In the past few years, Dr. Michael Koopmeiners has seen a surge in the number of veterans seeking help for war-related disabilities at the Minneapolis VA Medical Center.
At Koopmeiners' clinic, which evaluates new disability claims, business has more than doubled since 2004 -- from 6,800 to nearly 15,000 patients a year.
But only a fraction of the cases have anything to do with Iraq or Afghanistan.
Instead, most are Vietnam veterans who have waited until now, more than three decades after their war ended, to come forward and seek help. Vietnam veterans, he says, outnumber those of every other conflict combined.
Nationally, too, Vietnam veterans are coming forward by the tens of thousands with a vast array of medical problems, from hearing loss to cancer, that they believe are connected to their military service. In 2007 alone, a quarter of a million veterans were added to the VA disability rolls -- more than a third of them Vietnam veterans, according to a VA spokeswoman.
The question is why now?
To some extent, the recession is fueling the surge, say experts and veterans groups. Anyone with a military disability may qualify for free care and monthly payments from the Department of Veterans Affairs.
But aging bodies and changing rules have made more Vietnam veterans eligible than ever before, says John Rowan, president of Vietnam Veterans of America.
"Most folks walked off the battlefield in one piece and felt 'OK, I made it,' " Rowan said. "What they didn't know was there was a whole lot of stuff that would come up and bite them in the butt 40 years later."
Links to Agent Orange
In particular, many are developing illnesses that have been linked statistically to the notorious herbicide Agent Orange, which was widely used in Vietnam. Even though some conditions are quite common -- such as diabetes and prostate cancer -- the VA views them as service-related disabilities.
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So veterans such as Jim Fiebke, who never thought they would be asking the government for anything, are finally doing just that.
Fiebke, a retired sales executive from Rochester, spent a year as an Army clerk in Vietnam from 1969 to 1970.
"When I came home, I was tan and healthy and in good shape," said Fiebke, now 61. "I thought I was home free."
He had no reason to doubt it for 30 years, until he was 52 and developed multiple myeloma, an insidious form of cancer of the blood cells and bone marrow. At first, Fiebke figured it was just bad luck. But in 2003, a chance encounter in a parking lot left him wondering if his illness could be an aftershock of Vietnam.
"This lady walks up and says, is that your car?" he recalled. She had noticed his Vietnam veteran license plate, as well as the telltale signs that he was fighting cancer ("I didn't have hair and looked a little sick"). The woman told him that she had lost her husband, a Vietnam veteran, to cancer, and that there was a connection to Agent Orange. "You should get in and check on that," he remembers her saying.
"I did. And I was just shocked."
20 million gallons of herbicide
Fiebke learned that his cancer was one of the diseases that the VA calls "presumptive conditions" -- presumed, that is, to be caused by Agent Orange.
During the war, the U.S. military sprayed an estimated 20 million gallons of the herbicide on the Vietnamese jungle. Afterward, debate raged for years over its health effects as studies found high rates of cancer, nerve disorders and other ailments among veterans. Finally, in 1991, Congress authorized the VA to draw up a list of illnesses and treat them as war wounds; Type II diabetes was added in 2003.
Fiebke assumes he was exposed to Agent Orange; the area around his base camp "was just sprayed down to nothing." But all he needed to show was that he served even one day on Vietnamese soil to qualify.