study any conclusions reached would be at best unreliable. and so vulnerable to criticism as to be inconsistent with my duty

to inquire.

One study of relevance has been completed (birth defects), one is in train (mortality), and another is about to begin, all under the control of the Commonwealth Institute of Health in its Australian Veterans Health Studies section. The AVHS has been directed to report to me the result of the mortality study in early 1984.

The study which is about to begin is a morbidity study limited to neuro-psychiatric problems. The AVHS had previously proposed and prepared a detailed protocol for a full morbidity study but that was put on hold.

I am firmly of the view that the full morbidity study should proceed and under the control of the Royal

Commission.

I believe it should proceed because:

1. The partial morbidity study is of such a small sample size that its statistical power is low and therefore its scientific weight, in the production of either positive or negative result is, for my purposes, too

low.

2. The limitation of subject matter in the partial study, takes out of consideration a wide range of complaints and disabilities plausibly associated by Veterans with service in Vietnam and/or with exposure to chemical agents.

3. An answer limited to neuro-psychiatric conditions would, I believe, be unacceptable to the Veterans and to the public. It is, therefore, unacceptable to me.

4. I will need some such study in any event. It would. I believe, be hugely wasteful for me to "set up" a new study team to cover ground already covered by the AVHS in the planning and preparation of the abovementioned protocol.

5. Further, the inquiries made by those assisting me indicate that it would probably be impossible to gather together a team of appropriately qualified people, to work in competition with the AVHS team. There are simply not enough suitable experts available.

VI-11

6. The only alternative would be to seek out full details of all health complaints and then attempt to trace them back (with proper controls) to levels of exposure to chemicals and/or to service in Vietnam. This would involve many years of investigation and would be scientifically unsound anyway. For example, it seems

that those who are ill are too likely to believe that they were exposed, and those who were exposed are too likely to believe that they are ill. The study would be doubly invalidated.

7. I am informed that the full morbidity study would be the first reliable study done on this highly

contentious topic anywhere in the world and that it would produce data which would also be very useful in a variety of other fields of medicine. Some of the areas where the proposed morbidity study would produce useful data are set out in the sheet which is attached hereto.

Counsel Assisting me have taken the advice of Dr John Mathews, Μ.B .„ B.S., F.R.A.C.P.. Ph.D., a most eminent scientist in the field of epidemiology. He advises that the full morbidity study proposed is the best and most

flexible one available. He also agrees that any course of inquiry which involves as a starting point examination of Veterans who have already linked illness with exposure, would be unsatisfactory.

I believe that the study should proceed under my control so as to enhance the public and the Veterans ‘ acceptance of it; so also to remove any suggestion of Government control or direction of the study.

Clearly, the full morbidity study will be more costly than the partial study. In fact, an estimate of the cost of the full study of $6m. has been given to those

assisting me compared to between $2m. and $3m. for the partial study. It is estimated that a full study could be completed in sixteen or seventeen months. I am of course, mindful that this is a very large sum of money, but firmly

believe that if I was to set about putting together my own team to perform the scientific work that I believe must be done, that would necessarily involve much duplication and would be considerably more expensive, both in terms of

time and money, than the proposed AVHS full morbidity study.

VI-12

For the study which I propose to be successfully completed by late 1984, it is said to be essential that interviews of randomly selected veterans start in September 1983. and therefore that financial resources be made available before the end of July 1983.

It is vital to the proper conduct of this very costly Royal Commission that I am able to perceive and control my own direction. It is also important for the AVHS to know the direction in which they should proceed. I would accordingly be obliged if this matter could be given urgent attention.

Attachment

ADDITIONAL BENEFITS ACCRUING FROM THE MORBIDITY STUDY In addition to determining whether or not Vietnam service has produced deleterious health effects in Australian veterans of the Vietnam conflict, the proposed morbidity

study will produce data which will be very useful in a variety of areas.

1. Accurate Disease Frequency Data The morbidity study would provide a description of patterns of illness in a group of 30 to 40 year old

Australian men who were known to be in good health at age 20. Accurate data based on a full health evaluation of such a group is rare and would be a valuable contribution to knowledge in its own right.

2. Health Services Resource Allocation The illness patterns detected would provide information of use to health planners in reaching decisions on the most

efficient ways of distributing limited resources for health care. As an example, the study may reveal

asymptomatic clinical problems which, were they treated by local doctors, might avoid the need for future hospital treatment.

3. Alcohol and Tobacco Consumption This study would provide accurate data on the relationship between alcohol and tobacco consumption, and symptomatic disease and laboratory test abnormalities. In those

subjects with heavy consumption, it would be possible to detect abnormalities which might portend serious illness were such consumption to continue. This data could be

used for health education, and to describe the effects of heavy consumption in a relatively young age group prior to the development of disease.

VI-13

4. Armed Forces Health and Manning Policies Information arising from the morbidity study on the effects of war service, particularly in the tropics, would enable the armed forces to minimize long-term effects of combat service in their troops, and potentially maximize

their peace-time fitness and readiness.

5. Social Effects of Illness The morbidity study potentially has the ability to detect relationships between physical and psychological disability, and a range of social problems, including marital breakdown, drug abuse and unemployment. Such knowledge might have significant bearing on health and welfare policy.

6. Validation of Other Health Surveys A number of major health surveys both in Australia and overseas are forced to rely solely on verbal reports of subjects' descriptions of their health. The morbidity study provides a means of determining the reliability of such reports compared to clinical examination by doctors, and pathology testing. This data would be very useful in

interpreting the results of other studies, such as those by the Australian Bureau of Statistics, and may suggest ways in which data collection might be improved.

7. Model for Future Survey Research The considerable numbers of subjects to be investigated and the thoroughness of the ascertainment and tracing procedures to be used will constitute a model for future survey research. The study therefore has the potential to significantly improve the quality of future investigations of this type.

2 August 1983

To The Hon. Mr Justice Phillip Evatt, DSC From The Prime Minister

Thank you for your letter of 11 July 1983 concerning the Royal Commission on the Use and Effects of Chemical Agents on Australian Personnel in Vietnam.

The matters you have raised are, I believe, of

considerable significance and require careful and full consideration by the Government.

I am conscious of the urgency attached to a

substantive response to your letter and I will write to you again as soon as possible.

VI-14

25 November 1983

To The Honourable Lionel Bowen MP Acting Prime Minister from Justice Evatt

On 11 July 1983 I wrote to the Prime Minister

proposing that a full morbidity study of servicemen and veterans be undertaken and that the Royal Commission acquire the Australian Veterans Health Studies unit to undertake the study.

A decision on my proposition is outstanding but I understand that the study protocol and the budget for it are likely to be requested for consideration during the next few weeks.

In anticipation of such a request I have taken

preliminary steps to establish a panel of experts to review the AVHS protocol and I propose to make their findings available as required. The study budget, now in draft form, will be varied as necessary to match the protocol and will be submitted with it.

I propose that the panel comprise two members of the Scientific Advisory Committee set up to consider the original AVHS protocol and two overseas experts.

The use of overseas experts is considered essential to the enhancement of the study and to its acceptance by the scientific community at large. The selected experts are internationally recognised in scientific fields of significance to the Commission's inquiry. As well as assessing the protocol the experts may be asked to prepare papers for the Commission and/or give evidence to it.

The proposed panel is:-Dr Bruce Armstrong who was a member of the Scientific Advisory Committee set up by Senator Messner. He is a Fellow of the Royal Australian College of Physicians,

a Doctor of Philosophy, Epidemiology, at Oxford University. He is presently the Director of the NH&MRC Research Unit in Epidemiology and Preventive Medicine at the University of Western Australia.

Dr Tony McMichael MBDS PhD. His PhD was in

epidemiology and he is presently Principal Research Scientist at the CSIRO Division of Human Nutrition, Adelaide.

VI-15

Dr Dieter Riedel is the Head of the Reassessment Section, Environmental Health Directorate, Department of Health and Welfare, Canada. He is a toxicologist and attended the recent dioxin meeting in Lyons. He

is the Canadian Government's expert on dioxin and has an international watching brief for that Government. He has an international reputation for impartiality.

Dr Alvin Young led the American National Academy of Science Study on the Use of Herbicides in Vietnam. He is the US Veterans Administrations expert on the

consequences of herbicide use in Vietnam. He has published innumerable papers and is an acknowledged international expert on dioxins.

Dr John Mathews, Director of Studies, AVHS will present the protocol.

I anticipate that the assessment of the protocol by the panel will be carried out in mid-December.

30 November 1983

The Hon. Mr Justice Phillip Evatt, DSC From The Acting Prime Minister

I refer to your letter of 11 July 1983 to the Prime Minister seeking agreement to a scientifically valid epidemiological study of the morbidity of Vietnam Veterans as part of your investigations proceeding under the control of the Royal Commission.

The Government has given provisional approval to your proposal to conduct the proposed morbidity study subject to the Commission submitting to the Special Minister of State, within four weeks, a detailed budget and protocol and a report on how earlier criticisms, applying to previous protocols, regarding the adequacy of the sample size and the practicability of developing a useful index of exposure to herbicides have been or will be met. The Government will subsequently consider these papers and decide whether final approval should be given to the study being conducted.

If the study does proceed, the Government would expect the Commission to submit an interim report on the

establishment of an exposure index by 30 June 1984, when

VI-16

the Government would again review whether the study should continue. If the study continues following that review, the Government proposes that it should be completed by 30 June 1985; with the Commission adjourning no later than 31 August, 1984. reconvening at the conclusion of the

morbidity study and presenting its final report no later than 30 September 1985.

I understand that the Commission has approached some Australian and overseas experts to seek their assistance in certain aspects of the inquiry, including in the assessment of the proposed morbidity protocol. It would

be useful for the Government to have an expert assessment of the protocol when it is considering your report to the Special Minister of State.

You may wish to consider approaching the Australian Statistician for any assistance he can give you from a statistical viewpoint in the preparation of the expert assessment.

23 December 1983

The Hon. R.J.L. Hawke. A.C., M.P., Prime Minister From Justice Evatt

I refer to the Acting Prime Minister's reply of 30 November 1983 to my letter of 11 July 1983 in which I

proposed that a full morbidity study be undertaken by the Australian Veterans Health Studies unit for the Commission.

I have arranged today for the delivery of the detailed budget and protocol to the Acting Special Minister of State. The protocol itself deals with the earlier criticisms and also in extenso with questions of

statistical power and the feasibility of developing a useful index of exposure to herbicides.

These matters are dealt with fully in my letter to him and the enclosures.

There are however some aspects of the Acting Prime Minister's letter which cause me anxious concern.

I understand your Government's need to be sure that such a costly and extensive study should be

epidemiologically sound. To this end, I arranged for the AVHS draft protocol to be critically examined by the panel of experts whose credentials I advised by my letter to the Acting Prime Minister of 25 November 1983.

VI-17

Upon such critical examination the protocol was modified and in large measure re-written. The Panel is now unanimous that the study is epidemiologically sound and of guite sufficient statistical power to provide reliable data upon which I can found conclusions relevant to my terms of reference.

Dr Reidel wrote, in a letter to me, "The prospects for a successful morbidity study on Australian Vietnam veterans seem excellent if sufficient funds, independence of the investigators from interference by pressure groups, and an experienced scientific director can be guaranteed. The principal authors of the 1982 draft proposal and their collaborators are highly experienced and internationally highly respected, and in conducting the birth defects and mortality studies on Australian Vietnam veterans, the AVHS

team have already carried out much of the preliminary work reguired for the proposed morbidity study."

By way of further example of international approval I enclose a copy of a letter written to me by Dr Alvin Young whose 15 years of close involvement with the US studies on the Vietnam/chemical issue makes him the world's foremost

expert.

Having thus established the credentials for the morbidity study, I am disturbed that an apparent condition of its promotion beyond the present provisional approval status is the establishment of the feasibility of

developing a useful index of exposure to herbicides. The study protocol makes it clear that those working on the index of combat exposure are confident that a useful index of potential for contact with herbicides can be

developed. Indeed, such an index is and has been for some time the basis upon which the Department of Veterans' Affairs determines claims. But whether exposure

correlates with health outcomes cannot be known until the morbidity study is complete. In short, we cannot know if service in Vietnam caused sickness until we know whether those who served there are sicker than those who did not and in what ways.

The practical irrelevance of the exposure index question in relation to the morbidity study has been confirmed by the intention of the Vietnam Veterans' Association of Australia to present a case not limited to Agent Orange but which relies on alleged toxic effects of

all insecticides and herbicides used in Vietnam and alleges both synergistic and cumulative effects.

VI-18

To properly investigate such a claim (i.e. , of

exposure to, say, 20 chemicals in every possible

permutation and combination) is, in any practical sense, impossible if one starts from the exposure end of the chain of alleged causation (as opposed to the outcome end).

But to fail to investigate at all must leave the

government vulnerable to claims for pensions and health care which are 'not fanciful1 (being supported by

scientific evidence of at least Dr Van Tiggelin and John Evans) and accordingly payable pursuant to s 47 of the Repatriation Act 1920. Such claims could be in respect of a huge range of disorders many of which would be in fact

totally unconnected with war service.

In the above context a full morbidity study,

epidemiologically sound, already considered by me to be essential to my inquiry, is imperative regardless of whether or not a useful index of exposure to the dioxin contaminant in Agent Orange can be established. In other words, we must be prepared to start from the "outcome" end

of the chain of alleged causation.

I refer to the protocol. para 1.2 (a copy of which I enclose), which expresses these thoughts in terms chosen by the Scientific Advisory Panel.

Another matter with apparently disturbing implications is the suggestion of review of the morbidity study after six months progress. I have no difficulty with regular monitoring and reporting; my intention is to have a Scientific Advisory Panel to perform that function. However, I would find myself in a most difficult situation

in relation to staffing the AVHS study team if there is doubt about the study going beyond six months, i.e. , a third of the way. All the experts consulted agree that the study must be headed up by an experienced and highly qualified epidemiologist such as Dr Mathews or Dr Armstrong. No such person would be attracted to the study

if its continuation beyond six months is in doubt. Similar observations apply to subordinate scientific and medical professionals, as well as to data processor and menial staff.

To my letter to you of 11 July I attached a list of

additional advantages of the study. To those I add

(a) The study would be a study of the Australian Vietnam experience. This can only be done with soldiers. In Australia we have a unique opportunity to perform such

VI-19

a study. We have in our task force a defineable

population of manageable and locatable size. It is large enough for a statistically adequate study to be done but small enough to be manageable (unlike New Zealand on the one hand and the US on the other).

The matching of cases (veteran conscripts) with controls (non-veteran conscripts) is also easier in Australia than elsewhere because of the unique homogeneity of the conscript population and the random selection by birthday ballot.

The study population is also, with proper

encouragement, potentially a very willing population and high response rates, conducive to a very valid study, are likely. This is partly because of the Agent Orange background. It is also because expenses will be met and the study will provide the individual with a comprehensive and elaborate free medical examination of high value. The population is also potentially willing because of the strong Australian mateship concept which will lead even the very healthy

to wish to take part in the study so as to help their less fortunate fellow national servicemen.

(b) I have discerned from my inquiries so far a mood in the Australian public that not enough has been done to meet the concerns of Vietnam veterans about their health since they served in Vietnam. There is I believe a distinct feeling that these people have not been listened to. This study will establish

conclusively that the Hawke Government really is concerned for the problems and anxieties of veterans. It will also put to rest the impression which is in my view clearly at large that the Government, or at any

rate, the bureaucracy, really has something to hide.

(c) It seems likely that health consequences and outcomes amongst veterans can be connected at least in some measure to the selection process and in particular to the risk-taking attitudes of those who are selected

to serve in armed conflicts. If the Australian

Government does not display concern for those who have served and suffered untoward health consequences, particularly if those consequences are connected with soldier-like attributes, there will surely be » consequences in any future necessary recruitment

program.

VI-20

(d) Furthermore, a powerful, well educated and competent team is actually in place to perform the study. Many of the initial steps towards the doing of the

morbidity study have already been taken. The

Government has a significant investment in AVHS and to lose that investment by not taking the obvious next step would in my opinion be a shameful waste of

taxpayers' money. The team is in place, the data base is gathered and we are further down the track towards a reliable morbidity study than anyone in the world. The management capacity of the team is good.

Accordingly, the lead-time is negligible.

Each of these advantages adds to my certain conviction that the study should be done.

My discussions with Dr Alvin Young also confirmed my impression that a significant impetus to the Agent Orange problem in the US was that too little was done by

Government in the early stages. Our problem is of

comparatively small dimensions and a determined effort should now solve it. I am acutely conscious of the

expense and am actively striving to contain it on all fronts.

Finally on the question of adjournment of the

Commission by 31 August 1984 while extended studies proceed. I should mention that this date was volunteered by Senior Counsel Assisting in a situation in which notice of the question was not given. Subsequent detailed scheduling of activities suggests that a date nearer the end of 1984 would be realistic.

I feel so strongly about these matters that I would be willing to attend upon you personally at some appropriate time and place so as to discuss them further and in detail.

23 December 1983

The Hon. Mr John Brown. M.P., Acting Special Minister of State from Justice Evatt

In response to a letter from the Acting Prime Minister dated 30 November 1983 I hereby submit to you a detailed budget and protocol for an Australian Servicemens Health Study.

VI-21

I have noted the comments of the Commonwealth

Statistician and carefully studied previous comments made by the Scientific Advisory Committee. I believe that the issues of statistical power and sample size are adequately addressed in s 3.18 of the protocol, s 6.5 of the protocol and appendix 1 of the protocol. I have extracted these for your convenience. I also observe that at its meeting of 10 December the Scientific Advisory Committee noted that decisions of sample size were ultimately pragmatic and should be settled on social, political and pragmatic grounds rather than on strictly scientific grounds.

I have discussed the sample size in depth with all members of my Scientific Advisory Panel and all are of the view that on social and pragmatic grounds the sample size is appropriate. They are also unanimous that the study is epidemiologically sound in sample size and of quite sufficient power to provide reliable data for the

answering of the questions posed by my terms of

reference. Dr Bruce Armstrong discussed these questions with the Statistician on my behalf.

As far as the practicability of developing a useful index of exposure is concerned, s 1.2 of the protocol and s 3.19 of the protocol deal with this question and again I have extracted the sections for your convenience.

As to the quality of the protocol generally, the draft was reviewed by the panel whose names and qualifications were advised by my letter to the Acting Prime Minister of 25 November 1983. After review it was extensively

modified and re-written by the panel.

All members of the panel agree that the study is

epidemiologically sound and feasible and that its performance is scientifically desirable.

In a letter to me Dr Riedel said. "The prospects for a successful morbidity study on Australian Vietnam veterans seem excellent if sufficient funds, independence of the investigators from interference by pressure groups, and an experienced scientific director can be guaranteed. The principal authors of the 1982 draft proposal and their collaborators are highly experienced and internationally highly respected, and by conducting the birth defects and mortality studies on Australian Vietnam veterans, the AVHS

team have already carried out much of the preliminary work required for the proposed morbidity study."

VI-22

By way of further example of approval I enclose a copy of a letter to me from Dr Alvin Young, whose 15 years of close involvement in the US studies of the Vietnam and chemical issues makes him the foremost expert in the field.

I have written under separate cover to the Prime Minister in respect of certain aspects of the Acting Prime Minister's letter of 30 November 1983.

19 January 1984

The Hon. R.J.L. Hawke, A.C., M.P., Prime Minister From Justice Evatt

I refer to the penultimate paragraph of my letter of 23 December 1983 . I have again closely considered the work to be done if I am to properly investigate the terms of reference and made detailed assessments of the time to be taken. The result is that I do not believe that it

will be possible to adjourn the Commission before the end of 1984. For example, I have scheduled in consultation with those appearing, an estimated 20 weeks to take formal evidence in the contentious areas. As well, short

hearings in each of the capital cities are necessary.

Obviously, it is impossible to guarantee that this wide-ranging inquiry will be completed by the end of 1984 but I am confident that this is a realistic estimate. However, it does not include actual writing time apart

from a week for organizing material at the end of each formal session.

As well, the final settling of much of my final report must await the completion of the proposed morbidity study. I am assured that the study will be completed within 18 months of its commencement.

Accordingly. I expect to complete all the work then possible on the report by about the end of February 1985. I will then adjourn to await the completion of the

morbidity study. Counsel will return to their practices and I will resume duties as a Federal Court Judge. When the study is completed, I will reconvene the Commission to receive the report and to take evidence concerning it. Thereafter, my final report will be settled.

The terms of reference require me to report by 30 June 1984. I therefore formally request an extension until three months after my receipt of the morbidity study

VI-23

report. Such an extension will. I believe, be quite sufficient to permit proper investigation and report.

20 January 1984

The Hon. Mr Justice Phillip Evatt DSC From The Acting Special Minister of State

Thank you for your letter of 23 December 1983 with which you submitted a protocol and budget for a proposed Australian Servicemen's Health Study. You also enclosed a copy of a letter from Dr Alvin Young of the United States Veterans Administration.

I note that in his letter to you of 30 November 1983 the acting Prime Minister indicated that it would be useful for the Government to have an expert assessment of the protocol. I note that you have enclosed a copy of Dr Young's assessment and I should be grateful if you would

let me have the written comments of the other members of this panel if they are available.

25 January 1984

The Hon. M.J. Young, M.P., Special Minister of State From Justice Evatt

In reply to Mr Brown's letter of 20 January 1984 I advise that I had included in my letter of 23 December to him a paragraph that read, "All members of the panel agree that the study is epidemiologically sound and feasible and that its performance is scientifically desirable."

This was the view expressed by all of them in a joint conference held at the end of the Sydney meeting.

I also sought written confirmation of these

expressions of opinion and those of Dr Mathews, Dr

McMicheal and Dr Armstrong were forwarded to Mr Gavin of your Department on 23 January 1984. I enclose copies. I am expecting Dr Riedel's confirmation any day now. I will forward a copy of it to you and Mr Gavin when I receive it.

VI-24

16 February 1984

The Hon. M.J. Young. M.P.. Special Minister of State From Justice Evatt

Senior Counsel Assisting the Royal Commission met recently with legal and scientific advisers to the Vietnam Veterans Association of Australia.

Certain minor amendments were proposed to the protocol for the Study. These were considered by my scientific adviser. Dr John Mathews, in consultation with the AVHS team and those assisting me.

Agreed amendments were incorporated in an addendum to the protocol (attached).

I am assured by my adviser that inclusion of the

addendum will have no detrimental effect on the scientific integrity of the study.

I am further assured by both scientific and

administrative members of the AVHS team that the inclusion of the addendum will not increase the cost of the study or the time for its completion. Its inclusion has further increased the confidence of the Vietnam Veterans Association in the study which, they assure me, they

strongly support.

cc Mr J. Gavin, Dept of Special Minister of State

As appears later in the letter from the Commission to

Senator Gietzelt of 22 March 1984, the Commission had gone

to great lengths to ensure that W A A understood and agreed

with the new protocol for the proposed morbidity study.

As appears, an addendum was made to the protocol at the

behest of W A A and on 23 February 1984 Mr Thompson signed

a letter expressing the agreement of W A A that the

explanatory note attached to the addendum adequately

VI-25

reflected the Association's intentions as expressed in the

addendum. Accordingly, it came as a surprise to the

Commission when Senior Counsel for W A A provided a copy of

a letter dated 15 March 1984 forwarded by Mr Thompson to

Senator Gietzelt. That letter reads:

Senator the Honourable A.T. Gietzelt Minister for Veterans' Affairs from Phi11 Thompson President. Vietnam Veterans Association of Australia

On the 15 February 1984. the V.V.A.A. indicated its support for a scientifically valid Morbidity Study to be conducted by the Australian Veterans Health Study Group.

This support stemmed from requests by the Counsel

assisting the Royal Commission and senior officials from A.V.H.S.. who explained to us how important the Study was for the welfare of Vietnam veterans and their families.

This Association has always had the welfare of Vietnam veterans and their families as its primary concern and it was this background which gave rise to the support of a study, at that time.

When we indicated in writing (15/2/84) our support for a scientifically valid study, it was conditional to the production of a protocol based upon the mutually agreed information. Since our letter of 15/2/84 we have had no

indication of when, or if. a satisfactory protocol will be formulated.

Such being the case, we re-affirm our initial objections to the original protocol formulated by the Australian Veterans Health Study Group.

More recently, we have had the opportunity to review the Australian Veterans Health Study Group's Pilot Study Report into the "...feasibility of an epidemiological investigation of morbidity in Vietnam veterans.'

It is of great concern that this Pilot Study Report was only made available to us after our discussions with Counsel assisting the Royal Commission and senior members of the Australian Veterans Health Study Group.

VI-26

Analysis of the Pilot Study Report clearly indicates that the recommendations therein were not implemented in the protocol devised for a larger morbidity study.

Considering this rather anomalous situation, we must now have a clear statement from the concerned parties as to what their intentions are on the matter of a

scientifically valid study of the health status of Vietnam veterans.

Furthermore, we wish to re-emphasise that our contentions on the Known effects of chemicals used in South Vietnam in relation to human health are as strong as. if not stronger than, when this issue first became a matter of national concern.

The Royal Commission provides us with a unique opportunity of having the relevant scientific and administrative matters evaluated by a judicial body.

We have given our full support to the Royal Commission since its inception, and will continue to do so. Equally, we have cooperated with members of the Commonwealth Institute of Health and the Australian Veterans Health

Study Group in their pursuit of meaningful studies into the welfare of Vietnam veterans and their families. However, at this point in time, we are placed in the

position of not knowing exactly what the Australian Veterans Health Study Group intends doing about a

morbidity study of Vietnam veterans. Until this matter can be resolved. we are obviously not in a position to give our support to the Australian Veterans Health Study Group.

cc The Right Hon. R.J. Hawke The Hon. M. Young - Special Minister of State Sen. The Hon. A.T. Gietzelt, Minister for Veterans Affairs

22 March 1984

Senator The Hon. A.T. Gietzelt Minister for Veterans' Affairs From Justice Evatt

Senior Counsel for the W A A has provided a copy of a letter dated 15 March 1984 sent by that Association to you apparently withdrawing support for the proposed health study. This letter causes me considerable concern. I had been assured in the strongest possible terms of the support of the W A A for the study.

VI-27

The fourth paragraph of the letter is at best totally misleading and at worst false. On 13 February 1984 the President of the W A A who signed the letter of 15 March, together with WAA's Senior and Junior Counsel and

its scientific adviser, met with Counsel Assisting, the Chief Epidemiologist of AVHS and the AVHS Project Manager to discuss the study protocol dated December 1983.

Those representing W A A took issue with some of the statements made in the preamble to the protocol and made some suggestions for highlighting components of the study design. I should emphasise that this discussion took place after ample opportunity for examination of the protocol had been provided.

The result of the W A A input was an addendum

making requested changes to the protocol. This addendum dated 14 February 1984 was referred to in my letter to the Special Minister of State dated 16 February 1984. On 23 February 1984 the Project Manager of the AVHS prepared an

explanatory note to the addendum reflecting the

discussions held. On the following day Mr Thompson signed a letter expressing the agreement of the W A A that the explanatory note adequately reflected the Association's intentions as expressed in the addendum. A copy of this

letter was forwarded to the Special Minister of State on 27 February 1984.

I am. therefore, at a loss to understand the last sentence of the fourth paragraph.

As to the Pilot Study Report referred to in Mr Thompson's letter, it must be borne in mind that the Pilot Study related to the protocol of December 1982 prepared before the Commission came into existence. As its name suggests, a Pilot Study is a testing of the method of a proposed study. Many adjustments to that protocol were a result of problems uncovered by the Pilot Study. It is true that not all recommendations made as a result of the Pilot Study have been implemented in the December 1983 protocol but all recommendations have been considered by the expert scientific advisory group.

There also seems to be a suggestion that the Pilot Study Report was in some way concealed from the WAA. Since its publication in July 1983, it has been as available to the W A A as it has to those assisting me. No

document in relation to this matter has been concealed by the Commission from the WAA. Indeed, those assisting me have responded promptly to requests made by the W A A for

any information about this matter. The pilot study report

VI-28

in print-run form was only received by the Commission in recent weeks I understand„ after its receipt in that form by WAA.

In spite of the views expressed in the last

paragraph of the letter dated 15 March 1984 I do not

regard it as an indication of support for or cooperation with the Commission. The protocol and the addendum have been in the hands of the W A A for more than a month and

for the Association to say that it does not know what AVHS intends to do is not correct.

For completeness. I enclose copy of the addendum dated 14 February 1984, a copy of the explanatory note dated 23 February 1984 and Mr Thompson's letter dated 24 February 1984, together with a copy of the letter dated 27 February 1984 from the Commission's Secretary to the

Secretary, Department of the Special Minister of State and a copy of my letter of 16 February 1984 to the Special Minister of State.

Senior Counsel Assisting me has now spoken to Mr Me I lines QC, Senior Counsel for the WAA, as to the

contents of Mr Thompson's letter. He has taken the matter up with his client. His understanding was and is that the Association supports a scientifically sound study if the Commission wishes to have it. The Association is however

reluctant to commit itself in advance to the results of such a study. This seems understandable.

I feel obliged to say that I find it

extraordinary that the Government's decision in this vital matter should be dependent upon W A A approving the study. The study has the solid support of people qualified to understand it. Mr Thompson has no relevant experience or qualification.

As a matter of further interest, the protocol was recently critically examined by an independent expert retained by Monsanto (Australia), Emeritus Professor A.H. Pollard. A copy of his report is enclosed. If that

chemical company opposed the study would that influence the Government's decision? With respect, it ought not.

Mr Mclnnes QC says he will present a clear

statement of his clients' position as soon as possible.

cc The Hon. R.J.L. Hawke A.C.. M.P.

Prime Minister The Hon. Michael J . Young M.P. Special Minister of State Senator The Hon. Gareth Evans

VI-29

Attorney General The Hon. J.S. Dawkins, M.P. Minister for Finance The Hon. Neal Blewett, M.P. Minister for Health

17 April 1984

The Hon. Mr Justice Phillip Evatt, DSC from Senator A.T. Gietzelt Minister for Veterans' Affairs

Thank you for your letter of 22 March 1984

concerning the attitude of the Vietnam Veterans Association of Australia to the proposed morbidity study.

The Government is considering this matter and you will be further advised as soon as possible.

27 April 1984

Senator The Hon. A.T. Gietzelt Minister for Veterans' Affairs From Justice Evatt

Further to my letter to you of 22 March 1984 . Those assisting me have had three conferences with the representatives of the W A A in relation to the matters raised in the letters from Mr Thompson to you dated 15 and 22 March 1984. I personally chaired the last of such conferences for some time in an attempt to achieve some finality.

Despite our most earnest entreaties, the

representatives of the W A A were not assisted by a

qualified epidemiologist at any of those conferences. As a result a full and worthwhile dialogue on an

epidemiological topic with such representatives has been very difficult and at times impossible.

As a result of the conference held yesterday it now seems that their sole objection to the protocol for the study is the inclusion of a chemical exposure index. As I see it, this is an essential ingredient. Opposition

to it is hard to understand because a high correlation between bad health outcomes and high levels of exposure would support the Veterans' claims whilst the lack of it would not disprove them. The Veterans are truly in a

'no-lose' situation.

VI-30

In my view, such objection is both ill-advised and irrational. I am deeply concerned for the 35,000 unrepresented veterans, hundreds of whom have come through our doors indicating their earnest desire that a result be

obtained irrespective of what that result may be.

Accordingly, they have indicated full support for the study.

After yesterday's conference, I can now only trust that the good sense of the Government will lead it to disregard Mr Thompson's equivocation. I feel I should point out to you that my strong impression is that he, as president of an unincorporated association (apparently without rules) of some 9,000 members, makes decisions which purport to bind those members without any

consultation with the membership and, consequently, without its authority. In this regard. Officers of branches of the Association in other States have very

recently spoken to those assisting me indicating full support for the Study.

8 May 1984

The Hon. Mr Justice Phillip Evatt DSC From Senator A.T. Gietzelt Minister for Veterans' Affairs

Thank you for your letter of 27 April 1984 which also refers to your letter of 22 March 1984.

I am not sure how the misapprehension arose that the Government's decision in relation to the proposed morbidity study was dependent upon the W A A approving the study. I have noticed several media reports attributing

this misapprehension to Royal Commission 'spokesmen' or 'sources'.

The fact of the matter is that the Government has been merely carrying out its commitment to consultation with organisations whose members will be affected by a Government decision. It is only common sense that, before making any decision on a large and costly study, the Government seek the views of the association representing Vietnam Veterans before the Royal Commission. This is

especially important as the protocol you have submitted to the Government envisages that the support of the W A A will be used as an additional means of maximising compliance with the study.

VI-31

I feel bound to point out to you that, were it not for the efforts of the WAA, the Royal Commission would not have been established. Consequently. the Government decided that the W A A was the only Veterans' organisation that would receive financial assistance in order to pursue their case before the Royal Commission.

In this situation, the Government will not disregard the views of Mr Thompson, nor those of the W A A of which he has just been re-elected President. I also understand that delegates at the recent National Congress of the W A A unanimously supported their National

Executive's stance in relation to the morbidity study.

24 May 1984

The Hon. Mr Justice Phillip Evatt, DSC From The Prime Minister

I refer to your letters of 23 December 1983 and 19 January 1984 concerning your proposal that a full morbidity study be undertaken, the duration of the Royal Commission and other related matters.

The Government has been considering these matters and, in the light of your offer to discuss them with me, has concluded that it would be helpful if a small group of Ministers were to meet you personally and you were to

elaborate the points you have made in your letters.

I should, therefore, be grateful if you would meet the Ministers of Veterans' Affairs and Social Security and the Attorney-General, Senator the Hon. A.T. Gietzelt, Senator the Hon. Don Grimes and Senator the Hon. Gareth Evans, for a full discussion of your proposal and related issues. Senator Gietzelt will be contacting you and seeking to make mutually convenient arrangements.

The Government believes that such a meeting would assist it to reach fully informed decisions on the issues. There will need to be further Cabinet

consideration of the outcome of the meeting, following which I should be in a position to advise you of the

Government's decision.

VI-32

7 June 1984

Senator The Hon. A.T. Gietzelt Minister for Veterans' Affairs From Justice Evatt

forwarded to the Senator's home address by courier on 8 June 1984

I refer to the meeting of Wednesday last between yourself, Senator Grimes and myself arranged pursuant to the Prime Minister's letter of 24 May 1984.

My understanding of the outcome of our

discussions is as follows:

(i) The Commission's program as set out in Senior

Counsel's letter to you of 18 May 1984 and its attachment is acceptable;

(ii) An extension of my terms of reference to 31 March 1985 is immediately necessary and will be

attended to by the Department of Prime Minister and Cabinet;

(iii) I will provide a short Interim Report to the

Governor-General outlining the Commission's progress and its program to 31 March 1985. It will explain in detail why I regard the morbidity study, including an exposure index, as essential;

(iv) Upon approval of the study, (if granted). a

mechanism for its conduct will be established. This will include some AVHS staff members who will be under the control of the Commission. The Commission's Secretary will ensure proper policy

and resource management. A scientific director of equivalent status to Dr John Mathews will be appointed to ensure proper professional

direction. A proven project manager will direct day-to-day production and supervision. Senior Counsel will have a watching brief to ensure that the program is kept within the parameters

required by me and my terms of reference;

(v) Neither myself nor Counsel assisting will be

continuously or extensively engaged after the initial drafting of my report is concluded;

VI-33

(vi) Commission staff needed for continuing Commission business and involvement in control of the morbidity study will probably not exceed five or six officers including the Secretary;

(vii) As required, my services and those of Counsel will be called on during the study. I would expect the Secretary to provide me with regular and frequent briefings on progress;

(viii) At the conclusion of the morbidity study I would propose to conduct hearings to assess reactions of interested parties before making my final report;

(ix) I reminded the meeting that the August, 1984, estimate for completion of the taking of evidence was given by Senior Counsel at the meeting of 8 November 1983, in response to a question to him without notice. This estimate was modified in my

letter of 23 December 1983 to the Prime

Minister. By letter of 19 January 1984 more detailed scheduling was provided to the Prime Minister.

I would appreciate your agreement that the above accords with your view of the outcome of our discussions.

cc Senator the Hon. Don Grimes

Minister for Social Security Senator the Hon. Gareth Evans Attorney-General

12 June 1984

Senator The Hon. A.T. Gietzelt Minister for Veterans' Affairs From Justice Evatt

You raised a question as to a perceived

inconsistency between the use of the words "practical irrelevance" in my letter of 23 December 1983 to the Prime Minister and the word "essential" in my letter of 27 April 1984 to you.

The former letter was in response to a suggestion that in effect a guarantee of production of a reliable herbicide exposure index should be given in advance of approval of the study.

VI-34

I stressed that the experts believed that it could, but pointed to the "practical irrelevance" of such assurance before the study was approved, in a context of the acknowledged difficulties of such an index and the fact that the veterans latterly relate their symptoms to a cocktail of chemicals in an infinite number of

combinations.

The latter letter was in a context of performing the study without attempting (and I firmly believe, creating) such an index of herbicide exposure at least on a very high, high, medium, low, unexposed basis.

It is a basic tenet of epidemiological study that the researcher should seek assiduously for a dose-related response.

The most toxic of the chemicals used in Vietnam was the contaminant TCDD in Agent Orange. Other much less toxic chemicals were also used.

An important ingredient of the exposure evidence must be the subjective evidence of individual soldiers in the "base" group studied (i.e. Vietnam veterans). To omit the asking of questions re exposure to chemicals

(particularly as they are "coming through the door" anyway) and the detailed analysis of all material in respect of exposure (including records and the evidence given before me) would be irresponsible epidemiologically and forensically. Thus, the use of the word "essential".

I hope this clarifies the matter.

29 June 1984

The Hon. Mr Justice Phillip Evatt, DSC From The Prime Minister

I refer to your letters to me of 11 July and 23 December 1983 and 19 January 1984, your letter of 25 November 1983 to the Acting Prime Minister, and your letter of 16 February 1984 to the Special Minister of

State, the Hon. Michael J. Young.

As you are aware from your meeting with Ministers on 6 June 1984, the Government has been considering the matters you have raised relating to the Royal Commission. You will have received separately new Letters Patent dated

27 June 1984 and I am now in a position to advise you of the results of the Government's deliberations.

VI-35

You will see from the Letters Patent that the Governor-General has granted an extension of time for the inquiry, to 31 January 1985.

In order that the Commission can tender a final report by that date, the Government requests that you convene the Royal Commission at every opportunity consistent with your Federal Court duties, so that all necessary evidence gathering is completed as early as possible, and in any event no later than 31 December 1984.

In your letter of 25 November 1983 to the Acting Prime Minister you referred to your earlier proposal that the Royal Commission acquire control of the Australian Veterans Health Studies unit to undertake the morbidity

study. There are some practical aspects which need to be addressed and I think the appropriate course of action would be for you to raise the matter with the Special Minister of State, the Hon. Michael J . Young and the Minister for Health, the Hon. Neal Blewett, to make

suitable arrangements. The matter of funding also needs to be discussed by Ministers and I should be grateful if you would arrange to have estimates of the costs of the initial phase of the study prepared for that purpose as

soon as possible.

You expressed concern, in your letter of 23 December 1983 that the morbidity study may be subject to review. You will see from the supplementary Letters Patent that an analysis is required, by 31 January 1985 of the traceability of servicemen, their response rates in the study, the prevalence rate of particular conditions and the establishment of an exposure index, at which stage the Government will review whether the study should continue. I understand your concern that there are staffing implications in this approach. Nevertheless, you will appreciate that, given its cost, the Government and

the community must be assured of the viability of the s tudy.

The Government is always concerned that the costs of inquiries be kept within reasonable limits and you are requested to constrain the costs of your inquiry as far as possible. To this end, the Government has decided that further funding cannot be provided for overseas travel for, or on behalf of the Commission, except for witnesses, and that the use of consultants be restricted to obtaining essential scientific advice.

VI-36

The Government has also decided that Counsel assisting the Royal Commission will be paid at present rates but only for appearances at formal hearing days up to certain limits; the Attorney-General's Department will

be in touch with Counsel about the details.

In reaching these decisions, the Government, recognising the significance of the matters you raised, has given them the most serious consideration and has sought to accommodate your needs and requirements as far as is practicable.

3 July 1984

The Hon. R.J.L. Hawke, A.C., M.P., From Justice Evatt

I acknowledge receipt today of your letter dated 29 June 1984.

I am informed by the Commission's Secretary that a consequence of that letter is that he is unable to pay Counsel Assisting me whilst I am engaged in the Builders Labourers' Federation deregistration proceedings during

the month of July.

I had directed those assisting me to perform specific tasks during July which would have indeed kept them busy. For example, Senior Counsel was directed to prepare a report in respect of current research programs

in the United States and to draft a first report on the "exposure" hearing already held.

Until the question of the payment of Counsel's fees is resolved, the work of the Commission is at a

stand-still. Contact has been made by Mr T.A. Sherman, Deputy Secretary of the Attorney-General's Department, Canberra, with Senior Counsel, but I felt that I should inform you of the situation.

I will deal with this question and with other matters raised in your letter in due course.

VI-37

4 July 1984

The Hon. R.J.L. Hawke. A.C., M.P. From Justice Evatt

I refer again to your letter of 29 June 1984 and mine of 3 July 1984. Your letter raises a number of

serious concerns.

Royal Commissions have an important role in a democratic society. They provide a mechanism for

independent and searching inquiry separate from and unfettered by the Government of the day. The reputation they enjoy of fearless impartiality and rigorous inquiry is in particular a result of this independence and

separateness.

The use of Judges as Commissioners emphasises this independence and separateness from the Executive. Without these, no judicial officer would ever accept a Commission and without firm assurances of them I would not

have accepted my Commission.

It is in that context that I reply to your letter.

I have, I think, sufficiently emphasised the importance of the morbidity study to my deliberations. To require a final report before the conclusion of the study and analysis of the result is with respect quite

inappropriate. I recognise the Government's desire for an expeditious conclusion of the inquiry. I feel obliged to point out that had the request for the morbidity study been dealt with shortly after 11 July 1983 when I

requested it, the study would now be well on the way to conclusion and that as then planned it would have reached conclusion during the time when I will in fact be engaged in the writing of a final report.

Again, I have constantly stressed the need for sober and thorough analysis of material. The time needed for appropriate professional presentation of material for Counsel for the veterans, for Monsanto and for those assisting me makes "convening at every opportunity consistent with my Federal Court duties" unhelpful. Frankly, I find the request an unwarranted intrusion into

the manner of my inquiring.

Hearing days are but an aspect of my inquiry. As I said in my opening remarks:

VI-38

Some Commissions of Inquiry relate to specific past events and are designed to inform a

Government (and the public) of the truth of such events. Such inquiries adapt well to an

inquisitorial approach conducted along quasi-curial lines.

Others are investigatory and seek information about complex matters, so as to permit policy formation for the future. The present inquiry is one of the latter kind, and quite inappropriate

to an adversary litigious proceeding.

Subject to the Royal Commissions Act 1902, the way in which a Commissioner may conduct an

inquiry is a matter very much in the discretion of the Commissioner. In deciding what courses to adopt. I will have regard, inter alia, to the Letters Patent, the nature of the issues

involved, the public interest and the interests of persons who may be affected favourably or adversely by the evidence the findings or the report.

Without attempting to be exhaustive, it seems that this inquiry will involve:

1. Investigation of literature in relation to the toxic effects of chemicals in herbicides and pesticides before, during and after the period between 31 July 1962 and 11 January

1973, when Australian personnel were in Vietnam as defined in the Letters Patent.

2. Some investigation into the possibility of ascertaining the fact and/or the degree of exposure of servicemen and others to

chemicals in Vietnam during the relevant period and analysis of the data in relation to such exposure, by computer and otherwise.

3. Comparisons of expert scientific opinion in several disciplines.

4. Analysis of sampling procedures, data

control, computer analysis, statistical method and epidemiological validity.

5. Appropriate surveying and medical

examination of a number of veterans and controls, their wives and children.

VI-39

It is anticipated that information will be obtained in some or all of the following ways:

1. By the study of historical, scientific and other background data.

2. By examination of existing literature and research material.

3. By the use of reliable research teams,

whether presently in existence or assembled at a later date.

4. By research done by or

Commission itself.

on behalf of the

5 . By the hearing of oral evidence and oral

submissions.

6. By the taking of written submissions.

7. By the seeking of public response to

advertising, talk-back radio, informal and formal hearings, meetings and discussions.

8. By the use of modern computer eguipment.

As Sir Ninian Stephen said in R v. Collins 8 ALR 691 at 699, a Royal Commission's "mode of conducting its inquiry is entirely unfettered either by statute or by executive

direction."

Nor can I be sure that all necessary evidence will be gathered by 31 December 1984, although I am confident enough that it will be.

I am also disturbed at the content of the supplementary Letters Patent. An extensive pilot study was undertaken by Australian Veterans1 Health Studies. Its report dealt

thoroughly with traceability, response rates and prevalence of conditions. Since then the mortality study has been conducted which achieved response rates of 95%. The pilot study, without any of the special conditions of public relations exercises and Royal Commission

involvement achieved 72%. Dr Peter Greenwald’s study of New York veterans achieved 91%.

I have before me a 70 page document which is a sub-protocol dealing with tracing, contact and invitation of subjects.

VI-40

The likely prevalence of particular conditions and the exposure index have likewise been thoroughly investigated and details are now available. The details are, of course, not a matter which should concern you. What is of concern to me is that it will be quite

impossible to staff the study with appropriate people particularly at the senior level. No senior scientist of stature will make himself available unless certain that the study will proceed to finality.

Surely, after a pilot study costing more than $1 million and the advice of no less than five experts of international renown the Government and the community should have sufficient assurance of viability. I note

that the testimony of every expert witness thus far called has emphasised the need for an appropriate epidemiological study.

I add that my plans for the study include formal review of the number of subjects required after the first 2,000 are interviewed and examined. As previously advised, I am deeply concerned at the cost of the study and my consultants will at that stage advise me as to whether interview and examination of the whole or part of

the balance of 5,000 subjects is cost justified and essential to my inquiry. This may allow the total cost and the time for final reporting by me to be substantially

reduced. Consistent with appropriate independence, I ought to decide that question.

As far as the journey to the United States is concerned, I did not lightly decide that such a journey was necessary. That it should be peremptorily vetoed without even a question as to my reasons for that decision

is again in my view inappropriate, particularly as such a journey was previously approved.

A critical issue in this inquiry is whether agent orange, dioxin or 2,4,5-T cause cancer. The only

scientific support for veterans' contentions in this area is provided by the Swedish work of Harden et al. Dr

Hardell is presently working at Berkeley in San Francisco whilst on sabbatical and is unavailable to give evidence in Australia, although he is prepared to give evidence in San Francisco. Professor Cole, Dr Hardell1s greatest

critic, is also available in America and Counsel for the veterans is as anxious to cross-examine Cole as Counsel for Monsanto is anxious to cross-examine Hardell.

VI-41

As to health effects generally. Dr Ray Suskind and others have ready for presentation to the Royal Commission - not here but in Cincinnati - the results of a thirty year epidemiological study on industrial workers exposed to dioxin.

Dr Peter Greenwald at the National Institute of Health, near Washington, has both a case control study of cancer and Vietnam service and a mortality study of Vietnam veterans, not yet published but available for

presentation to the Royal Commission in America.

The Ranch Hand Report's research team (four investigators plus support staff) are all together in Texas and are more than willing to share all their work both past and follow-up with me.

Monsanto, U.S., have in-house research that they are prepared to show to the Royal Commission privately but not to allow it to be brought to Australia.

These are but a few of the important reasons for my decision to travel to the United States.

Further, I regard the assistance of Counsel as essential at all stages of my inquiry, during research, preparation and drafting as well as during "court" sessions. The capacity and industry of those assisting me has amazed me. Many consultants and witnesses and, in particular. Dr Alvin Young and Dr John Mathews, have paid glowing tributes in private conversations with me. It would be impossible for me to proceed without their

assistance. As to their fees, I note that Mr Sherman of the Attorney-General's Department has informed Counsel that there is no point in discussion "about the details" in view of Cabinet's decision. This dismays me.

Senior Counsel for Monsanto has expressed anxious concern at press reports of the recent developments which he observes threaten the capacity of the Commission for independent investigation, judgment and research.

Senior Counsel for the Vietnam Veteran's

Association of Australia informs those assisting me that his workload has involved 174 "out of courts" days for 39 days "in" and that restrictions such as are sought now to be imposed on Counsel Assisting would, if applied to him, make proper presentation of his client's case impossible.

VI-42

I hope that I may depend upon your good offices to resolve an unpleasant impasse. In view of my

commitment to the B.L.F. proceedings, I would be obliged if we could discuss the matter as soon as possible at a mutually convenient time. I note that the A.L.P . National Conference is to be held next week and contact this week

would be appreciated.

6 July 1984

The Hon. Mr Justice Phillip Evatt, DSC From The Prime Minister

I am writing by way of interim response to your letters of 3 and 4 July 1984 in which you raised a number of concerns about the future directions of the work of the Commission.

I am arranging for the relevant Ministers to study carefully the points you have made in your letters and to report back to Cabinet as soon as possible.

In this regard you will understand that Cabinet will not be meeting during next week, when the Federal Conference of the Australian Labor Party is being held.

I will also arrange for officials to hold early discussions with Counsel Assisting on the particular difficulties you see arising from the restraints on Counsels' fees.

I will be in touch with you again on these

matters as soon as possible.

On 15 June 1984 Senior Counsel Assisting was contacted by

telephone by the Attorney-General, Senator Evans,

concerning Counsels' fees. Senior Counsel, John Coombs

QC, advised the Commissioner of this conversation. The

Commissioner informed Coombs that any questions concerning

Counsels' fees was a matter between Counsel and the

VI-43

Attorney-General but that if the position arose that any

Counsel and. in particular, Senior Counsel, considered

returning his Brief, then Counsel were to speak to the

Commissioner prior to so doing.

Included in this correspondence is a letter from Senior

Counsel to the Attorney-General dated 7 July 1984. As the

subject matters are relevant to the climate that had

arisen in respect of the Commission in late June and July

1984, the letter is included:

7 July 1984

Senator the Honourable Gareth Evans Attorney-General From J. Coombs Q.C.

I refer to our telephone conversation of Friday. 15 June 1984. In that conversation you suggested that the terms of my appointment as Senior Counsel Assisting the Royal Commission be altered to:

(a) the daily fee to be payable only when the Royal

Commission actually sits;

(b) all necessary preparation to be done by others as far as possible; and

(c) fees for any preparation by me to be subsumed

within the daily rate.

In view of the limited time available for a reply on that day, I felt that a considered response was warranted. A fortiori in the light of the inclusion of an essentially similar proposal in a letter from the Prime Minister to

the Royal Commissioner dated 29 June 1984.

This Royal Commission is of the investigatory rather than the inguisitorial type. As the Royal Commissioner said in his opening remarks:

VI-44

Subject to the Royal Commissions Act 1902, the way in which a Commissioner may conduct an

inquiry is a matter very much in the discretion of the Commissioner. In deciding what courses to adopt, I will have regard, inter alia, to the Letters Patent, the nature of the issues

involved. the public interest and the interests of persons who may be affected favourably or adversely by the evidence the findings or the report.

Without attempting to be exhaustive, it seems that this inquiry will involve:

1. Investigation of literature in relation to the toxic effects of chemicals in herbicides and pesticides before, during and after the period between 31 July 1962 and 11 January

1973, when Australian personnel were in Vietnam as defined in the Letters Patent.

2. Some investigation into the possibility of ascertaining the fact and/or the degree of exposure of servicemen and others to

chemicals in Vietnam during the relevant period and analysis of the data in relation to such exposure, by computer and otherwise.

3. Comparisons of expert scientific opinion in several disciplines.

4. Analysis of sampling procedures, data

control, computer analysis, statistical method and epidemiological validity.

5. Appropriate surveying and medical

examination of a number of veterans and controls, their wives and children.

It is anticipated that information will be obtained in some or all of the following ways:

1. By the study of historical, scientific and other background data.

2. By examination of existing literature and research material.

VI-45

3. By the use of reliable research teams„

whether presently in existence or assembled at a later date.

4. By research done by or on behalf of the

Commission itself.

5. By the hearing of oral evidence and oral

submissions.

6. By the taking of written submissions.

7. By the seeking of public response to

advertising, talk-back radio, informal and formal hearings, meetings and discussions.

8. By the use of modern computer equipment.

It follows that the great bulk of the Royal Commission's work is being done out of Court. As Senior Counsel I have been responsible for the collection, collation and presentation of material. The Judge regards the

assistance of Counsel as essential at all stages of the inquiry - during research, preparation and drafting as well as during court sessions.

The hearing days themselves have demanded a deal of preparation. It would, I believe, be quite impossible for the preparation work either for presentation out of court to the Royal Commissioner or in court for the Royal

Commissioner to be done other than by Counsel. This is particularly so where a mastery of complex medical material, epidemiology, toxicology, spray drift physics, all in a forensic context is required.

Mr Barry O'Keefe, QC, Senior Counsel for Monsanto, whose brief is of course limited to Agent Orange questions has informed me that thus far he has spent at least six

eight-hour days out of court for every day in court. Mr Adrian Mclnnes, QC for the veterans, informs me that he has spent five days out of court for every day in court. My own experience is similar.

Perhaps I should mention that after preliminary

investigations it became obvious that material gathering was necessary and that my time would not be productively spent. I accordingly returned to my practice for two weeks during that gathering period.

I assure you that I do not remain at the Commission except when there is work to be done which warrants my attention.

VI-46

By way of further example, during part of the period when the Judge's commitments required him to preside over the BLF Deregistration proceedings, I was able to return to my practice for three weeks and charged only for minimal

supervision time.

I note that I accepted the fee proposed by the Crown

Solicitor without discussion. The hourly rate is of course lower than that obtainable in private practice and is dramatically reduced by the ceiling level of eight hours a day. Frankly, veiled suggestions have been made

that four hours of the twelve hour days ought to be put into other days. I have resented such suggestions and of course not complied with them.

Many members of the Inner Bar avoid the workload of such Commissions like the plague. I am sure I do not have to tell someone as busy as you the cost in personal and family terms of the involvement that such a heavy brief demands.

As to duration, as early as August 1983 we warned the then Crown Solicitor of the need for an extension of time. In my opening I foreshadowed inquiries lasting until towards the end of 1984. The BLF and some changes in approach by

the Vietnam Veterans Association of Australia have caused delays. Ironically, I have devoted substantial effort to organising the work of this Royal Commission so as to prevent protracted hearings of an open-ended sort. So far as our own work is concerned, we are close to schedule and

I personally monitor the work of the team at least

fortnightly.

In my initial conversations with Mr O'Donovan, (the then Commonwealth Crown Solicitor), we discussed the possiblility that the inquiry would last more than a year. He assured me at that time that an application for

increase of fees would be appropriate at the expiration of the year provided that the requested increase was not more than that granted to the working community by the

Arbitration Commission in accordance with CPI movements.

In all the circumstances, I am not prepared to agree to a change in the basis of my remuneration.

VI-47

9 July 1984

The Hon. R.J.L. Hawke, A.C., M.P., From Justice Evatt

Thank you for your letter of 6 July 1984. In view of its contents I have requested Counsel Assisting to resume work so that the program of the Commission will not be further delayed.

I have taken this step confident that you will ensure that they are paid on the previous basis for their work of last week. requested by me, and for further work carried out under my direction until the matters raised in my letter of 4 July 1984 are resolved and whatever the outcome.

I also confirm that I appreciate the Government's concern about cost. I have. with the close assistance and advice of my Secretary, Mr Meade and Senior Counsel, constantly exercised cost constraint.

That such constraint has been effective can be

demonstrated. The Parliament, no doubt advised by a bureaucracy well experienced in the management and conduct of Royal Commissions, voted a budget for this Commission,

of $3,199 mil. for the fiscal year 83/84. This vote

comprised:

1. Non-recurring establishment cost 2. Public service salaries 3. Administrative costs

$ 414,000 840,000 1,945,000 $3,199,000

Included in the Administrative costs was the sum of $575,000 to support the Vietnam Veterans Association of Australia in its appearance before the Commission. The expenditure of this sum was beyond our control. This left a balance of $1,370,000 for administrative costs which sum

included an appropriation of $638,000 for the fees of Counsel Assisting. Adding the public service salaries gives $2,210,000.

Costs actually incurred were:

1. Public Service Salaries $ 166,700

2. Administration (inc. counsel fees of $528,285) 875,000

$1,041,700

VI-48

It follows that savings over the estimates of more than $1 mil. have been achieved. This Royal Commission has functioned at less than half its budgeted costs by

stringent staffing, avoidance of heavy capital outlays and minimisation of costly external scientific and medical consultancies.

The substantial saving has been materially assisted by the willingness of those assisting to accept huge workloads (with much done in unpaid hours) and their capacity to learn the disciplines involved so as to reduce reliance on

a wide range of expensive specialist consultants.

Following the Prime Minister's letter of 6 July 1984 the

Minister for Veterans Affairs, Senator Gietzelt„ contacted

the Commission by telephone and indicated that the Prime

Minister requested that the Commissioner come to Canberra

again to further discuss the matters raised in

correspondence with Senator Gietzelt, Senator Grimes, and

Senator Evans. Senator Gietzelt stressed that the meeting

was to be with the Commissioner personally and that no

other person attend.

In normal circumstances. the Commissioner would not have

acceded to this request nor to the venue suggested by

Sena tor Gietzelt . namely , the Senate dining room at

Parliament House. When the Commissioner objected to such

a venue. Senator Gietzelt pointed out that the Senate was

then sitting almost continuously before rising for some

time and that a venue outside Parliament House was then

VI-49

impossible. Also, the Commissioner was somewhat

apprehensive of being 'jockeyed' into a position where a

possible dispute could arise as to what had transpired at

the suggested meeting.

Nevertheless, being of the view that every endeavour

should be made to convince the Government that the

proposed morbidity study should be conducted, the

Commissioner acceded to the conditions of the meeting.

Consequently, a meeting was held in a private dining room

in the Senate of Parliament House, Canberra on 25 July

1984 between the Commissioner and the three Senators.

The Commissioner returned from Canberra by air arriving in

his Sydney Chambers at about 5.15 pm. A vocadexed message

from Senator Evans, the Attorney-Genera1, awaited him on

his return. That vocadexed letter reads:-

VI-50

No addressee stated

From The Attorney-General

Vocadexed to the Royal Commission - vocadex no. (02)

2312685

Memorandum of discussion on future of Evatt Royal

Commission between Evatt J and Senators Gietzelt. Grimes

and Evans at Parliament House on 25 July 1984

1. The reporting date to be 28 February 1985 rather than 31 January.

2. The 'final' report of that date - on all matters

within his original terms of reference - would be subject to any reservations or qualifications the Commissioner might care to express: in particular, it to be understood that certain conclusions might be

expressed as subject to revision in the light of the outcome of the morbidity study (assuming approval of the continuation of that study by the Government).

3. The interim report on the viability (and proposed future methodology) of the morbidity study to be tendered on 28 February 1985, rather than 31 January.

4. The proposed trip to the United States to proceed, but on the basis of a maximum period away of two weeks and a party of no more than four (including the

Commissioner and his wife): the program, and costs, of that visit to be contained so far as possible.

5. Counsels fees to Coombs QC to be set at a ceiling of $80,000 for the period 1 July 1984 to 28 February 1985 with his tasks during that period to be resolved by the Royal Commissioner in consultation with him: the

expectation now being that Coombs QC's role henceforth would be primarily directed to assisting the

Commissioner in drafting the final report, rather than in preparing for and conducting hearings.

VI-51

6. Counsels fees for Messrs Kimber and Ellis for the same period to be calculated as per the Cabinet decision (viz on the basis of 64 "hearing days" at $550 and $400, totalling $35,200 and $25,600 respectively as a minimum with pro rata increases for any hearing days above that "minimum" number), these sums to be

subject, however, to some increase in the event of additional responsibilities being conferred following the withdrawal of Coombs QC from a day-to-day

supervision and hearing-preparation role; some adjustment to be also made to accommodate the extra month involved until reporting date.

26 July 1984

Senator The Hon. Gareth Evans Attorney-General VOCADEXED

From Justice Evatt

Re: Memorandum of Discussion on Future of Evatt Royal Commission between Evatt J and Senators Gietzelt, Grimes and Evans at Parliament House on 25 July 1984

1. A reporting date of 28 February 1985 would require me to cease taking evidence no later than 1 October 1984. This would prevent the hearing of a great body of evidence that the parties and those assisting would wish to call.

2. I have stressed that a final v r even an interim

"final" report on all matters within my terms of reference is not viable because:

(a) nearly all aspects will be affected and perhaps changed radically by the morbidity study;

(b) if one available view was then indicated by me on some aspects, e .g . , birth defects, mortality or exposure, veteran cooperation with the morbidity study might well cease.

3. I have previously indicated my attitude to external decision as to continuance of the morbidity study and the impossibility of staffing it on a basis that it may not proceed to finality.

4. None of my three Counsel is prepared to agree to the proposed unilateral changes to the contractual arrangements made at the beginning of this inquiry.

VI-52

My letter of 4 July 1984 directed to the Prime Minister states my position clearly enough. But again I stress that I do not regard my selection of the mode of my

inquiry as negotiable; nor do I regard the assistance of Counsel of my choice as negotiable. If the work of the Commission is to continue unhindered, I must have a response by 9.15 am, Monday next, 30 July 1984 (vocadex contact number is (02)231 2685). Failing this, I will announce at a public hearing of the Commission at 9.30 am my intention to return the Letters Patent and the reason

for so doing.

cc The Hon. R.J.L. Hawke, A.C.M.P. Senator the Hon. A .T . Gietzelt The Hon. Neal Blewett, M.P. Senator the Hon. D.J. Grimes The Hon. Michael J. Young, M.P. The Hon. J.S. Dawkins, M.P. The Hon. Gordon Scholes, M.P. The Hon. Bill Hayden, M.P.

On Friday 27 July 1984 two vocadexed letters were received

by the Commission.

The first was a letter from the Attorney-General, undated,

regarding directing future correspondence to the Special

Minister of State. That letter reads:

The Hon. Mr Justice Phillip Evatt, DSC.

I acknowledge receipt of your letter of 26 July 1984. The issues that you raise therein are matters which fall within the portfolio of the Special Minister of State. The Acting Special Minister of State has indicated that he wishes to discuss those matters with you next week, and will be contacting you today with a view to arranging a meeting.

VI-53

With respect to paragraph 4 of your letter, I must point out that the arrangements originally made with the then Crown Solicitor were for the period of the original Letters Patent. Accordingly, the arrangements were subject to review when consideration was given to

extending the original period of those Letters Patent.

I should be grateful if you would direct all

correspondence in respect of this matter to the Minister with portfolio responsibility for the conduct of Royal Commissions, that is, the Special Minister of State.

The second letter received on 27 July 1984 was from Mr Kim

Beazley, Acting Special Minister of State, reguesting that

a meeting be held between himself and the Commissioner on

Wednesday 1 August 1984. That letter, dated 27 July 1984,

reads:

The Hon. Mr Justice Phillip Evatt, DSC.

As you will be aware, the Prime Minister has asked me to assume Ministerial responsibility for matters falling within the portfolio of the Special Minister of State. As Ministerial responsibility for Royal Commissions falls

within that portfolio, the Prime Minister has asked me to address the matters raised in your letter of 26 July 1984 to the Attorney-General at the earliest opportunity.

You will appreciate that, in the current circumstances, it will not be possible today to give adeguate attention to the serious matters raised therein. I would therefore be

appreciative if you would defer any action in pursuance of these matters until I have had the opportunity to discuss them with you. As I anticipate being in Western Australia early next week, I would seek the opportunity to meet with you on Wednesday, if that is possible.

While I appreciate that you may hold strong views on the questions in issue, I trust that you will agree that the importance of the matters raised by your Letters Patent for Vietnam veterans and their dependants is such that no

possible avenue for resolution of these issues should be left unexplored.

VI-54

During the weekend, contact was made by telephone between

the Commissioner in Sydney and Mr Kim Beazley in Perth and

a meeting was then arranged for 10 am 1 August 1984 at the

Commission's Chambers in Sydney, it being agreed that the

Commission would not sit as intended at 9.30 am on Monday

30 July 1984. Following that meeting. the following

letter was received from the Prime Minister:

2 August 1984

The Hon. Mr Justice Phillip Evatt DSC

The Acting Special Minister of State, the Hon. Kim C. Beazley MP has informed me of the discussion he had with you on 1 August about the future direction of the work of the Commission. As you know, the Government is

concerned in the context of general economic restraint that the cost of the inquiry should be kept within

reasonable limits.

Mr Beazley conveyed to you the Government's particular concern about the proposed morbidity study. The Government appreciates your advice and recognises your conviction that such a study might assist you in your

examination, but is not convinced that a useful result can be achieved. As you are aware, the estimated cost of such a study has grown from an initial estimate of $6m to a latest estimate of some $10.5m. Against this background

the Government is not persuaded that the expenditure of public funds of the magnitude proposed is warranted and is now of the view that the morbidity study should not proceed.

I understand that Mr Beazley mentioned to you the approach taken by the then Government in its handling of the proposal by the Royal Commission on Barrier Reef Petroleum Drilling to conduct extensive scientific experiments in 1970/71. That government, on the grounds

VI-55

of cost effectiveness, did not agree to the conduct of the proposed experiments.

I appreciate that there is a need for the

Commission to obtain the widest range of evidence if it is to satisfy its original terms of reference. Accordingly, the Government is prepared to permit the Commission to travel to the United States in order for you to obtain additional material available in that country. I would expect that the details of the Commission's travel, such as the size of the party and the length of the visit,

would be worked out in consultation with the Special Minister of State in accordance with the Government's concern for economic restraint.

To allow you adequate time to complete your investigations the Government has decided that your reporting date should be extended to 30 April 1985.

The payment of Counsels' fees will continue to be handled by the Department of the Special Minister of State in accordance with the usual arrangements for servicing Royal Commissions.

Letters Patent to implement the above proposals are being prepared. These will be forwarded to you as soon as they are issued.

6 August 1984

The Hon. R.J.L. Hawke. A.C.. M.P.. From Justice Evatt

Thank you for your letter of 2 August 1984. As you know I have, since July 1983 , been of the view that a morbidity study could be of great assistance and

importance in determining answers to the questions raised in my original Letters Patent. Accordingly. I must express grave disappointment with the Government's decision not to fund the study but, of course, accept its reasons therefor. As earlier advised to certain other Ministers before the discussions with the Acting Special Minister, the Hon. Kim C. Beazley on 1 August 1984, I have

always believed that, as a matter of law, the Government has the ultimate budgetary control of any inquiry it sets up with the qualification that the Commissioner has at all times the right to return his commission if in his opinion

VI-56

his independence of inquiry is fettered or hindered by such budgetary control.

I note the Government's strongly expressed wish that I continue with my inquiry notwithstanding being informed that after hearing all available evidence I might still be obliged to express in my report reservations as a result of the lack of the study.

I have now decided to continue the inquiry

despite the lack of the study because:

. of the fact that the Letters Patent of 27 June 1984. which included paragraphs making express reference to the study, have been superseded. You will recall that my view was that these paragraphs. (inter alia),

inhibited or could be seen to inhibit my independence and consequently caused me concern,

. of the Government's express wish and its reasons therefor,

. of research developments since July 1983, particularly the Mortality Report, the work of Dr Peter Greenwald and the Ranchhand Baseline Morbidity Study,

. of the fact that the work of the Commission thus far has been considerable and it would be wasteful should the benefit of that work be lost,

. of my belief that a worthwhile report, albeit

restricted because of the lack of the study, can be delivered which, in my view, would make a substantial contribution to the learning on chemical exposure and

health consequences,

. of continued Vietnam Veterans Association opposition to any study which includes a herbicide exposure index which index is vital to a valid epidemiological study,

. of the need and wish of veterans to have at least the best answer that I can provide.

I greatly appreciate the courteous and amicable atmosphere under which the discussions with Mr Beazley took place. It undoubtedly enhanced those discussions.

VI-57

10 August 1984

The Hon. Mr Justice Phillip Evatt, DSC From the Prime Minister

Thank you for your letter of 6 August 1984 and for your advice that you have decided to continue the inquiry without the morbidity study.

I am pleased that the way is now clear for you to

proceed. The Government and, I am sure, Vietnam Veterans look forward to your report.

Press Release by SMOS on 7 August 1984:

The Government has decided to extend the Evatt Royal Commission to 30 April 1985 to ensure the widest possible inquiry both in Australia and overseas.

This followed the Government's decision not to fund the full Morbidity Study required by the Royal

Commissioner. The cost of the study had expanded from an initial estimate of $6 million to a latest estimate of some $10.5 million.

The Commissioner expressed grave disappointment at the Government's decision but accepted the Government's right to make such a determination and in all the circumstances agreed to continue the inquiry.

He considered that a worthwhile report can be delivered. though there might be some

qualifications because of the lack of a morbidity study. This would make a substantial

contribution to the learning on chemical exposure and health consequences. He noted also the wish of the Vietnam veterans to have the best answer that he can provide. In forming this view he took account of research developments since 1983 and continued opposition from the Vietnam Veterans Association to any study which includes a herbicide exposure index.

The Government agreed not to vary his initial terms of reference in a manner which the

Commissioner felt might have, or been seen to have, inhibited his independence.

VI-58

The Government and the Commissioner jointly recognise the need to continue to contain costs consistent with the maintenance of appropriate independence of the inquiry.

The usual arrangements for servicing the Royal Commission will continue to be implemented by the Department of the Special Minister of State.

1 This agreement establishes a fair and

cost-effective framework within which the inquiry can proceed independently.1 Mr Beazley said.

3. INDIVIDUAL VETERANS HEALTH COMPLAINTS - WAA'S TEN

BEST SHOTS

Necessarily, the number of veterans with typical disorders

to be called as witnesses had to be limited. After

discussions between the Commissioner, Counsel Assisting

and Senior Counsel for WAA, it was decided that such

proposed witnesses be limited to a figure of about ten.

This group came to be referred to as the "Ten Best Shots"

and were those whom W A A considered likely to be veterans

combining exposure to chemical agents in Vietnam with

typical, adverse health effects.

Thereafter, Counsel for the W A A provided those assisting

with material, albeit scant in some instances, in respect

of some 31 veterans. From amongst those veterans, ten

were selected by consultation between Counsel for W A A and

Counsel Assisting. Four "reserves" were added.

VI-59

In short, the officials of WAA, through their Counsel,

have exercised their right to call the "Ten Best Shots".

This sample approach is not unique - it was adopted by

both Judge Pratt and Chief Judge Weinstein in the American

Class Action in respect of Agent Orange.

In the course of the Health Effects hearings, Mr Mclnnes,

Senior Counsel for WAA. indicated that, in respect of the

"Ten Best Shots" it was never his intention that those

people were intended to be the worst cases - they were put

forward as a cross-section of the complaints made to

W A A . 11

The following section deals with the evidence of those ten

witnesses. In some instances some of this evidence was

received in camera and the transcript thereof remains

confidential. However, the greater part of the evidence

was open to the public and the fact that these ten people

gave evidence is a matter of common knowledge.

Despite the fact that the majority of the evidence was

given in public hearing, it is felt that no useful purpose

would be served by further identifying those who gave

evidence. Accordingly, in this section of the Report,

VI-60

those witnesses are identified by giving them a number

which represents the order in which they were called.

Hence, these witnesses are "numbered" one through ten. It

is appreciated that referring to people by names rather

than numbers is preferable. However, in the

circumstances. this system is adopted in order that the

health problems experienced by those ten witnesses. which

may rightly be regarded as personal, do not receive

unnecessary, identifiable publicity.

3.1 Evidence of Veterans re Health Complaints

Veteran 1

The witness was called up for National Service in July

1965 (aged 21, date of birth 25/6/45) and discharged in

June 1967. He then returned to work as a bank officer and

joined the Emergency Reserve Forces. In June of 1970 he

left his employment because "he was too closed in at the 12

bank" and joined the Regular Army.

In November 1970 he was posted to Vietnam and served in

the Free World Headquarters in Saigon where he observed

back-pack and fog spraying both around the compound and

within the buildings which was designed to eradicate

cockroaches, mosquitoes and vermin although he did not

participate in that spraying program.

VI-61

Subsequently he served for three or four weeks at the Ton

Son Nuit Air Base before being posted to Vung Tau where he

served with 5 Company, Royal Australian Army Service

Corps. He was attached to 25 Supply Platoon as an

administration clerk and storeman which involved him in

the issue of supplies to Australian troops in Vietnam.

He claimed that while at Vung Tau he worked in the stores

where chemicals were kept and that he was twice required

to weigh and dish out a particular chemical. During that

process he wore a face mask. The chemical was described

by him as a powdered one, stored in a forty-four gallon

cardboard drum with two black bands and a white skull

emblem on it. Clearly, it was not any of the herbicides

used in Vietnam owing to the powdered form and the

13

description of the container.

He observed aerial spraying at Vung Tau although his 14

evidence varied as to frequency: his statement,

suggested weekly, yet in cross-examination he estimated

that the spraying occurred only about every 6 weeks.

The statement of this witness suggested that he had been

caught outdoors during spraying on two occasions although

he only alleged one such occasion when he gave evidence.

VI-62

On this occasion he claimed that he got spray in his hair

and eyes. He claimed that he had subsequently been

hospitalised for two days due to an eye injury with later

follow-up care as an outpatient. However, he later

conceded to Counsel Assisting that he had not been in

hospital but only treated as an outpatient.

He also suffered a skin disorder which he described as

"tropical acne". This was said to have been reported at

the time and treated on an outpatient basis yet it did not

clear up. The witness claimed he now has recurrent eye,

skin and temperament problems, whereas prior to his

Vietnam service he was in excellent health.

As was the case with all ten witnesses called to give

evidence at the Health Effects hearings, all documentary

records held by the Department of Defence and the

Department of Veterans' Affairs were summonsed by the

Commission in order to make a full consideration of the

health and service details of each witness.

In respect of the first witness, such records revealed

that he did not report a body rash until some five months

after the spraying incident and that, when it was

reported, it was diagnosed as contact dermatitis.

VI-63

Further, that while he was doing National Service training

he twice reported skin rashes. On the former occasion the

diagnosis was "query tinea", on the latter "probably

pityriasis rosea". Additionally, prior to the spraying

incident, he had reported a rash on his wrist thought to

be an allergic reaction to a metal watchband.

The witness also claimed that he suffered from temperament

(nerve) problems following service in Vietnam, that he had

experienced "the shakes", attacks of anxiety and gets

"very, very tense when pressure is applied on him" These

symptoms are consistent with a personality trait.

Indeed, while on R and R (rest and recreation leave) after

six months service in Vietnam he developed a fever

(shivers, shakes, head cold and sweating). This was

initially diagnosed as malaria but later as an anxiety „ „ 15

state.

He was subjected to a number of emotionally traumatic

events both during and after his Vietnam service. Whilst

in Vietnam his first marriage broke up, he was involved in

an incident where three Australian servicemen were shot by

a comrade who ran amok with a machine gun and he witnessed

a man being run over by a jeep, which observation

subsequently involved him in a lengthy inquest. Following

VI-64

his return to Australia he was involved in a fatal road

accident and thereby another long inquest and his present

marriage experienced some difficulty.

The witness claimed that he is currently jumpy,

over-reactive, with a tendency to become violent, and has

trouble sleeping. He gave further symptoms of anxiety

state (excessive perspiration, cold sweats, chest pains

and shortness of breath). In 1983 he was admitted to the

Repatriation General Hospital in his home State for the

treatment of a chronic anxiety state and post-traumatic

stress disorder.

His dependency on alcohol and cigarettes is claimed to

have increased. The gout from which he suffers has been

attributed to his consumption of alcohol, upon which he

relies to calm down.

At the time he gave evidence he was employed as a bus

driver and field worker with a public corporation and, in

the course of his duties. he was involved in the

application of creosote and tordon. He wears a face mask

but prefers not to use gauntlets, gloves and sleeves as

they make handling the sprays difficult.

VI-65

In July 1983 he applied to DVA for medical treatment and a

pension. His application described his skin disorder as

tropical dermatitis. His claim was accepted in respect of

tropical dermatitis, anxiety state and gout.

There are a number of factors which weigh against the

conclusion that the health effects of this witness are due

to chemical agents: the low level of alleged exposure

generally and, in particular, with respect to herbicides;

the previous history in respect of skin rashes; the

various traumatic incidents which may be expected to have

caused or have contributed to his anxiety state; the

consumption of alcohol and usage of chemical agents since

Vietnam in the course of his employment.

Accordingly, the Commission does not believe that this

witness advanced the WAA's case to any extent. However,

the Commission wishes it to be clear that it does not

regard this witness as other than truthful and doing his

best to recollect matters which occurred some time ago.

Whilst this witness is undoubtedly experiencing health

problems as a result of his Vietnam service, the

Commission cannot conclude on the balance of probabilities

that, on the evidence available, the problems which he

outlined are caused by exposure to chemical agents in

Vietnam.

VI-66

Veteran 2

A philanthropic worker with the Australia and New Zealand

Red Cross Field Force was the second witness. Her duties

involved caring for hospitalised soldiers. In the course

of her service in Vietnam, which spanned the period from

February 1968 to February 1969, she occasionally travelled

to Nui Dat, Saigon, Black Horse and Ton Son Nuit, although

she was primarily stationed at Vung Tau.

This witness recollected having observed spraying around

the buildings within the hospital complex at Vung Tau on a

daily basis in the early evening by a serviceman using a

back-pack, and wearing protective clothing. Although not

directly sprayed, she reported "feeling spray coming down

like a very fine mist" as she walked from the dining room

to the officers' mess. She also observed "curls of fog

coming through the cracks in the dining room walls after

spraying had taken place". Her description is suggestive

of insecticide spraying: her statement16 suggests that

it was malathion.

She also observed spraying taking place one morning. The

smell was familiar to her; she could recall having

experienced a similar smell on other occasions at Nui Dat

VI-67

early in the morning upon her arrival. On another

occasion she observed aerial spraying in the distance on

the horizon whilst journeying in a jeep from Long Binh to

Saigon. She assessed the distance to this aerial spraying

as 30 minutes travel by jeep; she was unsure as to the

number of aircraft. However, she did not feel that she

came into contact with the spray and was not aware of any

unusual smell.

The health problems of this witness included sinus, skin

and back problems, fever, depression, tension, lethargy,

nightmares, tingling hands and feet, blurring of vision,

headaches, breast lumps and menstrual irregularities.

Dealing with each in turn:

The witness suffered from sinus problems whilst in Malaya

prior to her Vietnam service. Although she claimed that

her sense of smell had been numbed, as it were, by the

17

presence of the odour, she conceded that she was

unable to associate any of her hay fever or sinus symptoms

when in Vietnam with the spraying of chemicals. She

admitted that the symptoms might be associated with the

sand at Vung Tau. It is noted that she still suffers from

sinus problems "because of all the pollen in the air".

VI-68

Her history prior to Vietnam service mitigates the

likelihood of these symptoms being due to chemical agents

with which she came into contact during her Vietnam

service. Furthermore, an allergic reaction cannot be

ignored.

Skin rashes were experienced by the witness on various

parts of her body and were diagnosed as contact

dermatitis. The tropical climate in Malaya and Vietnam is

a likely cause, supported by the fact that the rashes

receded when treated with ointment whilst the witness was

in the air-conditioned atmosphere of St Vincents Hospital

in Sydney where the witness spent some time having tests

performed when she was home on R and R .

The back problems related to lifting heavy packages and

the witness did not associate this aspect with exposure to

chemical agents.

On two occasions whilst in Vietnam the witness was

admitted to hospital with gastro-enteritis accompanied by

fever and diarrhoea. The first such instance occurred

soon after her arrival and is not surprising in view of

the change of diet and climate involved. The second

occasion was at a time when she had been working hard and

VI-69

was generally feeling run down. She was treated with

antibiotics and anti-diarrhoeal substances and later

discharged.

Depression, tension, lethargy, nightmare and tingling of

the hands and feet are suggestive of an anxious

personality. The blurred vision and headaches occurred

and were investigated prior to her service in Vietnam.

The depression is triggered or worsened by flashbacks.

With regard to the blurred vision and headaches an

Out-Patient record was tendered.18 This revealed that

the witness experienced double vision as early as 1956

following a basal skull fracture when she was aged 20.

A lump developed in her breast while she was in Vietnam.

This was not considered to involve a tumour, but rather to

be hormonally related. The menstrual irregularities which

she also experienced support this diagnosis which is not

uncommon among unmarried, childless women.

As in the case of the previous witness, there are many

factors which prevent a finding that these health effects

are caused by chemical agents. These include - no

relevant exposure to herbicides; health problems which

VI-70

first arose prior to her Vietnam service; symptoms being

overcome by treatment with an anti-depressant, Sinequan,

and satisfactory medical explanations for the health

problems which explanations do not relate to chemical

exposure.

Veteran 3

The third witness who gave evidence on Wednesday 5

December 1984, was also a National Serviceman born 20 May

1946. His service spanned the period 28 September 1966 to

27 September 1968 and his Vietnam service amounted to some

nine months, from December 1967 until August 1968. He was

stationed at Vung Tau throughout this period of service in

Vietnam with the exception of some six or seven weeks

which he spent at Nui Dat.

In Vietnam he served with 102 Field Workshops as a motor

mechanic repairing vehicles, some of which he recalled had

tanks and pumps on them although he was not aware of their

usage.

At Nui Dat on one particular occasion he observed spraying

by 1 Armoured Regiment using "big water tankers" with "a

boom out the back of it" and he recalled that, following

VI-71

the spraying, the air had a bitter taste. He gave

evidence that it was "like the fogging (they had for

mosquitoes) they used to have every evening; it tasted

very similar." The sprayed ground was subsequently

covered with gravel and a workshop was erected on that

He said every evening "portable smoggers" were used to

spray the area, . These two aspects represent the only

contact which the witness alleges to have had with

chemicals whilst in Vietnam.

The witness described his health as good prior to going to

Vietnam other than having had a perforated ear drum which

did not prevent him being passed as medically fit. During

his Vietnam service he experienced occasions of upset

stomach, warts and skin rashes. The warts were burned off

upon his return to Australia and the skin rashes went away

over a course of three or four months.

He experienced stomach pains in the latter part of 1979.

This was diagnosed to be a seminoma with metastasis (ie.

secondary site). From March 1980 he underwent

chemotherapy which included cis-platinum treatment. He

now experiences hearing problems and audiograms taken

VI-72

before and after this treatment confirm that the treatment

was the probable cause thereof. However, since he was

exposed to noise in the course of his service in Vietnam,

a claim for partial hearing loss has been accepted by the

Department. The seminoma resulted in the removal of his

right testicle in May 1980 and in July of that year an

operation was performed to remove the fibrous remnants of

the malignant tumour from the stomach which was the

secondary site. Pursuant to Regulations 32B of the

Repatriation (Special Overseas Service) Regulations and

6 5A of the Repatriation Regulations, which permit the

Department to meet the cost of medical treatment for

malignant neoplasia (ie. cancer) for members who served in

Vietnam, the expenses related to treatment of this

seminoma with metastasis were met by DVA.

The witness attributes the difficulties he now experiences

with bending and tingling in his fingers to the operation

which involved the removal of fibrous remnants of that

tumour.

Temperament problems were also indicated by the witness as

first occurring following his Vietnam service although he

was unable to associate these problems with any particular

event. He did concede, however, that these problems did

VI-73

not manifest themselves until ten years after his return

from Vietnam and that they first occurred at a time when

he was changing jobs. In cross-examination, he agreed

with Mr Stowe (Counsel for Monsanto) that from late 1979

until some time in 1981 he was in fear of his life by

reason of the cancer diagnosis.

Once again, the witness did not give any account of heavy

or persistent exposure to herbicides. Whilst there is no

doubt that this witness was exposed to insecticides on at

least one occasion, there is nothing in his evidence to

suggest that his exposure was any greater than that of

many of his colleagues.

The medical report of Dr J. M. Killick dated 5 June 1981, 20 noted correctly that the member's first symptoms in

respect of the seminoma commenced some eleven years after

his service in Vietnam. This report dealt with the

incidence of seminoma of the testes with metastases and

noted that it was an uncommon malignancy which appears in

Caucasians, having an incidence of about 2 per 100,000

with a peak incidence being between the ages of 20 and 40

years. It notes that seminomas have not been produced

experimentally by carcinogens and that there is no mention

in the medical literature of any relationship to toxic

chemicals, pesticides or herbicides such as Agent Orange.

VI-74

This An article by Joan M. Davies was exhibited,

article, which first appeared in the Lancet„ April 25,

1981 was titled "Testicular Cancer in England and Wales:

Some Epidemiological Aspects." This article noted that

the incidence and mortality rates among young men for

testicular cancer have been rising in England and Wales

since the beginning of the 2 0 th century to the extent that

it is now the most common neoplasm (i.e. cancer)

registered among men aged 25 to 34. The article asserts

that little is known about the aetiology (i.e. cause) of

the disease. Based on an analysis of the data, the author

suggests that these increases in incidence may be related

to some features of modern life which have gradually

become more common throughout society and notes that "a

bewildering range of features of 2 0 th century life could

fit this definition and might possibly be relevant,

including central heating, clothing styles, use of hot

baths, car driving, changes in diet, earlier sexual

maturation and an increasingly sedentary way of life."

Having considered possible risk factors, the author

concludes that, "for practical purposes the aetiology of

the disease must be considered unknown."

21

VI-75

The nature and level of exposure coupled with the unknown

aetiology of the seminoma with metastasis precludes a

finding on the balance of probabilities that this

particular health effect was in this instance related to

chemical agents. A better picture on this aspect might

have been observed had the proposed morbidity study

proceeded as a consideration of the incidence levels would

have enabled a comparison of actual and expected numbers

for the group being studied. In the absence of this study

one particular case proves very little.

The Commission is satisfied that this witness was truthful

in his recollections and it is pleasing to note that his

prospects of not experiencing any further problems with

cancer are good. Exhibit 1785 was a report from a

physician in Oncology (ie. a surgeon specialising in the

field of cancer). This report noted that the "long-term

prognosis is now quite good with the very real potential

of no further recurrence of the disease".

Veteran 4

The fourth witness was born 27 January 1943. His service

records disclosed that he was a member of the Regular Army

from 1962 to 1968 and that he served in Vietnam as a Lance

VI-76

Corporal in D Company, First Royal Australian Regiment

from 10 June 1965 to 8 June 1966. Whilst in Vietnam he

was based at Bien Hoa although he occasionally visited

other places such as Vung Tau.

On the issue of exposure, this witness could not recall

having observed any spraying or fogging with chemicals.

The only evidence which he gave on this aspect was that on

one occasion, early in the morning, he saw a thick,

whitish fog. He was unable to stipulate the location,

whether it was aerial spraying or what it was that was

being sprayed.

Whilst serving in Vietnam he claimed to suffer diarrhoea 22

occasionally although paragraph 2 of his statement

denied any specific illness or sickness during his time in

Vietnam. He claimed good health prior to Vietnam service.

He gave evidence that since his return he has experienced

diarrhoea, constipation, bleeding from the bowel (which

first occurred in about 1981 but has since ceased), chest

pains which he regards as "nothing serious", blurred

vision, dizziness and sweating. He also had his right

kidney removed due to a Grawitz tumour in 1983. The

witness also indicated personality problems which he

VI-77

described as depression, anxiety and "feeling uptight".

Further. he spoke of rages which he claimed first occurred

some six months after his return from Vietnam. On the

o ther hand, he signed a proposal for life insurance in

1980 which stated that he was in good health and which

expressly denied any blurred vision, dizziness, fainting

spells or heart problems. A copy of this proposal form 23 was exhibited.

Prior to his army service the witness worked in a bank.

After leaving the army he spent some considerable time

travelling in America, Europe and South Africa where he

successfully commenced his own business and married. Upon

his return to Australia he was unemployed for seven months

before obtaining employment with the Department of Main

Roads with which he has now worked for almost seven years.

The witness is currently in receipt of a 40% pension.

Exhibit 1790 comprises the documents relating to the

determination of his application. His claim in respect of

the Grawitz tumour was originally rejected by the No. 3

Repatriation Board on 14 July 1983. A Delegate of the

Repatriation Commission subsequently obtained further

information in respect to the smoking habits of the

witness and the increased consumption of tobacco arising

VI-78

from Vietnam service. On 19 June 1984 that Delegate

accepted the claim in respect of the Grawitz tumour owing

to the possibility that the increased consumption of

tobacco as a result of service in Vietnam contributed to

the development of incapacity due to that tumour. The

current pension level of 40% may thus rightly be regarded

as due to the assistance which that officer of DVA

provided to the witness.

This witness only smoked about 3 or 4 cigarettes a day

before his enlistment. Whilst in Vietnam the level of his

consumption rose to as many as 60 per day. He gave

evidence that it was commonplace to stop for about ten

minutes every hour whilst on patrol and 'that the guards

posted at such times were non-smokers. He indicated that

he thought that this factor encouraged smoking and that,

to his recollection, the cost of cigarettes in South

Vietnam was about 7 or 9 cents a packet. Availability was

by ration packs and re-supply. He instanced three factors

which he believed contributed to smoking: the tension of

the conflict, the cheapness of cigarettes and the fact

that "it got you out of a few jobs from time to time".

VI-79

It is difficult to see why this witness was proposed by

Counsel for the WAA; he gave no evidence of exposure to

herbicides in general or Agent Orange in particular. His

evidence of exposure to pesticides was minimal to say the

least. He exhibited no symptoms whatsoever which might

relate to exposure to such chemical agents. In fact, the

only aspects of his service in Vietnam which might have

had or be having an effect upon his health appear on the

basis of the evidence before the Commission to be the

tension of the warfare and increased cigarette smoking.

He would appear to have successfully integrated into the

workforce. The Commission has no doubt that this witness

was being fair and truthful in his evidence.

Veteran 5

The service records of the fifth witness (born 5 September

1937) disclosed that in 1959, upon completion of his

National Service, he applied to join the Regular Army. He

served in Vietnam for three months from June 1967 and.

when his period of enlistment expired in 1977, he

re-enlisted for a further period of six years. He then

applied to return to New Guinea where he had previously

served in 1975 and 1977. He requested and was granted a

discharge in 1979 by which time he had completed twenty

years of Army service.

VI-80

Whilst in Vietnam the witness was involved in the repair

of engineering equipment including fogging and spraying

equipment which he stated often contained chemicals.

Furthermore, he stated that chemicals were used to test

such equipment following repairs although he was not able

to recall which chemicals were used or the nature of any

markings on the containers. In his evidence-in-chief he

claimed that chemicals came from the Battalion in

forty-four gallon drums. Under cross-examination, he

conceded that the chemicals which came from the store at

the workshop in which he worked came in either cardboard

canisters. plastic bags or in blue and white four gallon

drums. The witness stated that he did not wear protective

clothing, that he was unable to shower for up to four

hours following contact with the spray and that he had

vomited on a couple of occasions. He recalled observing

spraying around the perimeter wire at Nui Dat. He claimed

to have had contact. whilst in New Guinea, with chemicals

used for spraying vegetation although he was not able to

identify such chemicals.

Prior to his Vietnam service he experienced skin problems

which he described as industrial dermatitis. He claimed

that his problems had cleared up with his tour of duty and

VI-81

also stated that he suffered from infrequent

gastro-enteritis. In 1961 the witness had an acute rash

described as acne vulgaris. His medical records reveal

scarring of the skin of his arms and neck prior to his

service in Vietnam and treatment for headaches as far back

as 1963. In New Guinea he had experienced heat rash. The

witness now complains of headaches, skin rashes, excessive

sweating, bad nerves. dreams. rages, blood pressure,

kidney pains, gastric problems, nausea, muscular

twitching, sleeping problems, chest pains, dizziness and

vertigo.

He claimed that a multi-vitamin treatment which had been

administered by Dr Van Tiggelen in the twelve months to

September 1984 had "calmed me right down ... I still had

nerves but no other problems, virtually". Yet, on 30 March

1984, he made an additional claim to the Department of 24 Veterans' Affairs claiming that his condition had

deteriorated. This claim, inter alia, alleged headaches,

stomach upsets, inability to sleep or concentrate and when

questioned as to this claim he suggested that his nerve

problem had got worse during 1984.

The reason why this witness' service in Vietnam was 2 5

terminated was exhibited. Without elaborating

unnecessarily, it is simply noted that the witness was

VI-82

understandably distressed by domestic matters. Another

record26 revealed that his service in New Guinea

concluded prematurely for similar reasons. Evidence heard

in camera and contained in confidential sections of the

Transcript disclosed problems which arose in his early

life through no fault of his own. It would be surprising

if the health of this witness was not affected by events,

the nature of which are readily apparent from all of the

evidence, including those portions which remain

confidential. It should not be thought that the

Commission is in any way critical of the witness in this

regard. Rather, it illustrates the difficulty which

confronts this Commission when considering whether the

health of a witness has been adversely affected by

chemical agents: this aspect is but one alternative

explanation. However, this is not the only aspect which

renders difficult the task of drawing conclusions from his

evidence.

As has been earlier indicated this witness gave evidence

which was at times conflicting. Further, he was prone to

exaggerate. Examples of this include suggestions that he

had been involved in combat situations when in fact he had

not been involved in any such conflict and intimating that

he had served in Vietnam longer than was actually the

VI-83

case. He even sought to suggest that there had been a

confusion of records in order to maintain this last

mentioned allegation. In a claim lodged with DVA he

alleged to be

27

unemployed yet the evidence clearly

discloses that this was not the case. 28 This witness

submitted material to WAA, attended the Informal hearings

held by the Commission at Sale, Victoria, and gave

evidence at these Formal hearings. He thus evidenced a

willingness to contribute.

Instances of conflict and exaggeration represent problems

additional to those which have already been indicated in

respect of the previous four witnesses. In all the

circumstances, including the lack of reliability of this

witness, the Commission is unable to conclude that his

evidence establishes any of the allegations made in

respect of health effects being due to the usage of

chemical agents during the Vietnam conflict.

Mr O'Keefe Q.C., Senior Counsel for Monsanto, submitted

that this witness had indicated in his evidence that he

felt deprived of the opportunity to make a contribution to

the Vietnam war. He submitted that the witness sought to

compensate for this deprivation by being part of the Agent

Orange dispute in the post-conflict era. He further

VI-84

submitted that the witness was an example of the

. 2 9

displacement mechanism described by Dr Ellard in that

he now experienced physical manifestations of what is

essentially a psychological problem. Whilst there is

force in Mr O'Keefe's submissions, it is unnecessary to

deal with them in view of the stated conclusions of the

Commission.

Veteran 6

The sixth witness, born 10 December 1937, now experiences

a skin rash which covers some eighty per cent of his

body. It is accompanied. depending upon its severity, by

a number of other symptoms. Additional problems arise due

to the itchiness of the rash. Three photographs which

graphically depicted the rash became Exhibit 1796. There

can be no doubt that this witness is suffering from such

an ailment; nor can it be doubted that his plight is sad.

However, the issue which must be addressed is whether such

health problems are due to chemical agents used whilst the

witness served in Vietnam.

This witness was called up for National Service in 1955

and in 1958 joined the Regular Army. Following service in

New Guinea during 1959-61 and 1963-64, he served in

VI-85

Vietnam from April 1966 to April 1967 and was subsequently

discharged in 1970.

Suggested as evidence of exposure was the involvement of

the witness, whilst based at Nui Dat, in the construction

of roads. airstrips and the helicopter pad. Further,

that he was involved in the loading of sealed 'forty-four

gallon drums. the contents of which were not known to the

witness. into a front-end loader for transport to

helicopters which had landed at the pad. He claimed to

have come into contact with the contents when the

helicopters returned from their missions either from the

downdraft of the rotors or from the spray booms attached

to the craft.

On the other hand, aspects of the evidence of this witness

suggested that any substantial exposure to chemical agents

was unlikely. The pad was approximately 300-400 feet long

and 100 feet wide. The witness was stationed at the

southern end; the helicopters came in from the west,

switched off their rotors, refuelled and flew out to the

east. He never handled empty drums as this was done

mechanically and loading was infrequent: three or four

times one day and then not for another month.

VI-86

Prior to his Vietnam service. the witness contracted

hepatitis and malaria whilst in New Guinea and experienced

a skin rash in the groin.

In 1975, when his first wife left him, he went to a

hospital for treatment of his skin condition. He

indicated that the reason for seeking treatment was that

they would not serve him in a hotel "because of the

condition of my hands". This was the first time he had

sought medical treatment for his skin, some eight years

after returning from Vietnam. Previously he had used

ointment obtained from the chemist.

His rash got worse with worry, his alcohol intake also

increased with stress. The witness, who has been drinking

since the age of 18, (i.e. for thirty years), admitted

that his consumption of alcohol increased following the

breakdown of his first marriage when he was unemployed and

in financial difficulty. He conceded that he had

entertained suicidal feelings. He did not associate his

skin rash with his alcohol consumption: indeed, he claimed

that his rash persisted even though he has "stayed off the

drink". However, at the time he gave evidence, he was

consuming eight to ten cans of beer a day.

VI-87

The witness had a very disorganised and unhappy

childhood. He was involved in an incident whilst in

Vietnam when one of his men trod on a land mine. It

cannot be doubted that his responsibilities, as the senior

soldier at that time. have had an impact on him.

Furthermore, Exhibit 1798 reveals that a lengthy interview

with a specialist elicited no less than "fourteen very

traumatic combat-related incidents" and revealed clear

symptoms of Post Traumatic Stress Disorder (PTSD). He

receives a Totally and Permanently Incapacitated (TPI)

rate of pension for dyshidrotic eczema and PTSD.

In his written statement, the witness indicated "in

Vietnam I suffered various outbreaks of rashes, but

nothing as bad as the way the condition has been over the

past few years." The worsening with time is suggestive of

the operation of factors arising since his service in

Vietnam. The Commission's view is that it is far more

likely that the skin problems experienced by this witness

are due to stress and his consumption of alcohol rather

than chemical agents. His possible exposure to chemical

agents as a result of assisting in the loading of

helicopters was occasional and manifested no

contemporaneous adverse health effects.

VI-88

Veteran 7

The seventh witness (born 2 July 1924) served in Vietnam

as a Welfare Officer from 22 April 1966 to 30 April 1967.

His extensive service career commenced with the RAAF in

1943. He transferred to the Philanthropic Corps as a

Salvation Army Officer in 1964. In Vietnam, he spent his

first weeks at Vung Tau before moving to Nui Dat and,

while he was based at Nui Dat, he spent some six to eight

months in the field.

Having regard to the nature of the duties of this witness,

it is understandable that he heard a lot about spraying

activities both at the base and elsewhere in South

Vietnam. Although the Commission believes that the

witness was doing his best to accurately recall what he

was told. little weight can be placed on this aspect of

his evidence: as hearsay, it cannot be tested by

cross-examination. A substantial amount of first-hand

evidence in this regard has been received at the Exposure

hearings and the witness conceded that he was never

involved in any such spraying and that he had no idea of

what was being sprayed. Furthermore, in the Health

Effects hearings, the Commission was only concerned with

VI-89

the personal exposure of witnesses in order to consider

whether any adverse health effect might have resulted from

that personal exposure.

There was one incident in August or September of 1966

involving a single helicopter which the witness claimed to

have observed from inside the welfare hut. He suggested

that the helicopter was ten or fifteen metres away and

that the rubber trees shed their leaves some 3 to 5 days

after the spraying incident. He suggested that the rubber

trees at Nui Dat were about eight feet tall and that the

whole of the camp was similarly affected. He also alleged

that a Colonel, whom he named, had told the men that they

had been sprayed with a defoliant by mistake.

Evidence was given at the Exposure hearings of the

Commission of an incident in September 1966 alleged to

involve the accidental spraying of the rubber trees at Nui

Dat with herbicide. On 2 February 1984 a witness. W.R.B.

Harris, suggested that the rubber trees were 40 to 50 feet

high and that only some of the trees lost their leaves.

Brig. W. Rodgers was also in Vietnam at the relevant

time. His evidence on this aspect also indicated that

only some of the rubber trees lost their leaves.

VI-90

In the Exposure section of this Report, the Commission has

indicated that it is satisfied that there was an

accidental use of defoliant at Nui Dat in September 1966.

As this witness was inside the hut at the time, possible

direct exposure of this witness was very limited. The

Commission believes that he may have been indirectly

exposed on this occasion but is not satisfied that his

health up to the present has suffered from this incident.

There are a number of reasons for this conclusion. This

limited exposure could not have resulted in a sufficiently

large dose to result in long-term health effects, an

aspect more fully dealt with in the Exposure and

Toxicology sections of this Report. Secondly, the health

effects experienced by this witness are capable of

explanation by reason of manifestations of those effects

prior to his service in Vietnam. It is important to note

the lack of any immediate consequential health effects

following the alleged exposure.

The witness suggested, prior to his tour of duty in

Vietnam, his health had been "Al". Whilst in Vietnam he

claimed to have experienced "just normal gastric and

headache and vomiting".

VI-91

He now complains of anxiety, depression, hearing problems,

skin rashes, bad nerves, tremors in the hands, tension,

restlessness, lack of concentration, irritability,

dizziness, allergies, constipation, sores in the corner of

his mouth and blepharo-conjunctivitis.

A thorough consideration of the records relating to this

witness held by DVA and the Department of Defence reveal a

history of problems pre-dating his Vietnam service:

problems with hearing, skin, conjunctivitis and nerves.

The witness suffered perforated ear drums in 1953 whilst

serving in the regular army and in October 1961 he was

found to have a degree of deafness in his left ear and a

tone conductive hearing loss which was greater in the left

ear than in the right. Whilst in Vietnam he was regularly

exposed to noise of artillery fire and aircraft and he has

since obtained a pension in respect of his deafness.

A large number of documents were tendered from the medical

and service records of the witness. These, together with

the transcript of his evidence before the Commission,

demonstrate clearly that his skin problems did not relate

solely to his Vietnam experience. Dealing with these

aspects in chronological order:

VI-92

(i) Discovery that diesel fuel affected his skin in

1952;

(ii) Admission to Concord Hospital due to dermatitis . 31

on his scalp and face in August 1953 conceded

to flare up whenever he got worried;

(iii) A medical report dated 9 August 1954 reveals

"Recurrent dermatitis, concurrent with emotional 32 upsets since 1940";

(iv) A document entitled "Medical Examination for 3 3

Reclassification" dated 6 August 1963 reveals

that the witness "Has had seborrheic dermatitis

since 1940 still present

(v) Diagnosis

1964;34

of seborrheic dermatitis on 16 April

(vi) A questionnaire dated 8 October 1964 disclosed

that the witness claimed to have had seborrheic

3 5

dermatitis since 1953.

VI-93

The witness in his viva voce evidence was unable to

remember giving the information in this questionnaire to

the examining doctor and alleged that it was not a form

which he had completed suggesting that it was not his

writing on the form. However, the signature is identical

to an admitted signature of the witness in Exhibit 1804.

A sick report, which the witness was not able to remember„

disclosed that the witness had sought treatment for

blepharo-conjunctivitis on 6 August 1965.36 The witness

denied that he has suffered from nerves and tension for a

large part of his life. Yet his medical records reveal:

(i) Examination by a medical officer on 9 August 1954

who noted that he "suffers from more anxiety than

normal" ; 37

(ii) A report dated 29 July 1958 following a medical

examination which commented "he seems to have

pressing family problems and is very worried

about his failure on an Army exercise" ; 38

(iii) An outpatient reference sheet dated 24 July 1961

which stated "tablets have relieved his feelings

of tension and apprehensiveness (familial 3 9 trait)";

VI-94

(iv)

(V)

(vi)

(vii)

Exhibits 1808 and 1812 revealed that the witness

sought treatment on at least five separate

occasions over a nine week period due to nerves.

He was unable to recall these events;

In August 1963, when undergoing a medical

examination for reclassification, it was noted

"has periods of insomnia and irritability usually

40

relating to personal problems". Diagnosis

was allergic rhinitis, seborrheic dermatitis and

anxiety state;

Exhibit 1814 discloses that the witness sought

treatment in April, 1963 for a recurring pain

under his ribs. He was unable to recall this or

remember telling the doctor that he was at that

time fatigued, irritable and experiencing a loss

of concentration. He admitted that he was, at

the time, concerned about the drop in income he

would experience as a result of joining the

Salvation Army;

In February 1963 he received treatment for

tension headaches;41

VI-95

(viii) Records of his admission to Concord Hospital on 8 42 August, 1964 revealed a notation "he gave a

long history of minor disabilities all of which

appeared of nervous origin".

The witness was unable to recall many of the above

occasions and this is understandable given the passage of

time. Following his return from Vietnam the witness

sought further treatment for nerves, anxiety and

depression as revealed by Exhibits 1818-1821 inclusive.

A number of the exhibits relating to the medical history

of this witness reveal an onset of health effects

following periods in which he has been carrying out a

heavy and/or long workload. Exhibit 1821 discloses an

instance since his return from Vietnam. Without wishing

to criticise his dedication to his work, the Commission

feels that, at least on some occasions, his health appears

to have suffered due to the fact that he is such a willing

worker.

This witness has served his country in more than one

theatre of conflict over a number of years. It is not

doubted that his work with the Philanthropic Corps as a

welfare officer was of great service to the Australian

VI-96

Forces. His inability to remember details so long after

the event is understandable. There is no doubt that he is

suffering the symptoms of which he now complains.

Further, those symptoms may have arisen or, which is more

likely, have been aggravated by his service in Vietnam.

However, the Commission is satisfied that they are not due

to exposure in Vietnam to chemical agents: the

manifestations prior to his service in Vietnam weigh most

heavily against a contrary finding.

Veteran 8

The eighth witness (born 12 August 1947) gave evidence on

12 December 1984. His service records disclosed that he

was in Vietnam for but a short period: less than 11

weeks, from 27 February to 14 May, 1970.

While at Nui Dat he sprayed a chemical substance, which he

understood was to kill mosquitoes, from the back of a

truck. He gave no other evidence to suggest any contact

with herbicides. Like most of the witnesses at the Health

Effects hearings of the Commission, this witness alleged

that his health was excellent prior to his service in

Vietnam. He gave evidence that, whilst in Vietnam, he

suffered from a bronchial complaint and skin rashes. He

VI-97

claimed that the former first arose less than two weeks

after his arrival and recurred twice, the last occasion

requiring in-patient treatment. His skin rashes were

diagnosed as heat rashes.

Contemporaneous medical records reveal that the witness

developed wheezes, shortness of breath and congestion of

the lungs three days after his arrival in Vietnam which

required occasional treatment. On 7 May 1970 he reported

to the hospital with wheezing and indications of asthma

and was told that he would be evacuated back to Australia

on medical grounds.

He claimed to have developed a number of health problems

since returning from Vietnam: eye problems, dryness of

the skin, headaches, anxiety and tension, interrupted

sleep. increased sweating, intolerance to heat and

blackouts.

Subsequent claims under the Repatriation Acts in respect

of bronchial asthma, neurodermatitis, conjunctivitis and

personality disorder have been accepted. On a great number

of occasions the witness disputed the suggestion that he

had a history of asthma dating back to his childhood: he

was unable to recall having received treatment in October

VI-98

were 1968 and alleged that certain medical records

incorrect. He also denied suffering from skin eczema

since childhood. However, his medical records reveal a 44 contrary position. He claimed to be unable to recall

receiving treatment at Holdsworthy, an Army Camp in New

South Wales, prior to his Vietnam service, for skin and 45 eye problems. . This is in conflict with Exhibit 1830.

A specialist dermatologist who was consulted by this

witness stated in a report contained in Exhibit 1832 that

eczema runs in families, is associated with asthma and

becomes worse as a result of stress. This opinion is in

accord with views of such specialists given to the

Commissioner over many years in legal actions heard by him

as a Judge and is accepted.

Suggestions by the witness that his medical records were

incorrect were frequent and involved in all a total of six

different doctors. For this suggestion to be correct, it

is necessary to infer that various medical practitioners

have independently concocted a coincidentally consistent

litany of lies on different and numerous occasions. The

unlikelihood of this is obvious and the Commission cannot

but come to the conclusion that. in respect of at least

some aspects of his evidence, this veteran was not a

witness of truth.

43

VI-99

Further. the Commission accepts the submission of Mr

O'Keefe, Senior Counsel for Monsanto, that this witness

showed selectivity in the presentation of evidence to DVA

in respect of his various pension claims. He chose to 4 6

forward to the Department an BEG finding referred to 47 in his letter as abnormal but did not forward to the 4 8

Department a subsequent normal BEG finding. His

explanation for this was that he believed that he was

unable to present further evidence and hence was precluded

from submitting the latter BEG. This is obviously

incorrect as he did in fact submit additional evidence

concerning a nervous tension claim on another occasion.

He also claimed sick leave in respect of an illness

alleged to have arisen whilst he was overseas on

recreation leave which, even if true, confirms his ability

to make use of available means to his own maximum

advantage.

This witness was a willing contributor to the Commission:

his first submission was received by the Commission on 5

October 1983: it was detailed and included graphic photos

purporting to support his allegations. He attended the

Informal Sessions of the Commission when they were

conducted throughout Victoria in early 1984. He gave

VI-100

evidence at the Health Effects hearings in December 1984

and supplemented that evidence with further material on 6

February 1985. In short, the contributions of this

witness to the work of the Commission have been abundant

in quantity but, sad to say, deficient in quality.

The lack of evidence of any substantial exposure to

chemical agents generally and herbicides in particular,

the lack of evidence of any association between exposure

to chemical agents and his health effects, his pre-Vietnam

medical history and, last but not least, the unreliability

of his testimony, preclude the making of any finding that

the health problems which he has experienced since Vietnam

are causally related to the use of chemical agents in the

Vietnam conflict.

Veteran 9

The ninth witness (born 13 August 1948) enlisted in the

RAAF in 1967 and served in Vietnam from 27 February 1968

to 13 August of that year. He was an Air Field Defence

Guard, based at Phan Rang, whilst in Vietnam.

He alleged to have observed both spraying by hand and

aerial spraying and to have been in areas that had been

VI-101

sprayed, sometimes on the same day as the spraying. He

described the smell as a light petro-smell and added that

the smell had petrol/kerosene-like qualities.

The fact that he claimed to have seen only one camouflaged

aircraft spraying on the last occasion he observed aerial

spraying suggests that this was not a Ranch Hand mission.

(See the evidence of Lt.Col. Hubbs and Col. Dudenhoeffer,

both Ranch Handers - Chapter IV. )

This witness described a dramatic sequence of events

leading to his evacuation from Vietnam. He claimed in his

written statement, prepared for the purpose of giving

evidence, to have been lying on the ground on or about 21

July while on patrol, that within two days of the patrol

he became ill, collapsed on 24 July, was placed in 35

Tactical Air Force Hospital in Phan Rang, subsequently in

a U.S. Hospital at Cam Rang Bay, and returned to Australia 49 a quadraplegic.

He sought to infer that this paralysis was the result of

exposure to chemicals whilst lying on the ground.50 It

was not until he became involved in the Royal Commission,

some eighteen years after the incident, that he raised the

allegation that there might be an association between the

VI-102

alleged exposure and these health effects. His

51

handwritten statement of 19 February 1984 did not

allege any such association. Even his "affidavit" of 1 52 53

March 1984 and the accompanying letter forwarded

to Counsel for WAA, did not suggest any such association.

The history taken from the witness upon his admission to

hospital in Vietnam indicated fever, stiff neck. vomiting 54

and runny nose four days prior to his admission.

Although he claimed to be unable to remember giving this

history he gave the same history on other occasions to

doctors whom he consulted after his return to

Australia.55

The comparatively sudden onset of these health effects

would understandably give rise to a need of the witness to

find some explanation for them. There is no doubt that

the witness has severe physical disabilities. However his

evidence of exposure is very limited and the Commission is

firmly of the view that the diagnoses which have

previously been suggested, such as poliomyelitis or a form . 5 6

of encephalitis represent more likely explanations for

his present condition. The Commission believes that the

evidence of this witness represents a classic instance of

a serviceman who has made use of the publicity given to

VI-103

chemical agents in recent times to explain his present

condition. Whether the witness himself believes there to

be or that there might be an association between his

health problems and chemical agents. is. so far as this

Inquiry is concerned. not to the point. The question for

the Commission is whether such an association in fact

exists. The Commission is not so satisfied. It notes

that some improvement of the condition of this witness has

taken place since his return from Vietnam although he

still has difficulties in walking. It is sincerely hoped

that this improvement continues.

Veteran 10

The tenth and final witness (born 7 November 1946) in the

Health Effects hearings enlisted in 1966 for a six year

term with the RAAF and served in Vietnam from February

1969 to February 1970. Designated an equipment clerk,

which involved procuring and providing stocks of bombs and

small arms, he was based at Phan Rang although spending

some time at Vung Tau and Cam Ranh Bay.

He gave both general and specific evidence of exposure.

The general evidence included his observation of

VI-104

insecticide fogging operations every second day, usually

in the mornings. Also, he claimed to have observed aerial

spraying around the base once a month during the dry

season and fortnightly in the wet season by an aircraft

called "Patches". Evidence was given at the Exposure

hearings of the Commission that "Patches" was used solely

for insecticide flights after April 1967 and malathion was

the insecticide then used.

Further, it was alleged by the witness that the area to

the west of the base was sprayed by five or six aircraft.

He recalled that the lead 'plane was silver but was unable

to recall the colour of the other aircraft. When

cross-examined he indicated that this incident occurred

between July and September 1969 and that although he could

not really say that five aircraft were involved "it was a

squadron formation". This evidence is in conflict with

that given by Lt. Col. Hubbs, namely that all aircraft

used in herbicide spraying were camouflaged by the time of

his tour of duty, from June 1966 to May 1967, and that

missions with more than three 1 planes were flown "only a

few times". As the silver 'plane, "Patches", is reputed

not to have flown defoliant missions during the Vietnam

service of the tenth witness, it is difficult to draw the

inference from his evidence that the incident in question

was a herbicide flight.

VI-105

His specific evidence of exposure related to an occasion

in December 1969 when, whilst at the Phan Rang base, he

claimed to have become so wet from the spray that he had

to change his uniform. On other such occasions he

asserted that the spray did not settle on him to the same

extent.

It would appear that the flight involved the spraying of

insecticides since the rule was that herbicide planes did

not fly alone and the spraying of the base with

insecticide was a regular feature.

The witness stated that he had become progressively ill

after this exposure. His face began to swell up. the skin

on his face turned black, black mucous was coming from his

nose and he began vomiting a black tarry substance. He

estimated the amount of material vomited would fill a

waste paper bin.57

Despite these symptoms he waited until the next day to

seek medical attention. The reasons which he gave for the

delay were that he might be considered a malingerer or

told there was nothing wrong with him. The witness

claimed that when he reported to the base Medical Officer

VI-106

he merely had some tests done and returned to his work,

the M.O. apparently not being concerned about his

blackened face even although the witness claimed to have

reported it. The witness claimed that his condition

lasted about 2 days.

Amongst the records obtained from DVA and the Department

of Defence the only document dealing with the health of

the witness whilst in Vietnam became Exhibit 1870. It

revealed that a blood test performed on 9 December 1969

revealed a positive finding in respect of occult blood.

The absence of any other documents reflecting on the

health of the witness in relation to the incident which he

dramatically recounted is in all the circumstances

suggestive of exaggeration on his part after his return

from Vietnam. It is pointed out that examination of

medical records of veterans created within Vietnam (and

the Commission has examined many hundred files) show that

fairly comprehensive histories and complaints were taken.

There has been no suggestion by veterans that details of

reporting to Medical Officers are insufficient.

Prior to his service in Vietnam, the witness complained of

having vomited blood. His medical notes58 and his

VI-107

evidence suggested that it had occurred up to six times

before he went to Vietnam. He also suffered from diarrhoea

four or five times a year. Exhibits 1860, 1861, 1862,

1864 and 1866 revealed occasions, over the years, of

bleeding from the nose or the presence of blood in his

sputum. Diagnoses suggested included recurrent acute 59 ulcers or erosions, bleeding from the upper

respiratory tract,60 hiatus hernia,61 and recurring

acute peptic ulcer. 62

No contemporaneous record has been discovered in which the

witness told doctors of the dramatic incident which he

recounted in his evidence before the Commission. He

claims in his evidence to have reported it twice: to the

Medical Officer at Phan Rang and to Doctor Thompson at

Victoria Barracks, Melbourne. Surprisingly, there is no

report of either complaint. Paragraph 6 of his

statement63 indicates that the problem cleared up within

two days and no further investigations were carried out.

Further, in 1978, when he applied to re-enlist in the RAAF

he then stated that he had no physical disabilities or

serious medical complaints.

The witness assesses his state of health since his return

from Vietnam as "reasonably poor": headaches, hay fever.

VI-108

runny nose. pa ins in his lower back and a violent

disposition (which he claims now, (1984 ) , to be able to

keep in check), colitis, blackouts, loss of feeling in the

hands and feet, groin rash and depression. Additionally,

he claims to experience nausea (since 1971), vomiting, dry

retching and the shakes every morning. This shaking, which

he stated commenced three years before giving evidence had

been more severe in the 18 months immediately before then.

It is noted that the witness contracted viral meningitis 64 in 1973 and that he is currently in receipt of a

pension of 20% for irritable colon, acne vulgaris and

anxiety state.

65

In paragraph 11 of his written statement he claimed

that his attacks of severe shakes were worsening whilst in

his oral evidence he assessed his blackouts as becoming

more frequent. Yet he claimed that, having attended Dr

Van Tiggelen in 1984, the deterioration of his physical

state had ceased.

The Commission is satisfied that this witness has

exaggerated the events which occurred in December 1969.

This conclusion is supported by his failure to report the

signs and symptoms he claimed to have then experienced

VI-109

until the following day. The lack of documentation in

respect of this incident and the absence of follow-up.

clearly support this finding. Furthermore, the signs and

symptoms are not dissimilar from those pre-dating his

Vietnam service for which explanations have been

proffered. The specific chemical agent to which the

witness was likely to have been exposed from this incident

is more probable than not to have been malathion, the

toxic effects of which are dealt with elsewhere in this

Report.

The Commission is firmly of the view that the health

effects this witness is now suffering are not causally

connected with the use of any chemical agents during

service of the witness in Vietnam.

3.2 General Conclusions From the 10 Best Shots

For the reasons outlined above nothing emerges from the

evidence given by the 10 best shots to suggest any

relationship between exposure to chemical agents in

Vietnam and adverse health consequences.

It will be recalled that during exposure hearings evidence

was given which suggested that only a limited number of

VI-110

Australian personnel were at risk of exposure to Agent

Orange. Examples are the evidence of Mr Ducker in

relation to C Company. 5EAR; evidence of Mr Rhodes in

relation to the helicopter sortie and the evidence of Mr

Erbs in Operation "Massey Harris".

No evidence as to adverse health effects has been given by

any of those persons in respect of whom a finding of

significant exposure to Agent Orange could be made.

It has been submitted on behalf of Monsanto that there is

no more telling circumstance in this Royal Commission than

the failure of the W A A to call any direct evidence from

veterans demonstrating exposure to Agent Orange and an

adverse health effect reasonably or even arguably

referable to that exposure.66

This is indeed a telling submission.

Senior and Junior Counsel were retained by W A A on the

weekend of the 14/15 May 1983. The President of W A A and

Counsel addressed meetings of veterans in all capital

cities of Australia. In each of those capital cities they

interviewed many veterans.

VI-111

State and National office workers were described in

"Debrief" of August 1983 as working hard, even

"furiously", finding veterans with special problems or

special knowledge.

As well, questionnaires were circulated to all W A A

members and others on the Debrief mailing list. in August

1983.

The purpose of the health effects hearings was explained

by the Commission in its statement on 7 December 1984. as

follows:

To permit the W A A to call a number of veterans with typical disorders who could be considered as characteristic of classes of veterans suffering unfortunate health consequences allegedly related

to exposure to chemicals.67

On 7 December 1984 the Commission explained the mode of

selection of these witnesses.

After discussions between myself, those Assisting and Senior Counsel for the WAA, it was decided that such proposed witnesses would be limited to

a figure of about 10. This group came to be

referred to as the 110 best shots' and were those whom the W A A considered likely to be veterans combining 1 exposure1 with typical adverse 1 health effects'. Thereafter Counsel for the W A A

provided those Assisting with material, albeit scant in some instances, in respect of some 31 veterans. From amongst those veterans, 10 were

VI-112

selected by consultation between Counsel for the W A A and those Assisting. Four reserves were added. The five witnesses who have been called this week and the five who are to be called next week represent 10 from those 14.

In short, the officials of the WAA, through their counsel, have exercised their right to call 1 the 10 best shots'.68

It is perhaps appropriate to interpolate that the

consultation between Counsel for W A A and those Assisting

was consultation over timing, and medical and geographical

availability of the witnesses to be called. The selection

of those to be called was made by Senior Counsel for WAA.

In its final submission W A A said:

A number of veteran witnesses were called. It should be pointed out that the group called were taken from a list of about 60 names supplied to the Commission on request. The 60 were a diverse group. which endeavoured to show a wide range of different types of people, (sic) with different service records and from different parts of Australia who were likely to be able to attend

the Commission hearing and who were willing to do so. From these a short list was prepared in

consultation with the Commission's lawyers. The group was intended to be a random sample of

veterans who have health complaints. Certainly they are not intended to show the worst cases of physical or mental ill-health.69

Having regard to what has been said above it is clear that

the use of the words " random sample" is entirely

inappropriate in the circumstances. It is in the

VI-113

Commission's view unthinkable that the selection process

was not a most careful one, both as to the 31 and as to

the final 10. If the witnesses called were not intended

to exemplify a cross-section of health complaints in

veterans making credible allegations of exposure to

chemicals in Vietnam, it is hard to see why they were to

be called at all.

The fact that no witnesses were called whose evidence

demonstrated an association between exposure to chemical

agents and adverse health effects and the fact that in

WAA's final submission no such association is suggested

upon the basis of the evidence of the "10 best shots",

compels the Commission to the conclusion that no evidence

of such an association, at least amongst Australian 70

personnel being members of the WAA, is available.

4. OTHER EVIDENCE OF ADVERSE HEALTH OUTCOMES IN

AUSTRALIAN VIETNAM VETERANS FROM OTHER SOURCES

4.1 AVHS Mortality Study71

Other evidence which bears upon the health outcomes of

Australia 1s Vietnam veterans is to be found in this

Study. It is dealt with in detail in Chapter X

Mortality. It also bears upon general health.

VI-114

Its findings include the following:

(a) Overall Mortality

There was a slightly higher mortality rate among veterans

than among non-veterans, although the rates in both cases

were lower than national rates. The increased mortality

of veterans was statistically significant at 1.29 before

analysis for the confounding effects of Army Corps

groupings. After appropriate statistical techniques were

used for analysing that effect the relative mortality was

found to be 1.16 which was statistically insignificantly

more than 1.

The Commission notes that in its final submission (in a

bare two pages dealing with the mortality of Vietnam

veterans!) only the unadjusted finding of increased

relative mortality is referred to and the following

statement appears:

Whilst a lot of speculation has been engendered as to the cause, the fact is that the study does not disclose the cause: it merely says that there is an increase.72

VI-115

With respect to those making that submission, the causes

of increased relative mortality are either disclosed by

the study or may be inferred from its data. The oral

evidence given assists in the understanding of that data

and demonstrates the appropriate inference drawing process.

(b) Mortality and Term and Length of Service

Mortality was not statistically significantly different

between veteran subjects by reference to length of service

in Vietnam or to the calendar year in which subjects first 73 went to Vietnam.

If there were a true association between the mortality of

veterans and exposure to Agent Orange or to Agents Blue or

White one would have expected mortality rates amongst

veterans to vary by reference to the year in which they

arrived in Vietnam. That it did not is made clear by

Tables 7 and 8 in Chapter IV.

This is powerful evidence that there is no impact on

mortality from exposure to the herbicides.

VI-116

(c) Cancer Mortality

Cancer is dealt with in detail in Chapter VIII of this

Report. Suffice it for this section to say that the

mortality study demonstrates that there was no

statistically significant difference in the death rates

from cancer for veterans and non-veterans. The latency

period is probably still too short for any conclusion to

be drawn from this alone.

4.2 Particular Causes of Death

Pointers to General Health Effects

Prior to adjustment for the confounding effects of corps

groupings there were three classes of cause of death in

respect of which the rate for veterans was statistically

significantly greater than that for non-veterans. These

causes were:

(a) Diseases of the circulatory system;

(b) Diseases of the digestive system;

(c) External causes.

VI-117

(a) Diseases of the Circulatory System

These diseases comprised ischaemic heart disease (ICD

codes 410 to 419), other heart disease and hypertension

(ICD 8th codes 390 to 409 and 420 to 429) and other

74

vascular disease (ICD codes 430-458).

There were 23 deaths in these categories of causes amongst

veterans and 16 amongst non-veterans. In each of the

three subdivisions of the categories, there were

significantly fewer deaths of study subjects than expected

upon the basis of death rates for the Australian male

population.75

There was no statistically significant difference in the

mortality rates of veterans as opposed to non-veterans in

relation to any of the three subdivisions of this category

considered alone, even without adjustment for corps

groupings, but deaths were more common amongst veterans in

4 out of the 5 corps groupings, the exception being

76

non-field corps.

The authors of the study point out that these findings are

consistent with other observations concerning circulatory

diseases amongst servicemen.77

VI-118

The findings of increased mortality from coronary heart

disease in soldiers in the British Army have been

attributed to cigarette smoking. In other contexts

excesses of death from circulatory diseases have been

attributed to hypertension secondary to alcohol

consumption.78

It is suggested by the authors of the study and by Dr 79

Michael Fett in his evidence that the increased

mortality rates for veterans may be attributable to an

increase in consumption of cigarettes and alcohol as a

result of service in Vietnam where cigarettes were on free

issue and where beer was virtually free and readily

available in camp.

The Commission is satisfied:

(i) that there was extremely high stress involved in

service in Vietnam and limited opportunity for

release of that stress;

(ii) that personality traits which were conducive to

selection for service in Vietnam may also predispose

towards use of cigarettes and excessive alcohol

VI-119

consumption. (The "Gung-Ho" or "risk taking"

character theory);

(iii) that habits of alcohol use and cigarette use are

very likely to have been ingrained by their use for

stress relief in Vietnam.

The Commission finds that stress itself is a cause of

ischaemic heart disease.80

To put it at its lowest, there is now evidence that those

who served in Vietnam (and probably in all other theatres

of war), are more likely to die of diseases of the

circulatory system. It may confidently be inferred that

they are more likely to suffer diseases of the circulatory

system than people of comparable health who did not so

serve.

In the Commission's view a tribunal could not be satisfied

beyond reasonable doubt that an individual Vietnam

veteran's circulatory disease was not connected with war

service. Reasonable hypotheses connecting such diseases

with service can readily be postulated.

VI-120

It follows that in the context of either s . 47 of the

Repatriation Act 1920 as it was before 6 June 1985, or of

S16 of the Repatriation Amendment Act (1985). repatriation

claims by Vietnam veterans or their widows based on

disease of the circulatory system should as a matter of

policy be granted by the determining officers, and the

Commission so recommends.

The Commission finds no basis for connecting such

disorders with the use of chemical agents in Vietnam.

(b) Diseases of the Digestive System

There were seven deaths from diseases of the digestive

system amongst veterans and none amongst non-veterans. It

is thus not possible to calculate a relative risk.

(RR = 7__ = infinity) 0

The authors of the study point out that six of the seven

veteran deaths were due to alcohol consumption, whilst the

seventh was due to a bowel obstruction of unknown

81

cause.

Dr Fett explained in his evidence that it was possible on

clinical grounds to so attribute the deaths. In four

VI-121

cases cirrhosis of the liver was present and in two cases

pancreatitis.82

It is to be noted that after adjustment for corps grouping

veterans were signficantly more likely than non-veterans

to die of alcohol induced disease, which finding indicates

significantly increased alcohol abuse amongst veterans.83

A behavioural psychologist charged perversely with the

task of inducing alcohol addiction would surely choose to

place his victim in a highly stressful situation and to

provide him with alcohol at the time of cessation of

stress.To provide it in a popular form and almost free in

the stress torn situation of Vietnam was surely inviting

the increase in alcoholism that followed. and most likely

to ingrain the habit even in the well-controlled.

The Commission is therefore of the view that a tribunal

could not be satisfied beyond reasonable doubt that an

individual Vietnam veteran's alcohol-related disease, or

alcoholism itself was not connected with war service.

Reasonable hypotheses linking alcoholism with service in

Vietnam can readily be postulated.

VI-122

It follows that, as a matter of policy, claims for

repatriation benefits for alcohol induced diseases and

alcoholism should be granted by determining officers and

the Commission so recommends.

Again the Commission finds no connection between alcohol

related diseases with herbicides or pesticides.

(c) External Causes (ICD 8, Class EX VII)

There were 192 deaths (as against 207 expected) from all

external causes (excluding combat deaths) amongst veterans

and 198 (as against 270 expected) amongst non veterans.

The relative mortality rate as between veterans and non

veterans in respect of this cause was 1.27 which was

statistically significant.

After the appropriate adjustment for corps groupings, the

relative mortality rate was reduced to 1.13. Deaths due

to external causes comprised 75% of all deaths observed

and accordingly the excess among veterans of deaths from

this cause was highly significant in its contribution to

the overall excess. It would be fanciful to suggest a

connection between the physical injury causing death and

exposure to chemical agents in Vietnam.

VI-123

By way of analysis, if deaths had occurred in the veteran

group at the same rate as that at which they occurred in

the non veteran group (263 deaths in a population of

25677) there would have been approximately 197 deaths

amongst the veteran population.

There were in fact 260, so that it might be said upon the

basis of such an analysis that there was an excess of 63 84 deaths amongst the veterans.

If a similar calculation is made in relation to death from

external causes, the notional excess in veterans over

non-veterans in respect of such deaths can be calculated

to be 44. Similarly. in relation to deaths due to

diseases of the circulatory system, the notional excess in

veterans can be calculated at 11. Accordingly, if the

notional excesses in veterans for deaths from external

causes and deaths from diseases of the circulatory system

are added to the six deaths due to diseases of the

digestive system which are attributable to alcohol abuse,

no less than 61 of the notional excess overall of 63 are

accounted for.

VI-124

No rational hypothesis attributing these 61 deaths to

exposure to chemical agents has been put forward by any

scientific expert called by W A A before the Commission nor

indeed is any such hypothesis put forward by way of

submission. In those circumstances it is quite

inappropriate for the Commission to hold that any of these

deaths was attributable to chemical exposure.

Indeed. as the Commission's Senior Consultant explained.

it is rational and appropriate to understand the overall

excess of mortality in veterans in terms of the following:

(a) Personnel selection factors which led to those

national servicemen chosen for service in Vietnam

possessing attributes which rendered them more prone

to risk taking behaviour including excessive use of

alcohol and tobacco;

(b) Combat stress and other stress factors in Vietnam

providing a tendency to promote the effects of those

attributes; and

(c) The free availability of cigarettes and the subsidized

availability of alcohol tending to further promote

those effects.

VI-125

He summarised the possible explanations as follows:

The first possibility is that the characteristics of national servicemen being sent to Vietnam might differ from those not sent to Vietnam in ways which might subsequently affect their mortality. The second possibility is that because of the Vietnam experience, soldiers might change their behaviour in relation to drinking, smoking or other lifestyle factors in such a way that the subsequent mortality might be altered.

The third possibility is that combat stress or some other stress endured in the Vietnam war situation might have a delayed effect on

mortality.

The fourth possibility is that other exposures in Vietnam such as exposure to Agent Orange or other chemicals might have an effect on subsequent mortality.85

The considerations set out above persuade the Commission

that Dr Mathews was clearly correct in rejecting the

fourth possibility as an explanation of the excess and in

concluding that "within the limitations of the available

data, there is nothing to suggest any untoward effects of

chemical usage on mortality in the post-Vietnam

period".86

W A A 1 s submission that "the study does not disclose the

cause" is consistent only with the most superficial

reading and analysis of the study and the evidence given

about it.

VI-126

4.3 Informal Sessions

The Commission also obtained useful insights into the

health effects of Vietnam service from its informal

sessions which have been referred to in Chapter III. In

consideration of this material it is important to bear in

mind that those who attended the informal sessions were

self-selected, many being members of a group formed to

espouse the "chemical agent" cause. which thereafter has

saturated its members with propaganda. It was in no way

random.

This selection bias makes it likely that those who

attended would be those who believed in health

consequences of Vietnam service in general and in Agent

Orange or in chemical agent caused health consequences in

particular.

Despite the self-selection process. the Commission

observed that only a minority were prepared to assume that

chemical agents were the cause of any problems. Most,

however, expressed interest in knowing whether there was a

link between health outcomes and service and between

health outcomes and chemical exposure in particular.

VI-127

It is also significant that the majority of veterans

indicated that they experienced few health problems whilst

they were actually in Vietnam. The commonest health

problems spoken about was "the occasional bout of

diarrhoea" or "being sick in the stomach". Skin disorders

of various types were spoken of. Headaches were also

common.

In particular, however, notwithstanding the self selection

process and notwithstanding substantial W A A membership

amongst those who attended the informal sessions, no

veteran attending the informal sessions gave an account

consistent with any acute toxic or poisoning reaction.

Nor were there complaints of fevers of unknown origin.

W A A 1 s initial submission87 led the Commission to expect

that there would be many veterans complaining of acute

toxic reactions, or at least of fevers of unknown origin,

whilst on service in Vietnam. This did not transpire.

Despite the self selection process, the lack of random

sampling and the other epidemiological problems with the

informal session process the Commission nonetheless sets

out what it gleaned from the informal sessions about the

post-war health of Vietnam veterans.

VI-128

A. Psychological

(i) Bad temper;

(ii) Fits of cage with aggression - commonly directed

to the inanimate and, in particular, walls but

also occasionally towards wives or children;

(iii) Depression and anxiety;

(iv) Asocial behaviour. This took a number of forms

including "no friends now";

(v) lack of tolerance to noise (especially from own

children);

(vi) irritability;

(vii) insomnia or sleeping problems;

(viii) lack of concentration;

(ix) shakes;

(x) "my nerves are gone".

B . Skin Problems

(i) Recurring rashes on the hands. face, feet, groin

and body;

(ii) Eczema;

(iii) Excessive sweating.

VI-129

C. Neurological

(i) Dizziness;

(ii) Tingling;

(iii) Numbness;

(iv) Headaches;

(v) Memory problems.

D. Head

(i) (Headaches);

(ii) Hearing loss;

(iii) (Memory problems)

(iv) Blurred vision.

E. Chest

(i) Asthma;

(ii) Bronchitis.

F. Stomach

(i) Diarrhoea;

(ii) Pains;

(iii) Nausea.

G. Cancer

These were carefully noted and followed up in

view of the allegation that Vietnam veterans

experience a higher rate of cancer than the

general population.

VI-130

H. Organs

The most common sites for complaint in this area

were liver and kidney. Almost all of these were

conceded as alcohol-related.

4.3.1 Alcohol Use

The norm in respect of the period before Vietnam service

was that of a light social drinker. The vast majority

described their consumption of alcohol in Vietnam as

heavy, when available. Reasons for this included use of

alcohol for the relief of tension, the cheapness of it

and the lack of alternative recreation. Following

discharge, an alarming number described their consumption

of alcohol as heavy. Many of those now drink less,

lightly or not at all..

The number who were prepared to describe themselves as an

alcoholic was disturbing. One mother, whose son died from

an alcohol-related cirrhosis of the liver before age 30

said:

My poor son suffered so much and to lose him at (that age) was hard to accept. I still haven't accepted it... I could say a lot more only it

hurts too much.

VI-131

4.3.2 Smoking

Generally, veterans described their smoking habits before

Vietnam as light, or nil. During service in Vietnam they

claimed an increased incidence of smoking or higher

consumption. Following discharge. the habits of smokers

appeared to polarise either to total abstinence or a

sustained high level of smoking.

4.3.3 Veterans in Prison

There have been allegations that Vietnam veterans are

disproportionately involved in criminal activity. Almost

every veteran who attended the informal sessions denied

any trouble with the law. The very few who admitted

criminal activity elaborated with descriptions of drink

driving charges and street offences related to

aggression. Alcohol was a common ingredient to all.

The Commission notes that despite the regular repetition

in the media of the allegation that Vietnam veterans are

more commonly found in prison than expected, no submission

was made by W A A that this is so. The Commission made its

own inquiries.

VI-132

On a State by State basis separate statistics on a

veteran/non veteran basis are not kept by the prison

systems. However, as a result of a question asked in the

Federal Parliament, the Victorian Office of Corrections

included in its annual census two questions relating to

military service.

Those questions were:

(1) Has the prisoner been on active service in the

Australian Armed Forces?

Answer: Yes, No or Unknown.

(2) If yes to Question 1, indicate active service

zone. Eg, Vietnam career etc.

The information thus gained permits a comparison of

expected and actual number of Vietnam veterans in

Victorian prisons. That comparison is as follows:

VI-133

TABLE A

Age Prisoners Population Prisoners

Group Persons(a) Males(b) Males(c) 1000 males 15-19 161 156 176,721 0.88

20-24 498 483 174,941 2.76

25-29 417 404 163.836 2.47

30-34 256 248 159,896 1.55

35-39 184 178 141.085 1.26

40-44 120 116 116,243 1.00

45-49 42 41 101,563 0.40

50-54 36 35 105,095 0.33

55-59 26 25 99.947 0.25

60-64 11 11 79,089 0.14

65 + 2 2 166.837 0.01

TOTAL 1753 1699

(a) Australian Year Book 1984 page 222.

(b) Age distribution given only for persons; male distribution derived on a pro-rata basis.

per

age

(c) Estimated resident male population of Victoria at 30 June 1982; Source: Australian Demographic Statistics March Quarter 1983 ABS Cat. No. 3101.0.

(d) Five persons aged under 16 years have been included in the 15-19 year age-group.

Expected Numbers

At June 1982 almost 90% of Vietnam veterans were aged

between 30 and 44 years, and so from the above table a

proportion of between 1.00 and 1.50 per thousand would be

appropriate for calculating the expected number of Vietnam

veterans in prison.

The ABS surveys of Ex-Service Personnel have given the

following estimates of the number of Vietnam veterans

living in Victoria:

VI-134

October 1979

9.2 thousand

June 1984

11.0 thousand

The following table shows the expected number of Vietnam

veterans in prison in Victoria for various combinations of

imprisonment proportions and population sizes:

TABLE B

Prisoners per Number of Victorian Vietnam Veterans 1000 males 9000 10,000 11,000

1.50 14 15 16

1.25 11 13 14

1.00 9 10 11

Actual Number

The actual number reported by the Victorian Office of

Corrections for the Prison Census held on 30 June 1983 was

four veterans. aged 31, 33, 37 and 45.

No evidence from any other source was led. The Commission

is of the view that Vietnam veterans are not

disproportionately involved in criminal activity and that

it is not the fact that they are more commonly found in

prison than expected.

VI-135

4.4 The Team

4.4.1 Introduction

Paragraph (b) of the Letters Patent requires this

Commission to inquire into

(b) the effects on Australian personnel of exposure to the chemical agents used: ...

Paragraph (1) defines the expression "Australian

personnel" as meaning

Any persons. including members of the Australian Defence Force, who were engaged in performing defence service or any other function for or on behalf of Australia in Vietnam, whether as employees or otherwise.

This part of the Report deals with the members of the

Australian Army Training Team, Vietnam, ("the Team").

The Team is one of the less known features of the Vietnam

conflict. It operated in virtually uncharted territory

and with defence forces of traditions. training,

background, education and culture markedly different from

those with which it was familiar.

VI-136

This section of the Report examines the roles and health

of members of the Team. It was present in Vietnam from 31

July 1962 until 18 December 1972, during which period 990

members of the Australian Army and 10 members of the Royal

New Zealand Infantry Regiment served. Thirty-three

members died on service, and 122 members were wounded in

action. Individual members of the Team gained four

Victoria Crosses. six Military Crosses and numerous other

Australian military decorations. 245 United States awards

(including a Distinguished Service Cross), 376 Republic of

Vietnam Awards. and, as Unit Citations, the Republic of

Vietnam Cross of Gallantry with Palm, and the United

States Army Meritorious Unit Commendation.

The Team was a unique component of the Australian Defence

Force for a number of reasons. First, it existed only in

Vietnam where members joined it from Australia singly or

in drafts. Secondly, it comprised mainly Officers or

Warrant Officers who operated individually, in pairs, or

occasionally in groups not exceeding ten. Thirdly, its

task was unique; to train, advise, or command a variety of

Vietnamese forces, comprising individual elements of the

South Vietnamese Army, the Montagnards. Territorial Forces

and other government elements within and beyond the

borders of South Vietnam.

VI-137

Fourth, it was the first Australian unit into Vietnam and

the last out, achieving the distinction of being the

longest serving unit on Australian service in any theatre

of war.

The Team also operated with a variety of support units

from the United States and in every corps of Vietnam,

although the final phase was spent almost entirely in the

province of Phuoc Tuy.

Of the total complement of 1000, 194 were Officers, 659

Warrant Officers and sergeants. 143 corporals and 4

privates. According to its National President, the

Australian Army Training Team Vietnam Association now has

a total membership of 600, itself an extremely high rate,

and testifying to the camaraderie which has remained

between its members.

There are a number of accounts which detail the exploits

of the Team in Vietnam but the main study is that of Ian

McNeill The Team; Australian Army Advisers in Vietnam

1962-1972.88 Major McNeill (as he then was) also wrote

a detailed account of Australia's military role in Vietnam

"An Outline of the Australian Military Involvement in

Vietnam".89

VI-138

4.4.2 The Team" in Vietnam

The disposition of the Team in Vietnam was initially

concentrated in the North. Three groups were to be

located in I Corps which consisted of the five Northern

Provinces and one group would be located in II Corps to

the immediate South. They would be commanded from a

headquarters in Saigon. This initial disposition was to

shape the concentration of the Team for the next eight

years. Although with the subsequent expansion of numbers

the unit was spread throughout the length and breadth of

South Vietnam, its main strength, except for the final

phase of its presence, always remained in the North.

The strength of the Team fluctuated. Although authorised

at 100 (fifteen Officers and 85 Warrant Officers) in

January 1965, the numbers actually in Vietnam varied at

about ten below this figure until November 1968, from

which month its complete strength was reached

consistently. Until mid-1970 when the authorised strength

of the training team was substantially increased, the only

major change to the Team's deployment was the move into

advisory positions with the Territorial Forces in IV Corps

in the Mekong Delta in November 1968. Up to that time.

VI-139

and despite minor variations, the general nature of the

Team's activities and its approximate locations remained

stable. In June 1970 the authorised establishment of the

Team was increased to 21 Officers and 158 Warrant Officers

and Corporals. This increase promoted a major move of the

Team into Phuoc Tuy Province where I ATF was operating.

As well as expansion to Phuoc Tuy, obligations outside the

province were still maintained. A final increase to 31

Officers and 196 Warrant Officers and Corporals in August

1970 enabled Mobile Advisory Training Teams (MATTs) to be

established in Phuoc Tuy for the improvement of

territorial forces and later a Jungle Warfare Training

Centre (JWTC) at Nui Dat similar to the Australian JTC at

Canungra and completely advised by Australians.

Another change in 1970 was the switch away from

operational advising with ARVN and special forces towards

training activities and advising the Territorial Forces.

The training team reached the peak period of strength in

Phuoc Tuy Province during the last phase of its service.

From October 1970 to September 1971 the average monthly

strength was over 200. With the withdrawal of the Task

Force in late 1971 Government policy concerning the Team

radically changed. Members were withdrawn from

deployments elsewhere in South Vietnam and concentrated in

VI-140

Phuoc Tuy Province. By January 1972 all Team members,

except the headquarters element which remained based in

Saigon, were employed in Phuoc Tuy. The headquarters

joined the remainder of the Team in Phuoc Tuy on 1

February 1972.

The role of the Team in 1972 was limited to the JWTC, the

training of Territorial Forces using the MATT system and a

new task assisting in an American program for the training

of Cambodian Forces. All were carried out in Phuoc Tuy

Province. Coinciding with the limitations on its role,

the establishment of the Team was reduced to 68 in early

1972 until, on 8 December 1972, the 35 remaining members

of the AATTV received orders to return to Australia 10

days later.

4.4.3 Command Methods of the AATTV

There was no formal structure whereby the Commanding

Officer dealt with a group of subordinate Officers who in

turn led the men. A collection of individuals, each with

special skills and experience, were chosen individually

for appointments. They had been selected as the top of

their profession.

VI-141

The Americans catered for almost all operational and

logistical requirements of Team members. The Team members,

however, mostly worked singly or in pairs among the

Vietnamese and ethnic groups. The Team received first

class medical support from the American system.

Men of the team were subject to stresses not borne by

other soldiers. They were involved in the heaviest and

most sustained combat, and were required to fight not with

highly trained and disciplined Australian troops but with

Vietnamese soldiers often badly led and with little

training.

These stresses were manifest amongst team members in

predictable ways. Attempts to establish close ties with

other advisers were limited by Commanders, leaving the

individual feeling isolated.

The team was scattered throughout Vietnam and records of

position and duties are quite inadequate.

4.4.4 Submission of the AATTV.

The Team's Association sought from the Minister for

Veterans' Affairs assistance to permit it to brief Counsel

VI-142

and to appear before the Commission. This was declined on

the basis that "WAA was best able to represent the broad

interests of Vietnam veterans".

90

The President protested, pointing to the special and

anxious role of AATTV advisers and to the significant

difference between members of the AATTV Association from

members of the WAA.

He also disparaged the political methods of the W A A and

its position of emphasis on the chemical causation of

problems associated with service in Vietnam. He also

pointed to what he called the narrowness of the terms of

reference and recommending that they should be widened to

ensure that the effects of all features of service such as

climate, disease and stress were considered as well as

chemical agents.

The protests fell on deaf ears, however, and the

Commission has had only copies of the letters passing

between the Association and the Minister and anecdotal

information by informal sessions from the AATTV.

It has supplemented that information by reference to Ian

McNeill's book (supra).

VI-143

The Commission concludes that members of the AATTV

suffered extreme stress in Vietnam. If it be relevant, it

also concludes that assumptions of exposure to herbicides

ought to be made in their favour since they ranged far and

wide and identification of location for them at any

particular period is impossible.

4.5 Psychological Symptoms Found amongst Australian

Vietnam Veterans

This aspect of the Commission's inguiry is dealt with

extensively in Chapter IX. Suffice it for this section of

the Report to say that there is coherent and persuasive

evidence of psychiatric ill-health amongst Australian

Vietnam veterans, probably 3-4% more than in an

age-matched cohort of the same size.

There is a characteristic syndrome which includes some or

all of the following:

loss of sleep;

weight loss;

drug dependence, mainly alcohol;

rage reaction;

VI-144

paranoid reaction;

anti-social behaviour;

disruption of work habits;

isolation;

feelings of alienation and low self esteem;

nightmares;

marital difficulties;

reduced libido;

apathy;

lethargy;

vague neuritis complaints;

problems of memory and concentration;

depression.

This list is remarkedly similar to symptoms commonly found

by doctors in soldier returnees of World War II, amongst

prisoners of war, amongst those suffering operational

fatigue and amongst those returning from the Middle East

wars of 1956, 1967, 1968-70 and 1973.

Indeed. similar symptoms were described by Homer of

Ulysses on his return home.

The Commission has indicated in Chapter IX that it finds

that this syndrome was not caused by chemical exposure.

VI-145

Nor was any other psychiatric disturbance from which

veterans suffer. In brief summary its reasons for those

findings are:

(a) The syndrome is not specific but is similar to those

described in returnees from other wars in which

relevant chemical agents were not used, and

corresponds with symptoms found in persons suffering

stress as a result of the rigours of ordinary life.

(b) There was an absence of any statistical association

between the syndrome and exposure to chemicals.

(c) It was inherently unlikely for a chemical substance to

produce a chronic reaction, particularly a delayed

chronic reaction otherwise than after an initial

clearly recognisable acute reaction.

(d) Workers undoubtedly suffering from toxic neurasthenia

and those Vietnam veterans suffering the syndrome

under discussion clearly had been exposed to different

dosages of chemical agents. Workers who suffer from

toxic neurasthenia experienced daily exposure to high

dosages over a period of many years, whilst Vietnam

veterans may possibly have experienced intermittent

VI-146

exposure over the period of one year, if at all, and

of very low dosages.

(e) There is a positive case made which offers a

persuasive alternative explanation for veterans'

psychiatric disorders. It derives from the literature

on the occurrence of psychiatric disorders amongst the

veterans of previous wars. Although the literature

leaves much to be desired from an epidemiological

perspective, it reveals that veterans of previous wars

have suffered from a strikingly similar syndrome which

includes symptoms such as depression, rage,

gastro-intestinal problems, sleeplessness and

irritability and shows the features and disorders that

have been reported amongst Vietnam veterans, namely,

delayed onset and persistence.

4.6 Other Morbidity Evidence -Vietnam Veterans. Non-Australian

Two studies of Vietnam veterans were conducted in the

United States; Ranch Hand I and II. These provide

evidence useful in a consideration of health outcomes of

Australian veterans, since Ranch Handers were a healthy

military group undeniably heavily exposed to Agent Orange

as well as the other chemical agents in use in Vietnam.

VI-147

4.6.1 Ranch Hand I

This study involved a series of analyses of specific

causes of death amongst Ranch Hand personnel. The result

of those analyses for 1241 matched Ranch Handers and their 91

comparisons are set out in Table 18 of the study.

None of these analyses gave rise to a result which was 92 statistically significant.

As cancer is the subject of a separate Chapter of this

Report and as a number of the physical causes of death

(e.g. accident. homicide) could not feasibly be related to

contact with chemical agents. Table C has been compiled to

indicate relative risks for some causes of death which are

of interest to this Commission.

TABLE C

Cause Specific Mortality and Relative Risks (Extract from Exhibit 1755 Table 18)

Dead Relative

Cause RH Compsn Risk 95% Conf. Int.

Endocrine 1 1 5.000 (0-18.859)

Mental Disorder 0 1

Nervous System 0 2

Circulatory 16 70 1.002 ( .411-1.594 )

Respiratory 0 4

Digestive 5 11 2.273 (0-4.675)

VI-148

A dissection of digestive system mortality is set out in

Table 19 of the Ranch Hand I Report. The Commission

incorporates the information in that Table in Table D, a

comparative table.

TABLE D

Digestive System Mortality

ICD Cause (9th Ed) Deaths

Ranch Hand Comparison

Pancreatitis (5770) 1 2

Alcoholic cirrhosis (5712) 0 3

Non-alcoholic cirrhosis (5715) 3 3

Non-alcoholic fatty liver (5718) 0 1

Chronic liver disease (5728) 0 1

Alcoholic liver disease (5711) 1 0

Duodenal ulcer (5325) 0 1

5 11

It is clear from the spread of disorders in the digestive

system that there is no basis for concern about the

digestive tracts of Ranch Handers and no reason to

guestion the study's conclusion that "there is no

indication that Operation Ranch Hand personnel have

experienced any increased mortality or any unusual

patterns of death in time or by cause. They are not dying

in increased numbers, at earlier ages, or by unexpected 93 causes." (emphasis added)

There is no doubt that Ranch Hand personnel were exposed

to mala thion and to the range of insecticides and

pesticides to which Australian personnel were exposed in

VI-149

the same theatre of war. Most especially, regard must be

had to the fact that the Ranch Hand group was the most

herbicide exposed military cohort to have served in the

Republic of Vietnam. The conclusion that they were a

thousand times more exposed than Australian personnel is

inescapable.94

Accordingly, Ranch Hand I provides strong support for the

proposition that Australian Vietnam veterans are not

suffering ill effects as a result of chemical exposure.

4.6.2 Ranch Hand II95

This study involved the detailed examination of various

health outcomes in 1208 Ranch Hand personnel. As cancer

and reproductive outcomes are dealt with separately in

this Report they are not included in this examination.

(i) General Health Effects

The conclusions reached in the study are

. that it had "not identified statistical group

differences for illnesses commonly attributed to

dioxin exposure",96

VI-150

. that "there is insufficient evidence to support a

cause and effect relationship between herbicide

exposure and adverse health in the Ranch Hand group,

. that "the baseline study results should be viewed

as reassuring to the Ranch Handers and their Q7 families".

Dr Schneiderman was called to comment on the Ranch Hand II

study and no suggestion was made either by him or

elsewhere in the evidence that the results of the Ranch

Hand II study established adverse effects on the general

health of Vietnam veterans from chemical exposure.

It is also important to recall that the report by the

Chairman of the Agent Orange Registry of the Armed Forces

Institute of Pathology (AFIP) on the diagnoses of 1200

Vietnam veterans (1978-1983) states:

In these 1200 cases, there have been no evident clusters that have medical significance. Put another way, there have been no persistent patterns of adverse health effects noted.98

VI-151

(ii) Nervous System

Neurological assessment of the Ranch Hand personnel was

undertaken in the study. Cranial and peripheral nerve

functions were examined and an evaluation of the central

nervous system undertaken. Detailed testing of the

functioning of the 12 cranial nerves revealed no

statistical difference between the Ranch Hand and 99 comparison groups. When cranial nerve function was

related to an index of exposure to Agent Orange, no

adverse association was found.100.

Examination of peripheral nerve status did not demonstrate

statistically significant differences in neurological

functions between the Ranch Hand and comparison groups

except for a borderline association between the Ranch Hand

group and original comparison group and a significant

association in the entire comparison group in respect of

the Babinski reflex.101

The data from the Ranch Hand group were also analysed

against the exposure index. "No statistically significant

results were found in the analysis of exposure versus

examination parameters" and "No distinct patterns of

increasing abnormality with increasing exposure" was „ . 102

found.

VI-152

The evaluation of the functioning of the central nervous

system co-ordination process focused on the presence of

muscle tremor, co-ordination, gait and balance. As in the

analyses of the peripheral nerves, "there were no

significant interactions of these findings with chemical

exposures or group membership".103

Nerve conduction velocities were measured and "No

associations between the chemical exposures and conduction

104

velocities were identified."

It was thus concluded. "there are no neurological

abnormalities in the Ranch Hand group that can be

105

attributed to herbicide exposure in Vietnam".

The Commission accepts this finding and adopts it. It

notes also that Ranch Handers were exposed broadly to the

same anti-malarial regime and insecticides as Australians,

although to Dapsone for a longer period.

(iii) Liver Function

The liver status of Ranch Hand personnel was evaluated and

the following tests were undertaken:-

VI-153

SGOT, SGPT, GGPT

Alkaline phosphatase

Total bilirubin

Direct bilirubin

Lactic dehydrogenase

Cholesterol

Triglycerides

An examination of the percentage of abnormalities found by

the various tests in both the Ranch Hand personnel and the

comparison groups is set out in Table E .

VI-154

TABLE E

(extracted from Exhibit 1394 Table XIV-2)

Percent

Variable Grouo Abnormality

SGOT RH 13.9

COM* 14.8

SGPT RH 7.8

COM 8.6

GGPT RH 10.8

COM 10.3

Aik. Phos. RH 17.3

COM 16.9

T. Bill RH 1.8

COM 2.0

D. Bill RH 29.0

COM 29.7

LDH RH 1.7

COM 2.1

CHOL RH 26.0

COM 27.7

TRIG RH 34.7

COM 36.1

; fully compliant original comparisons.

In no test is the difference statistically significant and

as can be seen from Table E , the comparison favours Ranch

Hand personnel in 7 of the 9 tests, whilst in the other

two tests the differences are less than .5%

VI-155

The results of the tests were correlated with the exposure

index and an examination for urinary porphyrins

undertaken. Porphyria cutanea tarda is said to be caused

by exposure to TODD. This is a test for its presence. No

overall group differences were detected in uroporphyrins

or in coproporphyrins and overall the exposure index

analysis did not support determination of herbicide

,, „ 106

effect.

Such differences as were found in liver-related

biochemical variables, whether in the blood or in the

urine, were "most likely of minor or negligible medical

importance."107

However, twice as many Ranch Handers as comparison had

enlarged livers on physical examination. This finding was

not statistically significant and whether or not it is

related to alcohol consumption has not been stated.

However, the personal communication from both Dr Lathrop

and Dr Wolfe satisfies the Commission that the Ranch

Handers were a hard drinking group, as follow-up has

shown. This confirms the oral evidentiary impression.

VI-156

(iv) Skin

Because chloracne is a marker of exposure to chlorophenols

and dioxin, a very thorough examination of the skin was

undertaken in the course of Ranch Hand II. This

dermatological assessment was very carefully planned and

an appropriate history was obtained as well as a detailed

physical examination supplemented by biopsy where . „ 108

appropriate.

Chloracne is classically found on the temples, around the

eyes and the eyelids and in the region of the ears.

Accordingly, questions as to the location of rash were

asked of each participant who reported any form of

There were only four individuals (2 in the Ranch Hand

group and 2 in the comparison group) with acne in the

specified areas.

The dermatological examinations conducted on those who

reported acne together with the results of the biopsies

from 11 patients in whom biopsy was warranted resulted in

no case of chloracne being found.

VI-157

Certainly no case of chloracne has been reported amongst

Australian personnel who served in Vietnam.

An analysis was undertaken of the Ranch Hand group using

the exposure index, the information in their histories,

the examination findings and occupational categories. Of

the 21 different analyses performed none were

statistically significant.110

(v) Cardiovascular System

Examination of the following cardiovascular system

parameters was undertaken for the Ranch Hand II study:

(a) Systolic blood pressure - no significant differences

were observed after adjusting for age, smoking and

cholesterol level.111

(b) Diastolic blood pressure - no significant differences

were observed after adjusting for age, smoking and 112 cholesterol level.

(c) Electrocardiograms - no abnormalities associated with

group membership were observed.113

VI-158

(d) Heart sounds - no group differences were observed but

it should be noted that the data were too sparse for a 114 fully adjusted analysis.

The peripheral cardiovascular system was tested by

ophthalmoscopic examination of the eyegrounds.

auscultation of the carotid arteries and palpation for the

presence and quality of the five peripheral pulses.

The results can be summarized as follows:-

(a) Eyegrounds - no association was observed between

abnormal findings and group membership.115

(b) Carotid bruits - comparison revealed no difference

between the Ranch Hand and comparison groups there

being an equal prevalence in both groups.116

(c) Popliteal pulses - there was a difference w h i c h as

either borderline significant or insignificant in

those individuals without a history of *■ cardiovascula r

disease. However, interpretation of nis fin di ng i s

°Pinion w a s

that it related to current smoking118

not clear. Dr Wolfe's preliminary

VI-159

On comparison of the variables examined in the exposure

index it was found that there was no detectable

association between the herbicide index adjusted by

occupational category and any of the cardiovascular

variables119

(vi) Immunological Systems

Experimental data in animals have suggested that TCDD may

affect immune systems. For this reason immunological

evaluation of Ranch Hand personnel was undertaken.

The study concluded that.

From the clinical vantage point the immunological findings do not present a picture indicative of immunological alteration in the herbicide exposed

group . . .

and also that:-

no gross adverse immunological effects were noted between the herbicide-exposed group and the comparison group.120

VI-160

(vii) Endocrine Function

Since large doses of TCDD have been reported to produce

metabolic phenomena in experimental animals, endocrine

analysis was performed on the Ranch Hand personnel. The

findings of the study in regard to this bodily system were:

(a) No overall statistically significant dose response 121 relationship was found;

(b) No definite herbicide effect on thyroid function was

122

demonstrated;

(c) The Ranch Hand group differed from the comparison

group in normal and abnormal thyroid hormone

categories but the difference was "directionally

opposite to what would be expected on the basis of 123 subacute animal studies";

(d) No meaningful association of thyroid hormone levels

with the exposure index were found.124

It is interesting to note that Ranch Hand personnel were

found to have testosterone levels which were higher than 125

the members of the comparison group. This may reflect

VI-161

Type A personalities being more prevalent amongst Ranch

Hand personnel, a speculation which may find some support

in the evidence of Dr John Mathews.126

The Commission concludes then that Ranch Hand II

demonstrates an absence of adverse health effects amongst

a group which on any view was heavily exposed to Agent

Orange, other herbicides and to the general range of

insecticides.

The results of this study do not provide any support for

claims that adverse health effects amongst Australian

personnel are related to exposure in Vietnam to Agent

Orange or other chemical agents.

5. WAA's CASE - ALLEGED NEUROTOXIC AND OTHER EFFECTS

Having reviewed the evidence available, (which, one

interpolates. Counsel for W A A did not do), the Commission

turns to what it is W A A says about general health effects

in Australian Vietnam veterans. In its initial

. . 127 .

submission under the sub-heading Morbidity, the

following appears,

Probably the most common symptoms are headaches, rages (or forms of behaviour either emotional or

VI-162

physical to cope with feelings of rage), tingling in the hands and/or feet and rashes. - 1 -28

And later.

The other areas of complaint are in general terms emotional illnesses such as depression, anxiety, lethargy and the like, alterations to skin tone, convulsions. blood pressure alterations, liver and kidney disfunction, cancers (including rare

types), bronchial problems, problems of sight, muscular twitching and numbness, nausea, abdominal problems. urinary problems, heart problems, loss of libido, neurological problems, sweating and increased salivation, bowel problems.^29

Classifying the above symptoms the following might well be

regarded as typical of other descriptions of the "Vietnam

Veterans' Syndrome" and consistent with a diagnosis of

post-traumatic stress disorder:-

Headaches;

Rages and rage controlling behaviour;

Depression;

Anxiety;

Sweating;

An increased salivation;

Lethargy;

Bowel problems (the Commission has taken this to be a

reference to irritable bowel syndrome);

Muscular twitching;

Numbness;

VI-163

Loss of libido;

Tingling in hands or feet;

Abdominal problems.

Rashes were notoriously common amongst Vietnam veterans,

as, indeed, amongst all veterans who served in the

tropics. It is common that the area of the body where such

rashes existed whilst the veteran was in the tropics is

likely to be affected from time to time for years after

his return home, especially in hot and humid conditions.

Rashes are also a common consequence of any nervous

disorder.

Blood pressure and heart problems are cardiovascular

outcomes and there is evidentiary support in the AVHS

Mortality Study for an increase in these disorders amongst

Vietnam veterans in Australia (see supra).

Liver dysfunction is a common consequence of alcohol abuse

and there is certainly evidentiary support for the

proposition that the Vietnam veteran drinks more than his

non-veteran counterpart.

The Commission can find no support in the evidence or in

the literature for skin tone alteration or convulsions or

VI-164

of any genuine neurological problems amongst Vietnam

veterans.

In its submission related specifically to toxicology130

W A A commences with what it calls some fundamental

principles of toxicology and then deals with a selection

of the literature relating to a number of the chemical

compounds used in Vietnam. Analysis of dosages is

conspicuously absent. Acute symptoms of poisoning with

high doses of the various chemicals are described.

Nowhere in this submission is there to be found any

analysis of symptoms actually displayed by Australian

Vietnam veterans, either in Vietnam or post-war.

. , . 131

In its final submission W A A in a section headed

"Health of Veterans" seeks to discount a possible

diagnosis of post-traumatic stress disorder. In substance

this section of W A A 1 S submission relies upon

Dr van Tiggelen, Mr Davies of the Vietnam Veterans'

Counselling Service and Dr Peter Orris in respect of what

has been called the "Vietnam Veterans' Syndrome." This is

the syndrome described by Dr Van Tiggelen in evidence and 132

summarised in the Senate Report.

VI-165

In short, WAA, apart from side swipes at cardiovascular

problems and kidney and liver dysfunction, puts all its

eggs into the neurotoxic basket.

5.1 Van Tiggelen's Theory

Dr Van Tiggelen1s theory is that exposure to chemicals

with neurotoxic potential may. by a multi-factorial

process, produce pathology in the central and peripheral

nervous systems leading to inability to cope with

psychological and emotional stress and the whole range of 133

symptoms in the syndrome described by him and others.

Dr Van Tiggelen frankly and freely conceded that the

syndrome he saw and described was completely consistent

with post traumatic stress disorder.134

He is not. by his own admission, a scientist, a

13 5 neurologist or a psychiatrist.

Dr Van Tiggelen1s neurotoxic theory has in the

Commission's view, been totally rebutted.136 There is

no other support for a neurotoxic case and for reasons

outlined above, the alternative positive finding of

post-traumatic stress disorder is entirely appropriate.

VI-166

However. given the reliance by W A A upon a neurotoxic

response, the Commission proposes to turn to the evidence

relative to the following proposition:-

If exposure to a chemical agent produces no immediate

discernible effects (i.e. no acute effects), there

will be no long-term neurotoxic or other untoward

health effects as a result of such exposure.

If this proposition can be made out then the WAA's case

of chemical caused illness is in severe difficulties.

No evidence supportive of the proposition that acute toxic

reactions occurred amongst Australian personnel in Vietnam

has been called, save only for those involved in the 137 Holt/Lugg trials and Veteran No. 10 referred to above.

Nor did the Commission's own extensive investigations

indicate that it would have been available, if searched

for by others. On the contrary, there is no support for

the proposition that acute toxic reactions in Australian

personnel were common in Vietnam.

VI-167

Dr Norman Aldridge gave oral evidence. He is the Director

of the World Health Organisation's Collaborating

Laboratory for the Safety of Pesticides for vector

control, and visiting Professor in Toxicology at the

Universities of Surrey (UK), California (Berkeley) and

Trondheim (Norway).

He is a neurotoxicologist of world renown.

As to DDT Dr Aldridge said. in a context of human

volunteers eating large doses, and bearing in mind the

animal studies as well, "there is (no evidence of

long-term neurological effects) even in the context of

suicide attempts."

As to chlordane, Dr Aldridge was asked;

Would you expect any neurological deficit or neurological symptom long term in the human being who had not had an acute event, including

convulsions?-- I would not expect it from the rather limited information we have about

persistent exposure.

As to dieldrin. Dr Aldridge said: -

In the absence of any acute event, including convulsion, I would not expect any long-term neurological deficit.

VI-168

The same applies to lindane.

Recovery is rapid. No permanent neurological deficits1 3 8

As to pyrethrins, Dr Aldridge said:

Even in the case of poisoning, recovery is rapid and complete and that there would be no long-term neurotoxicological effects.1 3 9

As to malathion Dr Aldridge said:

. . . even in cases of severe poisoning unless the subject died, long-term neurological symptoms just do not happen. 1 4 0

Dr Aldridge was asked about exposure for a period and then

a gap of years before the onset of symptoms. He said:

I know of no examples where, with a delay period, a silent period of that length, there is not some evidence of acute toxicity to start with.1 4 1

He also said:

If I understand the documents that I have read, there is no firm evidence that symptoms of acute toxicity were seen in these soldiers, ... I would not have expected any long-term toxicological effects to emerge, neither delayed neuropathy

that we have just discussed nor any other

effects. May I repeat that; and no other effects have ever been seen at any other time in

experimental work or in man.1 4 2

VI-169

As to diazinon, Dr Aldridge said:

The general principles that are used with respect to acute toxicity and delayed neuropathy apply to diazinon as for malathion" . 1 4 3

Later a description of the so-called "Vietnam Veterans'

Syndrome" was put to Dr Aldridge. The following exchange

took place:

From your expert position as a neurotoxicologist, on the balance of probabilities, is it

likely or not that such a syndrome would be caused by chemical exposure?-- In my opinion a condition of this kind which has emerged or is postulated to emerge from exposure to chemicals which produces no immediate effects, discernible immediate effects, followed by a long silent period, there is no evidence that any chemicals that I am aware of, certainly not these, would cause, or be causally related to, the development of this condition1 4 4

If there were some immediate symptom, for example, a fever or a feeling of nausea or some irritation in the eyes or some

constriction in the chest, or something of that sort, but not leading to convulsions or hospitalisation or need for treatment of a serious sort, what then about a delayed neuropsychiatric syndrome?--- There is nothing we know of that even with minor

acute toxicity that would lead to this

syndrome. 1 4 5

He was pressed in cross-examination. He repeated: I

I have said that I know of no instance where there is no acute effect, no signs of

poisoning and such a long period before signs.14°

VI-170

He was further pressed:

Is it so for the chlorinated hydrocarbons that you do produce delayed neuropathy.--- The chlorinated hydrocarbons do not produce delayed neuropathy.1 4 7

Significantly Dr Ellen Silbergeld conceded that the

organo-phosphates like malathion and parathion do not

possess activity as delayed neurotoxins. Indeed her only

claim of a neurotoxic response to any of the various

chemical agents used in Vietnam is as a consequence of a

real lesion resulting from lack of oxygen to the brain.

She expressly disavows any direct action of the chemicals

themselves in the production of a neurotoxic response. In

other words the only neurotoxic effect relied upon by her

is as a consequence of a poisoning event so severe that

the victim stops breathing.1 4 8

Clearly, the proposition set out above has been

demonstrated.

To reiterate, the Commission is of the view that Dr van

Tiggelen1s neurotoxic theory has been totally rebutted and

it finds accordingly.

VI-171

6 . INDUSTRIAL AND ACCIDENTAL EXPOSURES

The Commission has carefully studied and evaluated the

data from the major industrial and accidental exposures to

TCDD, the putative villain.

Many of these are set out in the following table. This is

a reproduction of Table X in Chapter VIII (Cancer) where

the table and its footnotes are fully discussed.

VI-172

®HE F

YESR 1957 1955/77

nxmiCN Hnsarro Mtro.W.Vct. U.S.A.

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ΊΥΕΕ CF EXECGLRE

(i) Bplcelm

(ii) CccLfatdaial

MM$R CF < 3&S

(&) 122

(b) 884

HIICW IP

1978

1977

MM$R CF c m w s

9

35

SIS

Nd Yes

M O D I MH

1

1948/49 _TOxEfEary'‘ Vfestfalm ΟΞΠΤΒΤψ J^itadilriRrlienoI

TOD 2,4,5-ΊΟ? Chlorine teiaciilarcbsiaaTe

CccupatkiHl 17 1951 NIL ND* ND*

1952 MkHliine dRFNY /,4,5-ίιΙ O ’

ann MCH MnnodilcrcaCEtic add NfetharriL

CaapatierBl 60 1960 NIL ND* ND*

1953 btib1 lizMcptefei 2r4f5JlLl· ICED Bplcsicn 75 1979 7 to Nd

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2,4,5 γίιι / iced TIB

ill Lccucsticrai iuu aprax ill) S S S k n 17 (ill) ESplosim 21 - ND UKRvMlCM - * *

1954/55 ttxiirinyei4 IngtiTeim Rrrnrg "2T475=T

2,4,5-TT ICED MCH; TCB MricchlcrcaDEtic aedd

Cccqnticral 31 1976 Nil Nd Nd

1956 Uicndd- Alkalai ti^Eirk, N.J. U.S.A.

2,4-Ll 2,4,5-T ο π ό MncdTkxcacEtdc add toCH; Acetic add

CmpBtkral 29 1971 Nil Nd Nd

1963 t!iilipe- Dollar Ansterdart Η3Ί/Η)

2,4,5-JlCb> IfetochlarcfaaOaTe ‘ lei D Sodiun llichlraxrhaHte

bfeCH; I^thanoL

Bpkricn 106 1977 Nil Nd Nd

1951/71 1964 LCW- Midlard

Mchigan, H. U.S.A.

2.4.5- T 2.4.5- TCP am) Sbdiun ttnxhlmD-

(i) COdfatiaial

(it) Ccapaticnal

204

a

1976

1978

1

3

Nd

Yes

Nd

Nd

toCH ^ ^

ISCtalcdxl

1965/58 tmlara CZETHHO^KIA 2,4,5^1' am,· atm

HasadiksxteTzaTe tony enknctoi chaidcals & hsrfcdddes

Cfcnpaticnal 78 1778 2 Nd Nd

1964 U.S.S.K. /,4,5 γί · UuH Hticral 128 1970 Ml Nd* ND

1968 indite (rine Chemicals Lhit)

Eertvdiire U.K.

2,4,5-ΊΟ> ICE TOD Ctthdich]m±aBme NaCH

Dplcsicn 79 1978 Nil Nd Nd

1972/7J Litnuce-vote Linz, TIBIRIA 2,4,5-T ICED O^CLpaticml 50/100 - - * *

29T3775- (£fpcak) jyu isaiilx) Napcrt

gMHVRUS

i r t i i t r f t l l l e ^ X l lt3 t d t - έ KP Has Fteta and Ccfca ChlarcmbaTZDcticsdne

OccupaticrBl 41 1978 Ml Nd* Nd*

VI-173

In each of the instances referred to in Table F above

either acute high level exposure. chronic high level

exposure or exposure over a substantial period was

involved . It is sufficient for this section of the Report

to say that in the absence of immediate and dramatic toxic

consequences no long term health effects have been

established other than persistent chloracne with early

(within weeks) onset.

The Commission had a lengthy consultation with Dr Ray

Suskind at the University of Cincinnati in October 1984.

His thirty year follow up of the workers heavily exposed

to TCDD in the accident at Nitro West Virginia satisfies

the Commission that the proposition set out in the

proceeding paragraph is correct and the Commission finds

accordingly.

7. CONCLUSIONS

The Commission concludes that there are adverse health

consequences of service in Vietnam. These could have been

precisely identified and classified by the morbidity study

proposed by the Commission and for which funding was

refused by the Government in August 1984 (see section 2 of

this Chapter).

VI-174

alcohol These consequences are related to stress,

cigarettes and/or a risk-taking attitude

pre-existing or inculcated by service).

Such consequences are not related to exposure to

chemical agents.

(either

relevant

VI-175

ENDNOTES

1 .

2 .

3 .

4 .

5 .

6 .

7.

8 .

9 .

1 0 .

11.

12.

13 .

14 .

15 .

16.

17.

18 .

19.

See the views as to budgetary control expressed by the Canadian Law Reform Commission

"Commisssions of Inquiry Working Paper" 17. 1977 p 2 0 .

Exhibit 1755.

Exhibit 101.

Exhibit 906.

Exhibit 1391.

Exhibit 1394.

Dr Dunt1 s letter to W A A dated 16 April 1984, copy supplied to Royal Commission by Mr Mclnnes, Q.C. .

Response of the then Minister for Defence given in Parliament, May 1972.

Parliament of the Commonwealth, Parliamentary Paper No 160/1984, Budget Statements 1984-85, p 75. (Part of Exhibit 1964.)

18/3/85 Finance Officer, Recruiting Branch Personal Communication. (Part of Exhibit 1964.)

Transcript p 6290.

Transcript p 6145.

cf Army Report - Exhibit 892 and Young et al. - Exhibit 906 as dealt with more fully in the

Exposure section of this Report.

Exhibit 1779.

Transcript pp 6140 and 6161.

Exhibit 1780.

Transcript p 6194.

Exhibit 1781.

Transcript pp 6201-2.

VI-176

20. Exhibit 1788.

2 1 . Exhibit 1786.

2 2 . Exhibit 1789.

23 . Exhibit 1791.

24 . Exhibit 1794.

25. Exhibit 1792.

26. Exhibit 1793.

27. Exhibit 1794.

28 . Transcript pp 6256-8.

29 . See Ch IX.

30. Exhibit 1795, undated.

31. Exhibit 1822.

32. Exhibit 1810.

33 . Exhibit 1813.

34 . Exhibit 1802.

35. Exhibit 1803.

36. Exhibit 1807.

37. Exhibit 1810.

38 . Exhibit 1811.

39 . Exhibit 1816.

40. Exhibit 1813.

41. Exhibit 1809.

42. Exhibit 1815.

43 . Exhibits 1826, 1827 and

44 . Exhibits 1831, 1832 and

1834

1834

VI-177

45.

46.

47.

48 .

49.

50.

51.

52.

53.

54.

55.

56.

57.

58.

59.

60.

61.

62.

63 .

64 .

65 .

66 .

67.

68 .

69.

Exhibit 1836.

Exhibit 1839.

Exhibit 1837.

Transcript pp 6456-9, 6471 and Exhibit 1857.

Exhibit 1846.

Exhibit 1853.

Exhibit 1856.

Exhibit 1855.

Exhibit 1848.

Exhibits 1847 and 1854.

See Exhibits 1849, 1850, 1851. 1852 and 1854.

Transcript p 6512.

Exhibit 1861.

Exhibit 1860.

Exhibit 1864.

Exhibit 1866.

Exhibit 1868.

Exhibit 1869.

Exhibit 1865.

Exhibit 1859.

Exhibit 1881 p 34.

Transcript p 6289a.

Transcript p 6290.

Exhibit 1879 p 90.

Transcript pp 6426-7.

VI-178

70. Cf Jones v Dunkel (1959) 101 CLR 298.

71. Exhibit 1761.

72. Exhibit 1879, p 107.

73 . Exhibit 1761 Table 3.10.

74 . Exhibit 1761 para 4.3.3.

75. Exhibit 1761, para 4.3.3.

76 . Exhibit 1761 para 5.6.3.

77. For example, the British Army, Kilpatrick 1963, Lynch and Oelman, 1981, the United States Army, Keehn, 1974 and the Australian Armed Forces, Taylor et al 1983.

78. E.g. Mathews. J.D., et al. Alcohol

Hypertension, (1979) A. & N.Z. Jnl. of Med 9, pp 124-8. .

and

. Vol

79. Transcript pp 5986-5988.

80. Exhibits 1473 to 1475.

81. Exhibit 1761 para 5.6.4.

82. Transcript p 5980-81.

83. Exhibit 1761 Table 4.8.

84 . See also Dr Mathews' statement "60 deaths can be regarded as the notional excess" Exhibit 1773 p 9.

85. Exhibit 1773 p 6 and 8 .

8 6 . Ibid.

87. Exhibit 1040.

88 . University of Queensland Press in association with the Australian War Memorial, 1984.

89. Defence Force Journal. Number 24, (Sept/Oct 42-53. 80).

90. Letters dated 4/11/83 and 9/2/84.

VI-179

91. Exhibit 1755 p 17.

92. Ibid page ii.

93 . Exhibit 1755 p 39.

94 . Chapter IV.

95. Exhibit 1394.

96. Ibid P XIX-9.

97. Ibid P iii.

00 σ> Exhibit 1670 p 9.

99 . Exhibit 1394 p XI1-3.

1 0 0 . Ibid P XI1-6.

1 0 1 . Ibid P XI1-8.

1 0 2 . Ibid P XII-10.

103. Ibid P XII-11.

104 . Ibid P XI1-12.

105. Ibid P XI1-15.

106. Ibid P XIV-7.

107. Ibid P XIV-17.

108 . Ibid P XV-9.

109. Ibid P XV-3.

1 1 0 . Ibid P XV- 8 and XV-9.

1 1 1 . Ibid P XVI-1-2.

1 1 2 . Ibid P XVI-1-3.

113 . Ibid P XVI-1-5.

114 . Ibid P XVI-1-7.

115 . Ibid P XVI-1-8.

VI-180

116.

117.

118.

119 .

120.

121.

122.

123 .

124.

125.

126.

127.

128 .

129 .

130.

131.

132 .

133 .

134 .

135.

136 .

137.

138 .

139.

140.

Ibid p XVI-1-8.

Ibid p XVI-1-18.

Personal Communication, September 1984.

Exhibit 1394 p XVI-1-20.

Ibid p XVI-2-12.

Ibid p XVI-6-7.

Ibid p XVI-6-12.

Ibid p XVI-6-12.

Ibid p XVI-6-12.

Ibid p XVI-6-12.

Transcript p 6083-6087.

Exhibit 1040.

Ibid p 63.

Ibid p 64.

Exhibit 1878.

Exhibit 1879.

Senate Report, Exhibit 1448 p 102.

Exhibit 1343.

Transcript p 3438.

Transcript p 3314, 3382.

See Ch IX.

See Ch IV.

Transcript pp 3464-3469.

Transcript p 3471.

Transcript pp 3478-9.

VI-181

141. Transcript P 3480.

142. Transcript PE) 3481-3483.

143. Transcript P 3486.

144 . Transcript P 3489.

145 . Transcript P 3489 .

146 . Transcript P 3497.

147. Transcript P 3524.

148. Transcript P 5608.

VI-182