A hard way to die: why hundreds of thousands of Vietnam vets with Agent Orange-related diseases have been made to suffer without VA health care.

• Author: Longman, Phillip
• Position: A SPECIAL REPORT

Gary Nickel, 62, never liked to talk about his experiences in Vietnam. It's only recently that his wife, Terry, has gotten some details out of him about why he's started screaming in his sleep and locking his hands together as if he were choking someone. He's finally told her, for example, about the time when, at the giant Bien Hoa Air Base, twenty miles northeast of Saigon, a plane landed and all the men jumped off puking. Nickel, whose job was to load and unload aircraft, discovered inside the rotting head of a U.S. soldier stuck on a post.

Gary told her, too, about his flashbacks to the many times during the Tet Offensive when he shook in bunkers while under mortar attack. After much objection about "not wanting to be pegged" with a mental illness, Gary at last relented to his wife's insistence that he seek treatment for post-traumatic stress disorder, and now takes medication for it prescribed by private physician. But that's not his greatest medical need. Gary also suffers from Parkinson's disease, a degenerative brain disorder that impairs motor and cognitive skills. Parkinson's is most often found among the elderly, but Gary was only fifty-seven when he was first diagnosed, and he degenerated quickly.

Within two years of his diagnosis, he had to give up his job at the water treatment plant in Moorhead, Minnesota, and Terry had to give up her job as a nurse to stay with him around the dock. (The couple have no children.) Forced to live on a reduced income, including a $450-a-month Social Security disability check, they sold their home and bought a smaller, easier-to-navigate house furnished with a hospital bed, a trapeze, and special pillows to help with Gary's bedsores. Terry is also responsible these days for looking after her eighty-year-old mother, who now lives with them.

This might be just another sad story of another working-class American family struggling with poor luck and bad health, except that it gets worse in ways that involve us all. Terry thought it very important that she get her husband enrolled at the VA Medical Center in nearby Fargo, North Dakota, which would provide, among other benefits, equipment like the ramps he needs and, importantly, respite care for herself. She knew that at their income level the couple wouldn't meet the VA's strict means test for admission. But she'd been reading about growing scientific evidence linking Parkinson's disease to exposure to Agent Orange, a chemical defoliant widely used in Vietnam during the war. And, as it happens, the Bien Hoa base was and remains an Agent Orange "hot spot" in Vietnam--so much so that the U.S. government committed in 2008 to helping the Vietnamese government clean up the high levels of dioxins and other contaminants that still exist there. So in 2007 Terry applied for her husband to be admitted to the VA on the premise that his Parkinson's was a "service-connected" illness.

The bureaucracy at the Fargo VA, however, was unmoved. Fourteen months after making their application, the Nickels received a single-spaced, two-and-a-quarter-page letter, dated July 7, 2008, that spelled out the VA's rationale for rejecting Gary's enrollment. The case officer acknowledged finding a study on Wikipedia that showed that people exposed to herbicides like Agent Orange have "a 70...