[Federal Register Volume 88, Number 142 (Wednesday, July 26, 2023)]
[Notices]
[Pages 48291-48292]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-15624]


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DEPARTMENT OF VETERANS AFFAIRS


Notice of Plans for the Department of Veterans Affairs To Assess 
the Current Scientific Literature and Historical Detailed Claims Data 
Regarding Certain Medical Conditions Associated With Military 
Environmental Exposures and To Solicit Public Comment

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Department of Veterans Affairs (VA) announces its plan to 
assess the scientific literature and historical claims data regarding 
certain medical conditions associated with military environmental 
exposures. This assessment will consider the possibility of a 
relationship between the following medical conditions--acute leukemias, 
chronic leukemias and multiple myeloma--and exposure to fine 
particulate matter (PM2.5) from airborne hazards and open 
burn pits for service members who were deployed in the Southwest Asia 
theater of operations, Somalia, Afghanistan, Djibouti, Egypt, Jordan, 
Lebanon, Syria, Yemen, and Uzbekistan. Multiple myeloma, when it 
originates in the head or neck, is considered a presumptive condition 
pursuant to the PACT Act. However, cases of multiple myeloma 
originating outside of the head and neck have not yet been evaluated 
for association with exposure to PM2.5 from airborne hazards 
and open burn pits in the Southwest Asia theater of operations, 
Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, 
and Uzbekistan. Additionally, a scientific review of acute leukemias, 
chronic leukemias, and multiple myeloma and exposure to 
PM2.5 and its associated chemical composition from airborne 
hazards and open burn pits in the Southwest Asia theater of operations, 
Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, 
and Uzbekistan would provide an opportunity to review an organ system 
(blood) not included in the PACT Act. VA solicits public comment on the 
importance of completing this assessment of scientific literature and 
historical claims data for these conditions or others. Once the 
conclusions of this scientific assessment have been peer reviewed, they 
may be used to inform decisions regarding veteran's qualifying period 
of service, such as those who served on active military, naval, or air 
service in the Southwest Asia theater of operations during the Persian 
Gulf War, as well as Somalia, Afghanistan, Djibouti, Egypt, Jordan, 
Lebanon, Syria, Yemen, or Uzbekistan from September 11, 2001, until the 
present time.

DATES: Comments must be received on or before August 25, 2023.

ADDRESSES: Comments must be submitted through www.regulations.gov. 
Except as provided below, comments received before the close of the 
comment period will be available at www.regulations.gov for public 
viewing, inspection, or copying, including any personally identifiable 
or confidential business information that is included in a comment. We 
post the comments received before the close of the comment period on 
the following website as soon as possible after they have been 
received: http://www.regulations.gov. VA will not post on 
Regulations.gov public comments that make threats to individuals or 
institutions or suggest that the commenter will take actions to harm 
the individual. VA encourages individuals not to submit duplicative 
comments. We will post acceptable comments from multiple unique 
commenters even if the content is identical or nearly identical to 
other comments. Any public comment received after the comment period's 
closing date is considered late and will not be considered in any 
potential future rulemaking.

FOR FURTHER INFORMATION CONTACT: Health Outcomes Military Exposures, 
Director of Policy, Peter D. Rumm, MD, Master of Public Health, at 202-
461-7297.

SUPPLEMENTARY INFORMATION: In accordance with 38 U.S.C. 1172, as 
created by section 202 of the Sergeant First Class Heath Robinson 
Honoring our Promise to Address Comprehensive Toxics Act of 2022 (also 
known as the PACT Act), VA is publishing this notice about its planned 
scientific assessment of the possibility of a relationship between the 
following medical conditions--acute leukemias, chronic leukemias and 
multiple myeloma outside of the head and neck--and exposure to 
PM2.5 from airborne hazards and open burn pits in the 
Southwest Asia theater of operations, Somalia, Afghanistan, Djibouti, 
Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan. VA is also 
soliciting public comment about other conditions that would benefit 
from review of the possible association, the conditions, and health 
outcomes related to them.
    The rationale for the selection of acute leukemias, chronic 
leukemias, and multiple myeloma outside of the head and neck is based 
on their biological properties that may suggest correlation between 
these diseases and the described exposures. Lymphomas already are 
included in the PACT Act, and leukemias. Leukemias and multiple myeloma 
represent the remaining types of cancer of blood forming tissues. The 
latest classifications of these cancer types recognize that some 
leukemias and lymphomas are different forms of the same disease, as 
chronic lymphocytic leukemia and small lymphocytic lymphoma. The bone 
marrow can be sensitive to the toxicity of specific chemicals including 
waste that may have been disposed of in open burn pits, including, 
among others, arsenic, lead, and mercury. Acute leukemias, chronic 
leukemias, and multiple myeloma outside of the head and neck have not 
been previously evaluated for association with exposure to 
PM2.5 from airborne hazards and open burn pits in the 
Southwest Asia theater of operations, Somalia, Afghanistan, Djibouti, 
Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan.
    VA continues to review and assess information about military 
environmental exposure incidents, emerging scientific evidence 
regarding toxic substances, and health outcomes in deployed and non-
deployed cohorts. Additionally, active epidemiological surveillance and 
ongoing monitoring of military exposures in collaboration with the 
Department of Defense continues. VA's involvement in surveillance, 
monitoring, and research covers a wide variety of areas from garrison 
specific, such as Karshi Khanabad (K-2) Air Base, to exposure specific, 
such as perfluoroalkyl and polyfluoroalkyl substances, to military 
occupation specific, such as missileers. Additional information is 
available at Military Exposures--Public Health (va.gov). When the 
scientific review concludes that there is a statistically significant 
signal or possible association of military environment exposure and 
health outcomes, this may trigger an investigation that may lead to 
additional research or may be subject to a Federal Register notice and 
comment process required under section 202 of the PACT Act. Additional 
notices of this type will be published as VA moves forward in the 
review of conditions and their possible association with military

[[Page 48292]]

environmental exposures for the purposes of providing health care, 
services, and benefits to veterans entitled to them.
    After reviewing comments received in response to this notice, VA 
will conduct the scientific review of the specified conditions, taking 
into account the latest scientific classification schemes for blood 
cancers and scientific evidence regarding shared etiologies, and will 
consider whether to conduct scientific reviews of any other conditions 
in response to the comments received, as appropriate. VA will then 
follow the procedures in 38 U.S.C. 1172-1174 for initiating and 
conducting assessments and formal evaluations. If appropriate, the VA 
will designate a Technical Working Group (TWG) to conduct an assessment 
pursuant to 38 U.S.C. 1172(c), and the TWG may develop a recommendation 
for formal evaluation under 38 U.S.C. 1173, pursuant to 38 U.S.C. 
1172(d). Once a formal evaluation is commenced, a recommendation with 
respect to establishing a presumption of service connection must be 
submitted to the Secretary within 120 days, in accordance with 38 
U.S.C. 1173(d). And within 160 days of receiving the recommendation 
with respect to establishing a presumption of service connection, the 
Secretary must determine whether a presumption is warranted in 
accordance with 38 U.S.C. 1174(a). This may include commencing 
rulemaking to establish new presumptions for some or all of the 
conditions formally evaluated and/or publishing notice in the Federal 
Register of any determination that a presumption or presumptions are 
unwarranted for some or all of the conditions that were subject of the 
formal evaluation.

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved and signed 
this document on July 19, 2023, 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.

Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2023-15624 Filed 7-25-23; 8:45 am]
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