Morbidity of Vietnam Veterans - Vol 3 Validation Study: Foreword

Repatriation Commissioner's statement

REPATRIATION COMMISSION

10 November 1999

The Hon Bruce Scott MP
Minister for Veterans; Affairs and Minister Assisting the Minister for Defence
Parliament House
CANBERRA ACT 2600

Dear Minister

As Chairman of the Advisory Committee for the validation of the results of the Vietnam Veterans’ Health Study, I am pleased to forward the report entitled "Morbidity of Vietnam Veterans: A Study of the Health of Australia’s Vietnam Veteran Community. Volume 3. Validation Study." for your consideration.

This is the third and final volume of the study of the health of Vietnam veterans begun in 1997. Its findings are vital but do not stand alone. Because of the manner in which the Health Study evolved, the total findings are to be found by reference to each of the three Volumes. The findings of the Health Study also complement the results of two previous studies: "Dapsone Exposure, Vietnam Service and Cancer Incidence" (AIHW, Canberra, 1992) and "Mortality of Vietnam Veterans: the Veteran Cohort Study" (DVA, Canberra, 1997).

In Volume 1 of the Health Study, male Vietnam veterans rated their own health as very poor and reported a number of conditions, especially psychiatric conditions, at a prevalence that exceeded the community norm. They also reported in approximately 30 per cent of cases that their own health problems had led to health problems in their partners, and that their children apparently suffered a greater prevalence of death, cancer and congenital abnormality.

One of the recommendations from Volume 1 was that some conditions — cancers, motor neurone disease and multiple sclerosis in veterans; and some cancers, genetic abnormalities and deaths in veterans’ children — should be subject to validation at the level of a medical diagnosis or inclusion on a medical register. Validation would provide an accurate and reliable prevalence of each of these conditions as the basis for consideration of policy change, and as the basis for any future study into causation. The validation project is the subject of Volume 3.

Volume 2 of the Health Study reported the results of the survey of female Vietnam veterans, their partners and children. Here again, the female veterans reported their health as poorer than the general community, but not to the same extent as male veterans. Fourteen per cent reported their poor health had affected the health of partners. The female veterans did not report problems in children that exceeded expected levels, but the number of veterans responding was perhaps too small (223 as opposed to 40,030 male veterans) to constitute a statistically viable sample for this purpose.

The validation that is reported in Volume 3 commenced in October 1998 and has taken just over a year to reach a conclusion on the majority of conditions examined. Reports on multiple sclerosis and motor neurone disease are yet to be produced because the difficulty of diagnosis in these conditions means that some of those identified as potential sufferers will need to be examined by a small group of specialists to ensure accuracy. The results for multiple sclerosis and motor neurone disease will be published as an addendum to Volume 3 at a later date. Meanwhile, it should be noted that the prevalence of motor neurone disease identified through deaths of veterans and accepted DVA claims suggests a potential increase compared to community norms.

The Validation Study has taken longer than originally envisaged primarily because its methodology necessitated obtaining responses sequentially from the veterans involved, then from their children if required, and then from doctors or registers. Sufficient responses had to be obtained at each stage to ensure statistically reliable results. Campaigns to follow-up non-respondents were required to obtain the necessary numbers from all groups across the range of conditions. The need for these campaigns progressively delayed the Study’s finalisation.

The findings of the Validation Study are shown in this Volume. Some conditions in both veterans and children have been validated as exceeding the community norm, and thus signal a need for an appropriate policy response. The Advisory Committee commends the findings in this report to you.

The Advisory Committee also note that some findings of concern from Parts 1 and 2 of the Study could neither be responded to under current Repatriation provisions nor be subject to validation because of the absence of a clear diagnostic category to define the condition, or because of a lack of community data against which it could be compared. The effect of war-related illness in veterans upon their partners and families is a case in point. The Reports of Volumes 1 and 2 recommended consideration of policy responses to these wider findings, and these recommendations are again brought to your attention.

As the Health Study draws to a close there are two further matters of importance.

The first is to note that while the health of Vietnam veterans, their partners and their children has now been examined, this process only began in 1997. Thus all the veterans and children who died before this date have been excluded from the Health Study. There is an argument that these are the very veterans and children whose health would have been the poorest. The Committee has asked me to bring this to your attention. Your recent announcement of a health study for Gulf War veterans and routine health studies of veterans of future deployments should assist in alleviating this problem in future.

Finally, I would like to take this opportunity to thank all those connected with the Validation Study for their diligence and hard work. The Australian Institute of Health and Welfare conducted the Study and prepared the report. DVA staff assisted the drafting of the protocol for the Study, and participated in and supported the deliberations of the Study Advisory Committee. But principally I would like to thank the ex-service members of the Advisory Committee, Mrs Colleen Thurgar of the Returned and Services League of Australia, Mr John Methven of the Vietnam Veterans’ Association of Australia, and Rear Admiral Guy Griffiths of the Australian Veterans and Defence Services Council. Their advice and critical appraisal on behalf of the wider Vietnam veteran community was rigorous and much appreciated.

Yours sincerely

Paul Stevens

Chairman, Morbidity of Vietnam Veterans Study Advisory Committee and
Commissioner, Repatriation Commission