[Federal Register Volume 89, Number 83 (Monday, April 29, 2024)]
[Notices]
[Pages 33471-33472]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-09164]


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DEPARTMENT OF VETERANS AFFAIRS


Response To Comments for The Department of Veterans Affairs To 
Assess the Scientific Literature and Claims Data Regarding Certain 
Medical Conditions Associated With Military Environmental Exposures

AGENCY: Department of Veterans Affairs.

ACTION: Response to comments.

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SUMMARY: On July 26, 2023, the Department of Veterans Affairs (VA) 
published a notice soliciting public comment on its plan to assess the 
scientific literature and historical claims data regarding certain 
medical conditions (multiple myeloma, acute leukemias, and chronic 
leukemias) associated with military environmental exposures. On October 
24, 2023, VA published a second notice announcing its intent to host a 
virtual public listening session on this topic on November 7, 2023. 
This third notice provides responses to the public comments received 
during the open comment period and public listening session.

FOR FURTHER INFORMATION CONTACT: Peter Rumm, MD, Director of Policy, 
Health Outcomes Military Exposures, Veterans Health Administration, 
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 
20420, 202-461-7297. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: VA provided a 30-day comment period, which 
ended on August 25, 2023. Individuals or organizations submitted 26 
comments to this first Federal Register Notice (FRN). Participation in 
the public listening session included 12 comments presented by speakers 
and 13 comments submitted using the chat feature during the meeting. 
The Veterans Health Administration's (VHA's) HOME Program Office 
received and responded to 357 emails from Veterans and made 8 telephone 
calls to address individual Veterans' potential military environmental 
exposure concerns for those who were unable to speak during the 
listening session due to time constraints.
    Overall, comments supported VA's plan to assess the scientific 
literature and historical claims data regarding multiple myeloma, acute 
leukemias, and chronic leukemia associated with military environmental 
exposures although some discussed additional concerns. The 26 formal 
comments received during the 30-day comment period on the first FRN 
were grouped into 3 main categories, with some comments falling into 
more than one category:
     Category 1--Comments directly related to multiple myeloma, 
acute leukemias, and chronic leukemia: 18 out of 26 (69%). Notably, of 
the 18, 17 out of 18 (94%) of these comments expressed support for VA's 
plan to assess the scientific literature and historical claims data 
regarding certain medical conditions (multiple myeloma, acute 
leukemias, and chronic leukemias) associated with military 
environmental exposures.
    [cir] More comments were received specifically supportive of 
multiple myeloma versus the leukemias.
    [cir] There was only 1 non-supportive comment out of 18 (under 6%).
     Category 2--Comments pertaining to additional locations: 8 
out of 26 (31%) comments suggested VA consider presumptions for 
locations outside Gulf War and southwest Asia locations that are 
covered by the Sergeant First Class Heath Robinson Honoring our Promise 
to Address Comprehensive Toxics (PACT) Act.
     Category 3--Comments pertaining to additional conditions: 
7 out of 26 (27%) comments suggested various conditions for future 
review.
    VA thanks the commenters and attendees for their support and 
comments. To expand upon the comments in more detail, participants 
suggested that VA include additional conditions (e.g., neurologic 
conditions, sleep apnea, hypertension, chronic multi-symptom illness, 
and immune disorders) to be considered for association with exposure 
from burn pits and other toxic substances (e.g.,

[[Page 33472]]

benzene, formaldehyde, dioxin, and heavy metals) present on post-9/11 
deployments in addition to the PACT Act established categories of 
presumptive conditions. Other deployments, including burn pits or other 
toxins in Vietnam (see also below) were mentioned. Commenters also 
noted a preference for additional locations (e.g., Naval Air Facility 
Atsugi, Japan, Vietnam, Haiti, Honduras, Panama, and Bosnia) to be 
considered for toxic exposure, as well as various military bases or 
garrisons. Finally, some participants expressed a desire for more 
public input into the VA decision-making process.
    Senior VA leadership attended the November 7, 2023, WEBEX virtual 
public listening session. After Mr. Josh Jacobs, Under Secretary for 
Benefits (USB), provided opening remarks, Dr. Patricia Hastings, Chief 
Consultant HOME, delivered a presentation on the revised presumptive 
decision process. Twelve representatives from Veterans Service 
Organizations, academia, and the Veteran community expressed their 
views and comments during the session. In addition to the 12 speakers, 
the chat feature within WEBEX recorded an additional 13 comments. Dr. 
Shereef Elnahal, Under Secretary for Health (USH), provided closing 
remarks and emphasized VA and Congress' interest in responding to the 
public's instructive and important comments. USB Jacobs and USH Elnahal 
expressed appreciation for the public's participation in this process.
    The listening session allowed VA to be proactive in its approach to 
improve care, treatment, and benefits for toxic-exposed Veterans, and 
consider areas of public interest regarding current or planned research 
of potential presumptive conditions. During the listening session, most 
comments fell into the additional location and conditions categories. 
Several comments supported future study and potential recognition of 
sleep apnea as a presumptive condition. Listeners were assured that 
additional locations and conditions are continuously monitored and may 
be presented for a formal review in the future. HOME and Veterans 
Benefits Administration (VBA) Military Exposures Team staff members 
communicated with participants who raised specific questions during the 
session.
    VBA's compensation disability evaluation and rating system is 
complex, as is the arena of military environmental exposures. Some 
comments indicated misunderstandings of the VA's benefits system and 
decision-making process. Additional evidence of misunderstandings 
regarding VHA in areas such as the impact of vaccines and chemical 
exposures were also expressed. To limit misunderstanding, VBA and VHA 
are expanding outreach efforts each year to enhance understanding of 
Veteran health and benefits systems.

Moving Forward

    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 is ongoing. VA's involvement in surveillance, 
monitoring, and research covers a wide variety of areas. When a 
scientific review concludes that there is a statistically significant 
signal or possible association between military environment exposure 
and health outcomes, this may trigger an investigation that may lead to 
additional research or may be subject to an FRN and comment process 
required under section 202 of the PACT Act. Additional notices of this 
type will be published as VA reviews conditions and their possible 
association with military environmental exposures to provide health 
care, services, and benefits to Veterans entitled to them. VA has 
considered the issues presented by commenters and decided to conduct a 
scientific review of multiple myeloma and chronic and acute leukemias, 
taking into account the latest scientific classification schemes for 
blood cancers and scientific evidence regarding shared etiologies. VA 
will follow the procedures in 38 U.S.C. 1172-1174 for initiating and 
conducting assessments and formal evaluations. VA has designated a 
Technical Working Group (TWG) to assess cases of the toxic exposure of 
Veterans and their dependents pursuant to 38 U.S.C. 1172(c). 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 begins, a 
recommendation to establish or modify a presumption of service 
connection must be submitted to the Secretary within 120 days per 38 
U.S.C. 1173(d). Within 160 days of receiving the recommendation to 
establish or modify a presumption of service connection, the Secretary 
must determine whether a presumption is warranted per 38 U.S.C. 
1174(a). This may include commencing rulemaking to establish or modify 
presumptions for some or all of the conditions formally evaluated and/
or publishing notice in the FRN of any determination that establishment 
or modification of a presumption or presumptions are unwarranted for 
some or all of the conditions that were subject to the formal 
evaluation.

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved and signed 
this document on April 17, 2024, 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. 2024-09164 Filed 4-26-24; 8:45 am]
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