[Federal Register Volume 78, Number 176 (Wednesday, September 11, 2013)]
[Proposed Rules]
[Pages 55671-55675]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-22050]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AO78


Hospital Care and Medical Services for Camp Lejeune Veterans

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its 
regulations to implement a statutory mandate that VA provide health 
care to certain veterans who served at Camp Lejeune, North Carolina, 
for at least 30 days during the period beginning on January 1, 1957, 
and ending on December 31, 1987. The law requires VA to furnish 
hospital care and medical services for these veterans for certain 
illnesses and conditions that may be attributed to exposure to toxins 
in the water system at Camp Lejeune. This proposed rule does not 
implement the statutory provision requiring VA to provide health care 
to these veterans' family members; regulations applicable to such 
family members are currently in development and will be promulgated 
through a separate notice.

DATES: Comments must be received on or before October 11, 2013.

ADDRESSES: Written comments may be submitted through http://www.regulations.gov; by mail or hand-delivery to Director, Regulations 
Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Room 1068, Washington, DC

[[Page 55672]]

20420; or by fax to (202) 273-9026. Comments should indicate that they 
are submitted in response to ``RIN 2900-AO78, Hospital Care and Medical 
Services for Camp Lejeune Veterans.'' Copies of comments received will 
be available for public inspection in the Office of Regulation Policy 
and Management, Room 1068, between the hours of 8:00 a.m. and 4:30 p.m. 
Monday through Friday (except holidays). Please call (202) 461-4902 for 
an appointment. (This is not a toll-free number.) In addition, during 
the comment period, comments may be viewed online through the Federal 
Docket Management System at http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Terry Walters, Deputy Chief 
Consultant, Post-Deployment Health, Office of Public Health (10P3A), 
Veterans Health Administration, 810 Vermont Avenue NW., Washington, DC 
20420, (202) 461-1017 (this is not a toll-free number).

SUPPLEMENTARY INFORMATION: On August 6, 2012, the President signed into 
law the Honoring America's Veterans and Caring for Camp Lejeune 
Families Act of 2012, Public Law 112-154 (the Act). Among other things, 
section 102 of the Act amended section 1710 of title 38, United States 
Code (U.S.C.), to require VA to provide hospital care and medical 
services, for certain specified illnesses and conditions, to veterans 
who served at the Marine Corps base at Camp Lejeune, North Carolina 
(hereinafter referred to as Camp Lejeune), while on active duty in the 
Armed Forces for at least 30 days during the period beginning on 
January 1, 1957, and ending on December 31, 1987. This proposed rule 
would implement this statutory requirement by amending existing VA 
regulations and creating a new Sec.  17.400 in title 38, Code of 
Federal Regulations (CFR).
    The purpose of the Act is to ensure that these veterans receive 
care for illnesses and conditions that may have been the result of 
drinking contaminated water while they were stationed at Camp Lejeune. 
From at least 1957 to 1987, drinking-water systems that supplied Camp 
Lejeune were contaminated with industrial chemicals. The contaminated 
wells were shut down in February 1985. The primary chemicals found in 
the drinking water included perchloroethylene, trichloroethylene, 
benzene, and vinyl chloride. The duration and intensity of individuals' 
exposure to contaminated water at Camp Lejeune are unknown and cannot 
be positively determined. The geographic extent of contamination is 
unclear but can be limited based on certain factors that we discuss in 
greater detail below. In a 2009 report created at the request of the 
U.S. Navy, the National Academy of Sciences' National Research Council 
(hereinafter referred to as NAS) issued a study titled, ``Contaminated 
Water Supplies at Camp Lejeune: Assessing Potential Health Effects,'' 
which found that it cannot be determined reliably whether diseases and 
disorders experienced by former residents and workers at Camp Lejeune 
are associated with their exposure to contaminants in the water supply 
because of data shortcomings and methodological limitations, and these 
limitations cannot be overcome with additional study. Therefore, the 
NAS report recommended that policy changes or administrative actions 
should not wait for further studies. NAS, ``Contaminated Water Supplies 
at Camp Lejeune: Assessing Potential Health Effects,'' p. 22, National 
Academies Press (2009) (the NAS report).
    In response to information, including the NAS report, and informed 
by studies conducted by the Centers for Disease Control's Agency for 
Toxic Substance and Disease Registry, Congress established in 38 U.S.C. 
1710(e)(1)(F) that veterans who ``served on active duty in the Armed 
Forces at Camp Lejeune, North Carolina, for not fewer than 30 days 
during the period beginning on January 1, 1957, and ending on December 
31, 1987, [are] eligible for hospital care and medical services'' under 
38 U.S.C. 1710(a)(2)(F) for illnesses and conditions listed in 38 
U.S.C. 1710(e)(1)(F)(i) through (xv). Although this rulemaking proposes 
regulations to implement this statutory requirement, we note that VA is 
currently providing veterans with health care under the statutory 
mandate.
    We also note that a related statutory provision in section 102 of 
the Act codified 38 U.S.C. 1787, which requires VA to furnish health 
care to certain family members of veterans who resided at Camp Lejeune 
during the same time period to the extent and in the amount provided in 
advance in appropriations Acts for this purpose. This proposed rule 
does not implement section 1787, nor does it otherwise address family 
members. The implementation of section 1787 will be the subject of a 
future rulemaking.
    We now discuss each paragraph of the proposed regulation, 38 CFR 
17.400, implementing and interpreting our new authority under 38 U.S.C. 
1710(e)(1)(F).
    In Sec.  17.400(a), we would set forth the general principle, 
discussed above, that VA will provide hospital care and medical 
services to Camp Lejeune veterans. We also would state that VA will 
enroll these veterans in the VA health care system in accordance with 
Sec.  17.36(b)(6). The basis for enrollment under Sec.  17.36(b)(6), 
referred to as ``priority category 6,'' is established as follows. 
Under 38 U.S.C. 1710(a)(2)(F), VA is required to furnish hospital care 
and medical services to a veteran exposed to toxic substances and 
identified in section 1710(e). Section 1710(e)(1)(F) applies to Camp 
Lejeune veterans. 38 U.S.C. 1705 directs VA to establish a patient 
enrollment system, and 38 CFR 17.36(b) implements this authority 
through an enrollment system that establishes eight priority categories 
and directs VA to enroll veterans in accordance with the priorities. 
Priority category 6 applies to veterans who are not covered under 
priority categories 1 through 5 and are ``eligible for hospital care, 
medical services, and nursing home care under [38 U.S.C.] 1710(a)(2).'' 
38 U.S.C. 1705(a)(6). As noted above, section 1710(a)(2)(F) requires 
the provision of hospital care and medical services to veterans who are 
identified in section 1710(e), i.e., Camp Lejeune veterans. Under 
current 38 CFR 17.36(b)(6), these exposed veterans are enrolled in 
priority category 6. Therefore, we would amend Sec.  17.36(b)(6) to 
include Camp Lejeune veterans.
    Under 38 U.S.C. 1710(f) and (g) and 1722A, VA must collect 
copayments from certain veterans for VA-furnished hospital care and 
medical services. VA implements the requirements to assess such 
copayments in 38 CFR 17.108, 17.110, and 17.111. However, veterans 
eligible for hospital care and medical services based on specified 
toxic exposures under section 1710(a)(2)(F) and (e) are not required to 
pay copayments for such health care. VA exempts these veterans from 
copayments in Sec. Sec.  17.108(e), 17.110(c), and 17.111(f). However, 
pursuant to 38 CFR 17.36(d)(3)(iii), for care not related to such 
exposure, these priority category 6 veterans are placed in priority 
category 7 or 8, as applicable, for all other VA hospital care and 
medical services (if the veteran agrees to pay the applicable copayment 
for matters not covered by priority category 6, i.e., treatment for 
illnesses or conditions not related to the exposure that served as the 
veteran's basis for enrollment in priority category 6).
    We would amend current Sec. Sec.  17.108(e)(2), 17.110(c)(4), and 
17.111(f)(5) to reflect that copayment requirements do not apply to 
Camp Lejeune veterans, subject to Sec.  17.400. We note that veterans 
who will be eligible for health care as Camp Lejeune

[[Page 55673]]

veterans, but are already enrolled in priority categories 1-5, would 
not be moved to priority category 6 as a result of this rulemaking 
because under 38 U.S.C. 1705(a), VA is required to enroll veterans in 
the order of the priority categories listed in that section. VA 
implements this requirement in 38 CFR 17.36(d)(3)(ii). In this manner, 
Camp Lejeune veterans enrolled in a higher priority category would not 
lose their enrollment status as a result of this rulemaking.
    In proposed paragraph (b) of Sec.  17.400, we would define Camp 
Lejeune as ``any area within the borders of the U.S. Marine Corps Base 
Camp Lejeune.'' Neither the statute nor the legislative history of 
Public Law 112-154 indicates Congress' intent as to the geographic area 
covered by the reference to ``Camp Lejeune, North Carolina'' in 38 
U.S.C. 1710(e)(1)(F). The NAS report identifies contaminated drinking 
water as the method of exposure most likely to have the potential to 
cause the negative health effects noted in the study as being related 
to the chemical exposure. Because the water systems that supplied water 
to most of the residences and workplaces, in addition to other water 
systems on Camp Lejeune, have tested positive for contamination as 
noted in pages 29 and 67 of the NAS report, the geographic extent of 
Camp Lejeune for the purposes of this rule would include the entirety 
of the U.S. Marine Corps Base. We believe that this would allow VA to 
provide health care to all veterans who may have been exposed to toxic 
substances while at Camp Lejeune. U.S. Marine Corps Base Camp Lejeune 
includes base housing, training sites, and other facilities that would 
likely have exposed veterans who frequented these grounds to any toxic 
water.
    We propose to define a Camp Lejeune veteran in Sec.  17.400(b) as 
``any veteran who served at Camp Lejeune on active duty, as defined in 
38 U.S.C. 101(21), in the Armed Forces for at least 30 (consecutive or 
nonconsecutive) days during the period beginning on January 1, 1957, 
and ending on December 31, 1987.'' This definition aligns with the 
language in section 102 of the Act. We would include both consecutive 
and nonconsecutive days in the calculation of the 30-day requirement to 
clarify that VA will provide treatment to veterans who may have served 
at Camp Lejeune on multiple occasions that total at least 30 days. 
Although section 102 of the Act requires that the veteran served at 
Camp Lejeune for at least 30 days, the Act does not specify whether 
these days must be consecutive. For the purposes of exposure to toxins, 
we are not aware of a scientific or medical justification to interpret 
the law to require that the days be consecutive.
    Veterans would apply for hospital care and medical services as a 
Camp Lejeune veteran in the same manner as any other veteran applies 
for VA health care: They would complete VA Form 10-10EZ, ``Application 
for Health Benefits.'' This is the form used by all veterans to apply 
for hospital care and medical services. See 38 CFR 17.36(d). We would 
amend this form to include a specific box for individuals to identify 
themselves as meeting the requirements of being a Camp Lejeune veteran.
    As explained above, Camp Lejeune veterans, like all other veterans 
in priority category 6, would not be required to pay copayments for VA 
health care provided in connection with one of the 15 illnesses or 
conditions listed in 38 U.S.C. 1710(e)(1)(F)(i) through (xv). In Sec.  
17.400(d)(1), we would clearly state that the veteran would not be 
subject to copayments for care that is clinically associated with a 
condition or illness attributable to the veteran's service at Camp 
Lejeune. In Sec.  17.400(d)(1)(A) through (O), we would restate the 15 
conditions listed in 38 U.S.C. 1710(e)(1)(F)(i) through (xv). Although 
the copayment exemptions are addressed in the copayment regulations 
discussed above, (i.e., 38 CFR 17.108, 17.110, and 17.111) and the 
requirement that such care be for an illness or condition listed in the 
statute is established by section 1710(e)(1)(F), we believe it would be 
helpful and clear to restate these provisions in the regulation 
applicable to Camp Lejeune veterans.
    We note that, under 38 U.S.C. 1710(e)(2)(B), VA may not provide 
hospital care or medical services under 38 U.S.C. 1710(a)(2)(F) to 
veterans who would otherwise be eligible for health care under section 
1710(e) for ``a disability that is found, in accordance with guidelines 
issued by the Under Secretary for Health, to have resulted from a cause 
other than'' service at Camp Lejeune. A diagnosis of whether an 
individual has a specific illness or condition and identification of 
the cause of an illness or condition are clinical determinations. VA 
proposes to satisfy the requirements of the 38 U.S.C. 1710(e)(2)(B) 
limitation by implementing clinical practice guidelines developed by 
VA, as specifically authorized by the statute and referenced in 38 CFR 
17.400(c). In Sec.  17.400(c), we would explain that VA would assume 
that a veteran who has been diagnosed with one of the 15 illnesses or 
conditions listed in Sec.  17.400(d)(1)(A)-(O) has that specific 
condition or illness due to his or her exposure to contaminated water 
during service at Camp Lejeune. However, if VA is able to determine 
clinically, through guidance set forth in clinical practice guidelines 
developed for the conditions and illnesses listed in this rule, that 
the illness or condition resulted from a cause other than exposure to 
contaminants at Camp Lejeune, then any treatment for that condition 
would remain subject to the copayments. We would develop these clinical 
practice guidelines over time, as VA subject matter experts build 
expertise in treating Camp Lejeune veterans. VA has been providing 
health care to Camp Lejeune veterans since the signing of the Act and 
has been developing clinical best practices for the provision of health 
care to Camp Lejeune veterans. VA would use this expertise, scientific 
evidence, and recognized standards of clinical practice in developing 
the clinical practice guidelines, and we expect that these guidelines 
will continue to develop as we gain further insight and knowledge about 
the connection between the exposures at Camp Lejeune and the 15 
illnesses and conditions set forth in the law.
    Section 17.400(d)(2) establishes that VA would retroactively 
reimburse certain copayments made by Camp Lejeune veterans for VA-
provided health care. VA generally provides copayment exemptions to 
priority category 6 veterans for copayments as of the date they are 
assigned to that priority category, even if the veteran was previously 
enrolled in a lower priority category. However, because Camp Lejeune 
veteran status came into existence on August 6, 2012, we would consider 
them to be exempt from copayments as of that date only if they seek 
status as a Camp Lejeune veteran no later than September 11, 2015. We 
believe that 2 years would provide veterans sufficient time to learn 
about the new status and notify VA that they meet the requirements to 
be a Camp Lejeune veteran.
    Since the Act was signed into law on August 6, 2012, this is the 
earliest date for which VA is authorized to reimburse any copayments 
previously charged to Camp Lejeune veterans pursuant to this 
regulation.

Effect of Rulemaking

    The Code of Federal Regulations, as proposed to be revised by this 
proposed rulemaking, would represent the exclusive legal authority on 
this subject. No contrary rules or procedures would be authorized. All 
VA guidance would be read to conform with this proposed rulemaking if 
possible or, if not

[[Page 55674]]

possible, such guidance would be superseded by this rulemaking.

Administrative Procedure Act

    In accordance with 5 U.S.C. 553(b)(B), the Secretary of Veterans 
Affairs finds good cause to issue this proposed rule with prior notice 
and an abbreviated opportunity for public comment. This proposed rule 
is necessary to provide clarity regarding VA's duty to provide health 
care to veterans who may have been exposed to toxic substances due to 
their service at Camp Lejeune. Section 102 of Public Law 112-154 
requires VA to provide hospital care and medical services to Camp 
Lejeune veterans for the listed conditions and illnesses as of August 
6, 2012. Many of the 15 listed conditions or illnesses are life-
threatening and require immediate medical care. VA is capable of 
treating Camp Lejeune veterans for such illnesses or conditions 
immediately, which may lead to improved health outcomes for many 
veterans. However, this proposed rule is necessary to provide VA with 
the necessary framework to immediately implement this statutory 
requirement.
    This proposed rule clearly defines how VA proposes to identify and 
integrate Camp Lejeune veterans into its enrollment system so VA can 
provide necessary health care to these veterans. For example, Public 
Law 112-154 requires VA to provide hospital care and medical services 
to ``a veteran who served on active duty in the Armed Forces at Camp 
Lejeune, North Carolina, for not fewer than 30 days during the period 
beginning on January 1, 1957, and ending on December 31, 1987.'' The 
legislation, however, does not define the scope of who should be 
considered a Camp Lejeune veteran. This rule at Sec.  17.400(b) in the 
definition for ``Camp Lejeune veteran'' would explain that ``[a] 
veteran served at Camp Lejeune if he or she was stationed at Camp 
Lejeune, or if his or her professional duties required travel to Camp 
Lejeune.'' The proposed rule also explains that the 30-day minimum 
service requirement may be ``consecutive or nonconsecutive'' days. 
Without this provision, VA would not be able to clearly identify all 
the veterans who should be provided the necessary health care as a 
result of their service at Camp Lejeune. With these provisions VA will 
be able to identify those individuals who should be considered Camp 
Lejeune veterans and conduct outreach to the identified class of 
veterans. Although we expect most Camp Lejeune veterans to seek VA 
medical care for treatment of their illness or condition regardless of 
this rulemaking, there may be some veterans who may go without 
treatment if they are not identified as a Camp Lejeune veteran, and 
their illness or condition does not result in eligibility for 
enrollment. Because many of the 15 listed conditions or illnesses are 
life-threatening and require immediate medical care, an abbreviated 
comment period is necessary and appropriate to allow VA to provide 
medical care to all individuals identified as Camp Lejeune veterans as 
soon as possible.
    Furthermore, under the provisions of the proposed rule, VA would be 
able to reimburse veterans for copayments that certain veterans may 
already have paid for illnesses or conditions identified in this rule. 
The shorter comment period will allow VA to proceed more quickly to a 
final rule stage and provide VA with the ability to reimburse 
unnecessary copayments to alleviate this financial hardship for some of 
these veterans.
    For these reasons, the Secretary has concluded that a longer public 
comment period is unnecessary and contrary to the public interest. 
Accordingly, VA is issuing this proposed rule with an abbreviated 
comment period. VA will consider and address all comments that are 
received within 30 days of the date this proposed rule is published in 
the Federal Register.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before issuing any rule that may result in the expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any one year. This proposed rule would have no such 
effect on State, local, and tribal governments, or on the private 
sector.

Paperwork Reduction Act

    This proposed rule contains no new provisions constituting a 
collection of information under the Paperwork Reduction Act of 1995 (44 
U.S.C. 3501-3521). However, we note that veterans would apply for 
hospital care and medical services as a Camp Lejeune veteran under 
Sec.  17.400 by completing VA Form 10-10EZ, ``Application for Health 
Benefits,'' which is required under 38 CFR 17.36(d) for all hospital 
care and medical services. As discussed in a separate notice (78 FR 
39832, July 2, 2013), we are amending this form, which will include a 
specific box for individuals to check to identify themselves as meeting 
the requirements of being a Camp Lejeune veteran. This particular 
amendment to the form will have no appreciable effect on the reporting 
burden for the revised VA Form 10-10EZ. We also do not anticipate a 
significant increase in the total number of applications filed because 
most Camp Lejeune veterans likely would have applied for VA medical 
care for treatment of their illness or condition regardless of this 
rulemaking.

Regulatory Flexibility Act

    The Secretary hereby certifies that this proposed rule would not 
have a significant economic impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act, 5 
U.S.C. 601-12. This proposed rule would directly affect only 
individuals and would not affect any small entities. Therefore, 
pursuant to 5 U.S.C. 605(b), this proposed rulemaking is exempt from 
the initial and final flexibility analysis requirements of 5 U.S.C. 603 
and 604.

Executive Order 12866 and Executive Order 13563

    Executive Orders 12866 and 13563 direct agencies to assess the 
costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health, and safety effects, and other advantages; distributive impacts; 
and equity). Executive Order 13563 (Improving Regulation and Regulatory 
Review) emphasizes the importance of quantifying both costs and 
benefits, reducing costs, harmonizing rules, and promoting flexibility. 
Executive Order 12866 (Regulatory Planning and Review) defines a 
``significant regulatory action,'' requiring review by the Office of 
Management and Budget (OMB) as ``any regulatory action that is likely 
to result in a rule that may: (1) Have an annual effect on the economy 
of $100 million or more or adversely affect in a material way the 
economy, a sector of the economy, productivity, competition, jobs, the 
environment, public health or safety, or State, local, or tribal 
governments or communities; (2) Create a serious inconsistency or 
otherwise interfere with an action taken or planned by another agency; 
(3) Materially alter the budgetary impact of entitlements, grants, user 
fees, or loan programs or the rights and obligations of recipients 
thereof; or (4) Raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or

[[Page 55675]]

the principles set forth in this Executive Order.''
    VA has examined the economic, interagency, budgetary, legal, and 
policy implications of this regulatory action, and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866. VA's impact analysis can be found as a supporting document 
at http://www.regulations.gov, usually within 48 hours after the 
rulemaking document is published. Additionally, a copy of the 
rulemaking and its impact analysis are available on VA's Web site at 
http://www1.va.gov/orpm/, by following the link for ``VA Regulations 
Published.''

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this rule are 64.007, Blind Rehabilitation 
Centers; 64.008, Veterans Domiciliary Care; 64.009, Veterans Medical 
Care Benefits; 64.010, Veterans Nursing Home Care; 64.012, Veterans 
Prescription Service; 64.013, Veterans Prosthetic Appliances; 64.014, 
Veterans State Domiciliary Care; 64.015, Veterans State Nursing Home 
Care; and 64.022, Veterans Home Based Primary Care.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Jose D. 
Riojas, Chief of Staff, Department of Veterans Affairs, approved this 
document on July 31, 2013, for publication.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Health care, Health 
facilities, Health professions, Health records, Homeless, Medical 
devices, Medical research, Mental health programs, Nursing homes, and 
Veterans.

    Dated: September 5, 2013.
Robert C. McFetridge,
Director, Regulation Policy and Management, Office of the General 
Counsel, Department of Veterans Affairs.

    For the reasons set forth in the preamble, we propose to amend 38 
CFR part 17 as follows:

PART 17--MEDICAL

0
1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501, and as noted in specific sections.

0
2. Amend Sec.  17.36(b)(6) by removing ``38 U.S.C. 1710(e);'' and 
adding, in its place, ``38 U.S.C. 1710(e); Camp Lejeune veterans 
pursuant to Sec.  17.400;''.
0
3. Amend Sec.  17.108(e)(2) by removing ``or post-Gulf War combat-
exposed veterans'' and adding, in its place, ``post-Gulf War combat-
exposed veterans, or Camp Lejeune veterans pursuant to Sec.  17.400.''
0
4. Amend Sec.  17.110(c)(4) by removing ``or post-Persian Gulf War 
combat-exposed veterans'' and adding, in its place, ``post-Persian Gulf 
War combat-exposed veterans, or Camp Lejeune veterans pursuant to Sec.  
17.400.''
0
5. Amend Sec.  17.111(f)(5) by removing ``or post-Persian Gulf War 
combat-exposed veterans'' and adding, in its place, ``post-Persian Gulf 
War combat-exposed veterans, or Camp Lejeune veterans pursuant to Sec.  
17.400.''
0
6. Add Sec.  17.400 to read as follows:


Sec.  17.400  Hospital care and medical services for Camp Lejeune 
veterans.

    (a) General. In accordance with this section, VA will provide 
hospital care and medical services to Camp Lejeune veterans. Camp 
Lejeune veterans will be enrolled pursuant to Sec.  17.36(b)(6).
    (b) Definitions. For the purposes of this section:
    Camp Lejeune means any area within the borders of the U.S. Marine 
Corps Base Camp Lejeune or Marine Corps Air Station New River, North 
Carolina.
    Camp Lejeune veteran means any veteran who served at Camp Lejeune 
on active duty, as defined in 38 U.S.C. 101(21), in the Armed Forces 
for at least 30 (consecutive or nonconsecutive) days during the period 
beginning on January 1, 1957, and ending on December 31, 1987. A 
veteran served at Camp Lejeune if he or she was stationed at Camp 
Lejeune, or traveled to Camp Lejeune as part of his or her professional 
duties.
    (c) Limitations. For a Camp Lejeune veteran, VA will assume that 
illnesses or conditions listed in paragraph (d)(1)(A) through (O) of 
this section are attributable to the veteran's active duty in the Armed 
Forces unless it is clinically determined, under VA clinical practice 
guidelines, that such an illness or condition is not attributable to 
the veteran's service.
    (d) Copayments. (1) Exemption. Camp Lejeune veterans are not 
subject to copayment requirements for hospital care and medical 
services provided on or after August 6, 2012, for the following 
illnesses and conditions:
    (A) Esophageal cancer;
    (B) Lung cancer;
    (C) Breast cancer;
    (D) Bladder cancer;
    (E) Kidney cancer;
    (F) Leukemia;
    (G) Multiple myeloma;
    (H) Myleodysplasic syndromes;
    (I) Renal toxicity;
    (J) Hepatic steatosis;
    (K) Female infertility;
    (L) Miscarriage;
    (M) Scleroderma;
    (N) Neurobehavioral effects; and
    (O) Non-Hodgkin's Lymphoma.
    (2) Retroactive Exemption. VA will reimburse Camp Lejeune veterans 
for any copayments paid to VA for hospital care and medical services 
provided for one of the illnesses or conditions listed in paragraph 
(d)(1) of this section, if the following are true:
    (A) The veteran requested Camp Lejeune veteran status no later than 
September 11, 2015; and
    (B) VA provided the hospital care or medical services to the Camp 
Lejeune veteran on or after August 6, 2012.


(Authority: 38 U.S.C. 1710)


[FR Doc. 2013-22050 Filed 9-10-13; 8:45 am]
BILLING CODE 8320-01-P