[Federal Register Volume 59, Number 132 (Tuesday, July 12, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-16624]
[[Page Unknown]]
[Federal Register: July 12, 1994]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 3
RIN 2900-AG76
Diseases Specific as to Former Prisoners of War
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: This document amends Department of Veterans Affairs (VA)
adjudication regulations concerning diseases subject to presumptive
service connection in former prisoners of war by stating that the
statutory term ``beriberi heart disease'' includes ischemic heart
disease in former prisoners of war who had experienced localized edema
during captivity. The effect of this amendment is to broaden VA's
interpretation of that term based upon new epidemiological evidence.
EFFECTIVE DATE: August 24, 1993.
FOR FURTHER INFORMATION CONTACT: Donald England, Chief, Regulations
Staff, Compensation and Pension Service, Veterans Benefits
Administration, (202) 233-3005.
SUPPLEMENTARY INFORMATION: In 1970, Congress passed Public Law 91-376,
Sec. 3, 84 Stat. 787, 788 (1970), which established a presumption of
service connection for seven categories of diseases and conditions,
including ``beriberi (including beriberi heart disease),'' developing
to a ten-percent degree of disability at any time after active service
in the case of a veteran held as a prisoner of war in World War II, the
Korean Conflict, or the Vietnam War who suffered from dietary
deficiencies, forced labor, or inhumane treatment in violation of the
Geneva Conventions. The intent of Congress was to recognize diseases
suffered by former prisoners of war during captivity for which there is
no medical documentation.
Concern remained, however, as to the problems encountered by these
veterans in their efforts to prove service connection for disabilities
attributable to the conditions of their capture and imprisonment. Some
claimed that their ability to prove service connection for disabilities
was hampered because there are inadequate medical records and that
certain disabilities which were considered to be minor at the time of
release from service were becoming more serious. Congress therefore
enacted the Former Prisoner of War Benefits Act of 1981, Public Law 97-
37, 95 Stat. 935, which eliminated the requirement that former
prisoners of war must have suffered from dietary deficiencies, forced
labor, or inhumane treatment during confinement in order to qualify for
the presumption of service connection.
Beriberi is a disease caused by a deficiency of thiamine (vitamin
B1). Early thiamine deficiency is characterized by anorexia,
irritability, and weight loss. Later, patients experience weakness,
peripheral neuropathy, headache, and tachycardia. Advanced thiamine
deficiency presents with involvement of two major organ systems
predominantly: the cardiovascular system (the syndrome known as ``wet
beriberi,'' i.e., beriberi heart disease) and the nervous system, both
central and peripheral (known as ``dry beriberi''). Cecil Textbook of
Medicine 1171 (James B. Wyngaarden, M.D., Lloyd H. Smith, Jr., M.D., J.
Claude Bennett, M.D., ed., 1992).
In 1992, the Medical Follow-up Agency of the Institute of Medicine,
National Academy of Sciences, issued a study entitled ``The Health of
Former Prisoners of War'' which reported the results of a medical
examination survey of former World War II and Korean Conflict POWs and
comparable control groups. That study found what it termed a noteworthy
association between ischemic heart disease and earlier reporting of
localized edema of feet, ankles and legs--presumably due to beriberi
heart disease (wet beriberi)--while in captivity. While there is no
known satisfactory explanatory biological mechanism linking beriberi or
malnutrition and subsequent chronic heart disease, the examination data
from the current study provides epidemiological evidence to suggest
there is a connection between conditions during captivity and the later
development of ischemic heart disease. According to the study, the
reporting of edema in prison camp indicates a specific nutritional
deficiency, beriberi, and the location of edema in the feet, ankles and
legs is presumably related to beriberi heart disease in prison camp
which is caused by thiamine deficiency.
After reviewing this study the Secretary has determined, in keeping
with the intent of Congress to provide a presumption of service
connection for former prisoners of war who have diseases which result
from dietary inadequacies or unsanitary conditions and for which
service connection may be difficult to establish, that the term
beriberi heart disease found at 38 U.S.C. 1112(b)(2) includes ischemic
heart disease if the former prisoner of war suffered localized edema
during captivity. We have amended 38 CFR 3.309(c) accordingly.
This amendment is effective August 24, 1993, the date of the
Secretary's decision. Since this amendment is an interpretation of
existing law, publication as a proposal is not required and the
amendment is being issued as a final rule.
Because no notice of proposed rulemaking is required in connection
with the adoption of this final rule, no regulatory flexibility
analysis is required under the Regulatory Flexibility Act (5 U.S.C. et
seq.). Further, the rule will not directly affect any small entities;
only VA beneficiaries could be directly affected.
This regulatory amendment has been reviewed by the Office of
Management and Budget under the provisions of Executive Order 12866 of
September 30, 1993, entitled Regulatory Planning and Review.
The Catalog of Federal Domestic Assistance program numbers are
64.109 and 64.110.
List of Subjects in 38 CFR Part 3
Administrative practice and procedure, Claims, Health care,
Individuals with disabilities, Pensions, Veterans.
Approved June 27, 1994.
Jesse Brown,
Secretary of Veterans Affairs.
For the reasons set out in the preamble, 38 CFR part 3 is amended
as set forth below:
PART 3--ADJUDICATION
Subpart A--Pension, Compensation, and Dependency and Indemnity
Compensation
1. The authority citation for part 3, subpart A, continues to read
as follows:
Authority: 38 U.S.C. 501(a), unless otherwise noted.
Sec. 3.309 [Amended]
2. In Sec. 3.309(c), add a note at the end of the paragraph
preceding the authority citation to read as follows:
Note: For purposes of this section, the term beriberi heart
disease includes ischemic heart disease in a former prisoner of war
who had experienced localized edema during captivity.
[FR Doc. 94-16624 Filed 7-11-94; 8:45 am]
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