[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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