[Federal Register Volume 90, Number 241 (Thursday, December 18, 2025)]
[Notices]
[Pages 59325-59326]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-23311]
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DEPARTMENT OF VETERANS AFFAIRS
[Docket No. VA-2025-VACO-0002]
Response to Comments for the Department of Veterans Affairs to
Assess the Current Scientific Literature and Historical Detailed Claims
Data Regarding Exposure to Per- and Polyfluoroalkyl Substances (PFAS)
and Kidney Cancer
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: On September 26, 2024, the Department of Veterans Affairs (VA)
solicited public comments on VA's plan to assess the current scientific
literature and historical claims data regarding exposure to Per- and
polyfluoroalkyl substances (PFAS) and kidney cancer. The notice
provided an opportunity for veterans, caregivers, survivors, and the
public to share relevant information with VA to inform decisions
regarding presumptive benefits that could impact veterans who may have
experienced environmental and/or occupational exposures to PFAS during
military service. Additionally, VA held a virtual public listening
session on November 19, 2024, for the public to provide feedback on the
planned assessment. This notice provides VA's responses to comments
received from the public.
FOR FURTHER INFORMATION CONTACT: Erin Dursa, Ph.D., MPH, Director of
Surveillance Military Environmental Exposures, Health Outcomes Military
Exposures, Veterans Health Administration, (202) 461-7297.
SUPPLEMENTARY INFORMATION: On September 26, 2024, VA published a notice
in the Federal Register to inform the public that it had plans to
assess the relationship between exposure to PFAS and kidney cancer. 89
FR 78986. VA received 42 comments from veterans, family members,
Veterans Service Organizations (VSOs), and other members of the public
in response to the notice. Overall, comments supported VA's plan to
assess the scientific literature and historical claims data to
determine whether there is an association between PFAS and kidney
cancer.
Thirty-six comments were positive and/or in agreement with VA's
planned scientific assessment, while the remaining six were neutral. No
comments disagreed with the planned scientific assessment. Seventeen
comments provided veteran testimony, exposure experience, or personal
medical history. Thirteen comments voiced concern that kidney cancer is
a narrow scope of possible conditions associated with PFAS exposure.
Ten comments were requests to establish kidney cancer as a presumptive
service-connected condition due to possible PFAS exposure. The
remaining two comments requested benefits consideration. Twenty-two
comments spoke to exposures at a specific location or in an occupation;
of those, nine comments discussed firefighting foam/gear as the chief
exposure concern. Eight comments discussed medical conditions other
than kidney cancer. Three comments dealt with exposures other than
PFAS. Of the remaining nine comments, six dealt with personal medical
histories, two provided scientific evidence, and one was unclear.
Discussion on Comments
With the enactment of Sergeant First Class Heath Robinson Honoring
our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), VA
enhanced the presumptive decision-making process to align with 38
U.S.C. 1171-1176 and implement recommendations from National Academies
of Science, Engineering, and Medicine's (NASEM) review of the process.
Under the current enhanced process, every year VA announces in the
Federal Register plans for formal evaluations. VA also invites comments
and holds an open meeting for the public to provide input.
In accordance with this process, VA established a working group
called the Military Environmental Exposure Sub-Council to conduct
ongoing surveillance and scientific assessments that may lead to a
recommendation for formal evaluation. The duration of a scientific
assessment is dependent on the availability, volume, and complexity of
relevant literature and data. VA is required to complete formal
evaluations within 120 days in accordance with the requirements in 38
U.S.C. 1173.
At this time, VA will focus solely on the possibility of a
relationship between
[[Page 59326]]
PFAS exposure and kidney cancer for the current scientific assessment.
Other conditions that are possibly associated with PFAS exposure may be
considered for future assessments. The scientific assessment committee
will be provided the details from the comments that include veteran
testimonies and exposure experiences. If the assessment results in a
formal evaluation, the veteran testimonies and exposure experiences
will also be provided to the formal evaluation team for consideration.
VA agrees that the NASEM report ``Guidance on PFAS Exposure,
Testing, and Clinical Follow-up'' (2022) is an important resource, and
it will be one of several resources VA uses to inform its scientific
assessment. However, under the PACT Act and 38 U.S.C. 1172, VA follows
a specific process to support any decisions regarding creating new
presumptions of service-connection. This process generally includes a
scientific assessment, which requires convening an interagency expert
panel and reviewing relevant peer-reviewed scientific literature and
historical claims data across multiple evidence streams. The panel will
make recommendations to VA leadership regarding whether the evidence
supports conducting a formal evaluation. The panel will not make any
recommendations regarding future studies, as that is outside of the
scope of the scientific assessment.
This current assessment will focus on kidney cancer because it is
the disability identified in the NASEM report as having the strongest
evidence linking it to PFAS exposure. The other outcomes categorized as
having ``sufficient evidence of an association'' were either clinical
indicators (not disabilities) or were conditions that occur in
children. VA only has the authority to create presumptions for
disabilities in veterans; policies related to care/compensation for
children would require Congressional mandate and appropriations. Other
disabilities, such as those included in other categories identified by
NASEM, may be assessed in future assessments as additional data becomes
available. VA remains committed to transparency, scientific integrity,
and supporting the health of all veterans affected by PFAS and other
military environmental exposures.
VA agrees that it is important to ensure that the scientific
assessment includes PFAS compounds and exposure routes specific to
military settings, such as those involving fire-fighting foams or
aqueous film-forming foam used to extinguish jet fuel in military and
commercial settings. The assessment will examine all peer-reviewed
studies involving relevant PFAS compounds, including those with known
military applications. The Department of War is still in the process of
identifying all of its uses of PFAS; therefore, not all potential
exposure routes related to military service are known. To ensure that
the assessment allows for as broad of a review on the potential
relationship between PFAS and kidney cancer as possible, any published
data on this relationship in any population will be considered.
Regarding potential exposures at Fort McClellan, Alabama, section
801 of the PACT Act required a Congressionally mandated epidemiological
study to conduct analyses of morbidity and mortality vis-[agrave]-vis
veterans who served at this location between January 1, 1935, and May
20, 1999. VA is currently conducting this research and will disseminate
the results upon completion.
VA does not currently offer PFAS blood testing. This is because
PFAS blood tests have limited clinical value in that they can detect
levels of certain PFAS in an individual's body at one point in time,
but they cannot be used to determine when an individual was exposed,
the source of exposure, or whether it could affect an individual's
health now or in the future. These tests also do not guide treatment
decisions. Veterans who are still interested in testing may choose to
do so through private laboratories outside the VA health care system.
If an individual has concerns about PFAS exposure, they can speak with
their primary care provider, who can review the individual's health
history and determine if additional evaluations are needed.
VA does not plan to create a PFAS registry, since self-reported
registries have limited scientific value. Instead, VA is conducting
epidemiologic studies to try to improve our understanding of the impact
of PFAS exposures in military populations. Further, under the PACT Act,
VA is conducting a review of the current evidence linking PFAS exposure
to kidney cancer as the first step in the presumptive decision process.
Additional conditions may be considered in future phases of review. The
findings of this and all presumptive decision process reviews will be
shared in the Federal Register.
VA cannot comment on veteran medical histories or claims shared
through the public comment process. VA encourages all veterans who feel
their military service has negatively impacted their health to submit a
claim for disability compensation. VA will review the claims on a case-
by-case basis. Veterans who have evidence of an in-service toxic
exposure and developed a non-presumptive disability related to that
exposure may be entitled to receive compensation benefits under the
direct service connection provisions if a medical opinion provides a
causal link between the two. VA is unable to grant benefits if a link
between the veteran's medical conditions and military service is not
found. When determining eligibility for benefits, VA considers all
avenues of service connection, which includes direct service
connection, secondary service connection, and presumptive service
connection. Service connection is not limited to potential exposures
and may be warranted for chronic conditions manifesting to a
compensable degree within the recognized time. If a claimant disagrees
with a claim decision, they can choose from the following decision
review options: Supplemental Claim, Higher-Level Review, or Board
Appeal, to continue their case. Visit www.va.gov or call (800) MYVA411
to learn about the options available.
Moving Forward
VA will provide status updates on the scientific assessment at the
PACT Act Quarterly Briefing for VSOs and stakeholders. Additionally, VA
will publish the annual notice for fiscal year (FY) 2025 as required by
38 U.S.C. 1172. The FY 2025 notice will announce plans and details for
the annual listening session. The quarterly briefings, annual notice,
and listening session will provide the opportunity for veterans, family
members, VSOs, stakeholders, and the public to provide their input.
Signing Authority
Douglas A. Collins, Secretary of Veterans Affairs, approved this
document on December 15, 2025 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.
Nicole R. Cherry,
Alternate Federal Register Liaison Officer, Department of Veterans
Affairs.
[FR Doc. 2025-23311 Filed 12-17-25; 8:45 am]
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