| Title | 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 |
| Source | Both Chambers |
| Date | 22-08-1985 |
| Parliament No. | 34 |
| Tabled in House of Reps | 22-08-1985 |
| Tabled in Senate | 22-08-1985 |
| Parliamentary Paper Year | 1985 |
| Parliamentary Paper No. | 289 |
| System Id | publications/tabledpapers/HPP032016003934 |
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 ReportâJuly 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 aboveâ 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
, â 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 â 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 Î , 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.
Furtherâ 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 Tiggelenâs 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 $7â000,000 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, Î.B .â 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 â 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
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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 understandâ 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.
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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.
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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.
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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.
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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 Greenwaldâs 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 teamsâ
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
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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 Gietzeltâ 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.
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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,
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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.
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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.
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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.
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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 â â 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
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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.
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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 Lancetâ 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
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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
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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 rememberâ
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.
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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 â . 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
,, â 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 . â 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 *â 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.
OEMKKLS ÎÎÎ3ÎÎÎ 2.4.5- T 2.4.5- OCP TOD teCH totterd. Ttetadilaxtenaaie
ÎÎ¥ÎÎ 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'â Vfestfalm ÎÎΠΤÎÎ¤Ï J^itadilriRrlienoI
TOD 2,4,5-ÎÎ? Chlorine teiaciilarcbsiaaTe
CccupatkiHl 17 1951 NIL ND* ND*
1952 MkHliine dRFNY /,4,5-ίιΠO â
ann MCH MnnodilcrcaCEtic add NfetharriL
CaapatierBl 60 1960 NIL ND* ND*
1953 btib1 lizMcptefei 2r4f5JlLl· ICED Bplcsicn 75 1979 7 to Nd
CIRmY 1CB; teCH 1953/71' 1956 1966
Hm^Rxllax: Ciexble & Rant
de Claire EBPJCE
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 Ï Ï MncdTkxcacEtdc add toCH; Acetic add
CmpBtkral 29 1971 Nil Nd Nd
1963 t!iilipe- Dollar Ansterdart Î3Î/Î)
2,4,5-JlCb> IfetochlarcfaaOaTe â 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-ÎÎ> 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 - Î 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 Ï> 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