[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]
BILLING CODE 8320-01-M