Improving the Presumptive Disability Decision-Making Process for Veterans (2008) / Chapter Skim
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From page 434... ...
F-74 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Date Legislation Presumptive Disease Etiology of Location/Date Presumptive Additional or Regulation Disease of Service Period Information Primary liver cancer • Exposure to Certain Herbicide Agents: Acute and subacute peripheral neuropathy; Chloracne or other acneform disease; Chronic lymphocytic leukemia; Hodgkin's disease; Multiple myeloma; Non-Hodgkin's lymphoma; Porphyria cutanea tarda; Prostate cancer; Respiratory cancers (lung, bronchus, larynx, or trachea) ; Type 2 diabetes; Soft-tissue sarcoma (adult fibrosarcoma; dermatofibrosarcoma protuberans; malignant fibrous histocytoma; liposarcoma; Prepublication Copy – Uncorrected Proof
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From page 435... ...
APPENDIX F: SUMMARY OF PDDM LEGISLATIVE HISTORY (BY DATE) F-75 Date Legislation Presumptive Disease Etiology of Location/Date Presumptive Additional or Regulation Disease of Service Period Information leiomyosarcoma; epithelioid leiomyosarcoma; rhabdomyosarcoma; ectomesenchymoma; angiosarcoma; proliferating angioendotheliomatos is; malignant glomus tumor; malignant hemangiopericytoma; synovial sarcoma; malignant giant cell tumor of tendon sheath; malignant schwannoma; malignant mesenchymoma; malignant granular cell tumor; alveolar soft part sarcoma; epithelioid sarcoma; clear cell sarcoma of tendons and aponeuroses; extraskeletal Ewing's sarcoma; congenital and infantile Prepublication Copy – Uncorrected Proof
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From page 436... ...
or Bone cancer: liver, lung, ovarian, other activities manifest within pancreatic, prostate, where they 30 years after rectum, salivary participated in exposure gland, skin, atmospheric stomach, thyroid, testing of nuclear Leukemia: urinary bladder, any weapons manifest any other cancer; time after Prepublication Copy – Uncorrected Proof
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, nasopharyngeal, laryngeal, squamous cell carcinoma of the skin; Chronic conjunctivitis; Prepublication Copy – Uncorrected Proof
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From page 438... ...
F-78 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Date Legislation Presumptive Disease Etiology of Location/Date Presumptive Additional or Regulation Disease of Service Period Information Corneal opacities; Keratitis; Scar formation • Nitrogen or sulfur mustard or Lewisite: Chronic form of: asthma, bronchitis, emphysema, laryngitis Chronic obstructive pulmonary disease • Nitrogen mustard: Acute nonlymphocytic leukemia 38 CFR 3.317 Compensation for certain Southwest Asia Manifest either Chronic disabilities due to Theater during during active disabilities for the Persian Gulf military, naval, a period of 6 undiagnosed illnesses during Persian Gulf War War or air service or months or • Undiagnosed illness to a degree of 10 more or • Medically unexplained Southwest Asia percent or more intermittent Theater includes not later than episodes of chronic multisymptom Iraq, Kuwait, December 31, improvement illnesses defined by a Saudi Arabia, 2006 and worsening cluster of signs or neutral zone over a 6-month symptoms: between Iraq and period Chronic fatigue Saudi Arabia, syndrome; Bahrain, Qatar, Fibromyalgia; Prepublication Copy – Uncorrected Proof
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From page 439... ...
illness: Abnormal weight loss; Cardiovascular signs or symptoms; Fatigue; Gastrointestinal signs or symptoms; Headache; Joint pain; Menstrual disorders; Muscle pain; Neurological signs and symptoms; Neuropsychological signs or symptoms; Signs or symptoms involving skin; Signs or symptoms involving the respiratory system Prepublication Copy – Uncorrected Proof
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From page 440... ...
F-80 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Date Legislation Presumptive Disease Etiology of Location/Date Presumptive Additional or Regulation Disease of Service Period Information (upper and lower) ; Sleep disturbances Prepublication Copy – Uncorrected Proof
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From page 441... ...
1921 diseases were • Purpura 36 defined on • December 2, 1921 Rickets • Scurvy • Amends list of 1925 Disease contracted During World War Characteristic Veterans' Bureau Arthritis (deformans constitutional during military or naval I manifestation Schedule for and chronic) • diseases services in World War I within one year Rating Disabilities Carcinoma, sarcoma from date of (based upon the and other tumors • separation from WW Veterans Act, Cardiovascular-renal active service 1924)
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607, 615 resigned on or before November 11, 1918 or on or after July 2, 1921 Prepublication Copy – Uncorrected Proof
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from active service (Also called Paget's or at a time when disease) Prepublication Copy – Uncorrected Proof
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301. 85th amends or when standard active service with Prepublication Copy – Uncorrected Proof
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of the U.S. during a period of war, campaign, or expedition Period of service after Nov 11, 1918 and before July 2, 1921, if served after April 5, 1917 and before Nov 12, 1918 Period after December 31, 1946 and before July 26, 1947, if period began before January 1, 1947 Feb 24, 1961 Disease contracted Lays out criteria Disease subject to during active military, for presumption presumptive naval, or air service wartime service service connection for connection.
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34529 34533. 38 CFR Part 3 38 CFR 3.307 Former prisoners of war Wartime and Prepublication Copy – Uncorrected Proof
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from separation of service 38 CFR 3.309 Military Service Chronic Diseases: Chronic Diseases: see section 3.307 On or after January above 1, 1947 following service in a period of war or peacetime service • Leprosy (also called April 12, Amends list of Executive Order 1933 chronic diseases 6089. Instruction Hansen's disease)
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1957 during active military, legislation and from active service with the enemy in Public Law 85-56. naval, or air service Sec.
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:1581-1582. Factual basis: may be established by medical evidence, competent lay evidence or both Pensions, bonuses, Dec 1, 1970 Active service Service of 90 days Chronic Diseases: Prepublication Copy – Uncorrected Proof
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From page 450... ...
:55872 55875. 38 CFR Part 3 38 CFR 3.307 Former prisoners of war Wartime and service on or after Military service January 1, 1947 90 days or more during a war period or after December Prepublication Copy – Uncorrected Proof
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from separation of service 38 CFR 3.309 Military Chronic Diseases: Chronic Diseases: see section 3.307 On or after January 1, Service above 1947 following service in a period of war or peacetime service Veteran who 38 USC §1112 Approved Active military service Chronic disease: Disease manifest to served for 90 days 2/27/06 10 percent or more or more during a within one year period of war from separation of such service Tuberculous Disease (active) and Hansen's Prepublication Copy – Uncorrected Proof
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487, 535. Aug 14, Amends list of Executive Order Osteitis (deformans)
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1957 during active military, engaged in combat after separation previous rules and Prepublication Copy – Uncorrected Proof
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83, 95. a period of war, campaign, or expedition Period of service after Nov 11, 1918 and before July 2, 1921, if served after April 5, 1917 and before Nov 12, 1918 Period after December 31, 1946 and before July 26, 1947, if period began before January 1, 1947 Lays out criteria Feb 24, 1961 Disease contracted Disease subject to for presumption during active military, presumptive wartime service naval, or air service service connection for connection.
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:18280 18283. 38 CFR Part 3 Wartime and 38 CFR 3.307 Former prisoners of war service on or after January 1, 1947 Military service 90 days or more during a war period or after December 31, 1946 Chronic: manifest to degree of 10 Prepublication Copy – Uncorrected Proof
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31, Disease contracted See Veterans See Veterans Added to list of and veterans' 1950 during military service Regulation 1 (38 Regulation 1 (38 Chronic and Prepublication Copy – Uncorrected Proof
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18, 42 Stat. resigned active 147, 153 Characteristic service on or manifestations of before November the disease to 10 11, 1918 percent or more April 12, Executive Order Amends list of Tuberculosis: 1933 manifest to a degree 6089.
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9, 1949 Disease contracted Wartime service Pensions, bonuses, Factual basis: established by after separation during military service prior to January 1, and veterans' medical evidence, from active 1947 to July 25, relief. Part 3: competent lay wartime service 1947 Veterans' claims; evidence, or both miscellaneous Within one year amendments.
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From page 459... ...
83, 95. a period of war, campaign, or expedition Period of service after Nov 11, 1918 and before July 2, 1921, if served after April 5, 1917 and before Nov 12, 1918 Period after December 31, 1946 and before July 26, 1947, if period began before January 1, 1947 Lays out criteria Feb 24, 1961 Disease contracted Disease subject to for presumption during active military, presumptive wartime service naval, or air service service connection for connection.
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From page 460... ...
:1581-1582. disease Factual basis: may be established by medical evidence, competent lay evidence or both Dec 1, 1970 Active service Service of 90 days Pensions, bonuses, Chronic Diseases: or more during a manifest to a degree and veterans' war period on or of 10 percent or relief.
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From page 461... ...
from separation of service 38 CFR 3.309 Military Service Chronic Diseases: Chronic Diseases: see section 3.307 On or after above January 1, 1947 following service in a period of war or peacetime service Prepublication Copy – Uncorrected Proof
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581. Prepublication Copy – Uncorrected Proof
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been incurred months of July 25, S 3.80; 1947; or more than S 3.86 (a) , 3.95 6 months then Chronic disease: Manifestations evidence of sufficient to continuity of identify the disease characteristic entity and sufficient symptoms during observations to the first 6 months establish chronicity after termination at the time of active service Prepublication Copy – Uncorrected Proof
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83, 95. a period of war, campaign, or expedition Period of service after Nov 11, 1918 and before July 2, 1921, if served after April 5, 1917 and before Nov 12, 1918 Period after December 31, 1946 and before July 26, 1947, if period began before January 1, 1947 Lays out criteria Feb 24, 1961 Disease contracted Disease subject to for presumption during active military, presumptive wartime service naval, or air service service connection for connection.
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:18280 18283. 38 CFR Part 3 38 CFR 3.307 Former prisoners of war Wartime and service on or after Military service January 1, 1947 90 days or more during a war period or after December 31, 1946 Prepublication Copy – Uncorrected Proof
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581. • Leishmaniasis after separation • Leprosy from active service • Loiasis or at a time when • Malaria standard and • Onchocerciasis accepted treatises • Oroya fever indicate that the • Pinta incubation period Prepublication Copy – Uncorrected Proof
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been incurred incidence of the S 3.80; disease under S 3.86 (a) , 3.95 consideration Tropical disease: When shown to exist at a time when standard and accepted treatises indicate that the incubation period of the diseases commenced during active service Characteristic manifestations of the disease to 10 percent or more, Prepublication Copy – Uncorrected Proof
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From page 469... ...
83, 95. a period of war, Within one year campaign, or after separation expedition from active service or when standard Period of service and accepted after Nov 11, 1918 treatises indicate and before July 2, incubation period 1921, if served after April 5, 1917 and before Nov 12, 1918 Prepublication Copy – Uncorrected Proof
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From page 470... ...
:1581-1582. Factual basis: may be established by medical evidence, competent lay evidence or both Dec 1, 1970 Active service Service of 90 days Pensions, bonuses, Tropical Diseases: manifest to a degree or more during a and veterans' of 10 percent or war period on or relief.
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From page 471... ...
:55872 55875. 38 CFR Part 3 38 CFR 3.307 Former prisoners of war Wartime and All tropical diseases listed.
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From page 472... ...
F-112 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Presumptive Legislation or Date Etiology of Location/Date Presumptive Additional Disease Regulation Disease of Service Period Information Military service January 1, 1947 90 days or more during a war period or after December 31, 1946 Tropical: manifest to a degree of 10 percent or more within 1 year from separation of service or time when standard accepted treatises indicate incubation period; diseases resulting from therapy administered 38 CFR 3.309 Military Service Tropical Diseases: See section 3.307 above Prepublication Copy – Uncorrected Proof
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From page 473... ...
F-113 SUMMARY OF PDDM LEGISLATIVE HISTORY (BY HEALTH OUTCOME) Presumptive Legislation or Date Etiology of Location/Date Presumptive Additional Disease Regulation Disease of Service Period Information 38 USC §1112 Approved Active military service Veteran who Tropical disease: Disease manifest to 2/27/06 served for 90 days 10 percent or more or more during a Tropical disease: within one year period of war Disorders or disease from separation of originating because of such service therapy, administered in connection with such Or Standard or disease, or as a accepted incubation preventative periods Hansen's disease: Disease manifest to 10 percent or more within 3 years from separation of such service Prepublication Copy – Uncorrected Proof
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3. 91st air service and was held Japanese for not less than 6 presumption for prisoner of war Government or the months former prisoners of heart disease)
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38 CFR Part 3 Aug. 14, 1981 Former prisoner of war While serving in Characteristic Amends list of Former Prisoner of active military, manifestations of the associated diseases War Benefits Act naval, or air service, disease to 10 percent of former prisoners of 1981.
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From page 476... ...
28, 1986 Former prisoner of war Amends list of Veterans' Benefits • Post-traumatic osteoarthritis associated diseases Improvements and of former prisoners Health-Care of war Authorization Act of 1986. Public Law 99-576.
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• Cirrhosis of the liver February 10, Former prisoners of war Detained for at least Amended list of Presumption of 2003 30 days diseases associated service connection Evidence: with prisoners of war for cirrhosis of the Significantly higher risk of liver in former death from cirrhosis in prisoners of war. former WWII POWs than Proposed rule.
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2651 Avitaminosis, Beriberi, Chronic Dysentery, Cirrhosis of the liver, Helminthiasis, Irritable bowel syndrome, Malnutrition, Pellagra, Peptic Ulcer Disease, Peripheral neuropathy, ) • Atherosclerotic disease or Presumptions of October 7, Former prisoner of war Eliminated the 30- Amended diseases service connection 2004 day detained associated with Hypertensive vascular disease [including for diseases requirement for former prisoner of Prepublication Copy – Uncorrected Proof
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From page 479... ...
presumption of The new diseases in 38 CFR Parts 1 service connection this rule are and 3 presumed to be service connected following any period of POW activity Final rule without June 28, Presumptions of change from Oct 7, 2005 service connection 2004 interim rule for diseases associated with service involving detention or internment as a prisoner of war. Affirmation of interim final rule as final rule..
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Benefits Act of 2005 amend the list of • Heart disease 2005 (proposed diseases associated • Stroke with former act) • 109th Congress 1st Osteoporosis prisoners of war Session Senate Bill 1271 Wartime and 38 CFR 3.307 Former prisoners of war service on or after January 1, 1947 Military service 90 days or more during a war period or after December 31, 1946 Former prisoners of war: manifest to a degree of 10 percent or more after discharge or release for active Prepublication Copy – Uncorrected Proof
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F-121 SUMMARY OF PDDM LEGISLATIVE HISTORY (BY HEALTH OUTCOME) Presumptive Legislation or Date Etiology of Location/Date Presumptive Additional Disease Regulation Disease of Service Period Information service 38 CFR 3.309 Former Prisoner of War Former Prisoner of War: manifest to a degree of 10 percent or more after release or discharge from active military, naval, or air service Prisoner of war associated diseases: not less than 30 days as a prisoner of war (for the following diseases: Any other nutritional deficiency, Avitaminosis, Beriberi, Chronic Dysentery, Cirrhosis of the liver, Helminthiasis, Irritable bowel syndrome, Malnutrition, Pellagra, Peptic Ulcer Disease, Peripheral Prepublication Copy – Uncorrected Proof
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From page 483... ...
Public 1991 or air service Vietnam; Vietnam lymphoma and acneform disease) Prepublication Copy – Uncorrected Proof
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: acid or other chemical manifest 10 percent compound in an or more disability herbicide agent Chloracne: 10 percent or more disability within one year after the last date active duty in Republic of Vietnam • Chloracne Lists diseases Oct. 15, Exposure to herbicides Republic of Claims based on Chloracne: • Soft-tissue sarcoma associated with manifested not later 1991 containing dioxin Vietnam; Vietnam exposure to exposure to than three months era herbicides (adult fibrosarcoma; herbicides from the date of containing dioxin dermatofibrosarcoma containing dioxin exposure (soft tissue protuberans; malignant sarcomas)
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From page 485... ...
• Military service Proposed rule Jan. 21, 1992 Herbicide (containing Claims based on Peripheral Peripheral neuropathy amends diseases dioxin)
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From page 486... ...
Part 3 tarda: certain herbicide 10 percent or more agents; wartime manifested within a During active military, and service on or year after the last naval, or air service after January 1, date veteran was 1947 exposed to an herbicide agent during active military, naval, or air service • Multiple myeloma Amends list of June 9, 1994 Herbicide agent Republic of Disease associated Multiple • Respiratory cancers: diseases associated exposure Vietnam; Vietnam with exposure to myeloma: with chronic, Disease manifest to era certain herbicide Bronchus tropical or prisoner 10 percent or more During active military, agents (multiple Larynx of war, or exposure at any time after naval, or air service And wartime and myeloma and Lung to certain herbicide service service on or after respiratory Trachea agents January 1, 1947 cancers)
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From page 487... ...
tarda: 10 percent or more manifested within a year after the last date veteran was exposed to an herbicide agent during active military, naval, or air service Respiratory cancers: Within 30 years after the last date on which the Prepublication Copy – Uncorrected Proof
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From page 488... ...
two years of the 38 CFR Part 3 date of onset • Amends diseases Illness manifest to a May 8, 2001 Herbicide exposure In the Republic of Disease associated Type 2 Diabetes associated to degree of 10 Vietnam during with exposure to exposure to percent or more the Vietnam Era certain herbicide herbicides agents: Type 2 Or active military diabetes. Final service rule.
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From page 489... ...
• cancers and Expansion Act of Vietnam Veteran active diseases: up to Respiratory Cancers additional diseases 2001. Public Law service September 30, 2015 107-103.
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From page 490... ...
Herbicide agent to certain herbicide more (containing dioxin or agents 2,4 In addition: dichlorophenoxyacetic Prepublication Copy – Uncorrected Proof
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From page 491... ...
Porphyria cutanea tarda and Chloracne: within 1 year from active military service Wartime and 38 CFR 3.307 Former prisoners of war Herbicide agent Presumptive service service on or after exposure: connection for chronic, January 1, 1947 Republic of Herbicide agent tropical, or prisoner-of-war Vietnam (Jan. 9, exposure (specifically related disease or disease 90 days or more 1962 to May 7, 2,4, D; 2,4,5-T and its associated with exposure during a war period 1975)
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From page 492... ...
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From page 493... ...
Public miners Uranium miners • 31, 1958 or June downwind in Law 101-426. Downwind to Prepublication Copy – Uncorrected Proof
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From page 494... ...
30, Radiation exposure Adds diseases to Cancer of the: Radiation 1992 the list associated Salivary gland Prepublication Copy – Uncorrected Proof
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From page 495... ...
106 Stat. 4774 • March 26, Ionizing radiation Amends diseases Claims based on Ovarian cancer • 1993 associated with exposure to Parathyroid adenoma exposure to ionizing radiation.
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:50993 50995. 38 CFR Part 3 Amends list of Radiation July 10, 2000 Nuclear atmospheric Lung Cancer: Leukemia: diseases associated Onset of disease at Exposure testing Physically present Nuclear Atmospheric to radiation least 2 years after Compensation Act in affected area for Testing: • Male breast cancer exposure and first exposure Amendments of Uranium mining at least 1 year Jan manifestation of 2000.
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From page 497... ...
:43699 43700. 38 CFR Part 3 Amends diseases February 14, Radiation exposure Claims based on • Polycythemia vera from exposure to 2002 exposure to ionizing radiation; Ionizing ionizing radiation.
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F-138 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Presumptive Legislation or Date Etiology of Location/Date Presumptive Additional Disease Regulation Disease of Service Period Information claim that polycythemia vera is a radiogenic disease as long as there is scientific or medical evidence to support the claim Veteran who 38 USC §1112 Approved Active military service Radiation-exposed All diseases listed above Veterans: Disease served for 90 days 2/27/06 manifest after or more during a Radiation exposed active military, period of war Veteran: Radiation risk naval, or air service activity Radiation exposed Veteran: Participation in a test involving atmospheric detonation of a nuclear device; Occupation of Hiroshima or Nagasaki, Japan (August 6, 1945 to July 1, 1946) ; Internment as a prisoner of war in Japan or service on active duty in Prepublication Copy – Uncorrected Proof
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• Prisoner of War in Japan exposure of ionizing radiation comparable to above exposure • Total of 250 days before Feb. 1, 1992 on Prepublication Copy – Uncorrected Proof
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or other prostate, rectum, salivary years after exposure activities where gland, skin, stomach, they participated thyroid, urinary bladder, in atmospheric Leukemia: any other cancer; manifest any time testing of nuclear • Non-malignant thyroid after exposure weapons nodular disease • Posterior subcapsular Posterior subcapsular cataracts • Parathyroid adenoma cataracts: manifest Prepublication Copy – Uncorrected Proof
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: 10 percent 3.309(e) fibrosarcoma service involved or more within a • Malignant ganglioneuroma duty or visitation year after the last in the Republic of date veteran Prepublication Copy – Uncorrected Proof
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From page 502... ...
Vietnam 38 CFR Part 3 • Diabetes Mellitus (Type Amends list of Republic of Approved Active military naval, or 38 USC § 1116 Republic of 2) diseases associated Vietnam (January 2/27/06 air service Vietnam Diseases: • Hodgkin's disease with Vietnam Manifest disease 10 9, 1962 –May 7, • Multiple myeloma Service.
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From page 503... ...
or trachea) Porphyria cutanea tarda and Chloracne: within 1 year from active military service Diseases Associated with Exposure to Mustard Gas • Asthma Chronic forms of Proposed rule for During World War Mustard Gas exposure January 15, Claims Based on • Bronchitis the diseases chronic effects of II; participating in by participating in full 1992 chronic effects of • Conjunctivitis manifested after in-service exposure full-body, field, or body, field or chamber exposure to • Corneal opacities exposure to mustard gas chamber experiments to test mustard gas.
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experience 38 C.F.R. Part 3 Prepublication Copy – Uncorrected Proof
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113 STAT. 1545 Prepublication Copy – Uncorrected Proof
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exposure to military service and Full body exposure to formation, or the • Keratitis mustard gas and either full-body nitrogen or sulfur Proposed rule. following • Corneal opacities other vesicant exposure to mustard or Lewisite Federal Register cancers: • Scar formation agents in response nitrogen or sulfur 59(15)
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From page 507... ...
disability or air service theatre during the 1994 Signs or symptoms of: certain • Abnormal weight loss resulting in one or Persian Gulf War undiagnosed • Cardiovascular signs more signs and (Iraq, Kuwait, illnesses. symptoms and Saudi Arabia, Proposed rule.
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or symptoms • percent degree or Bahrain, Qatar, the 38 C.F.R. Part 3 Headache • more no later than United Arab Joint pain two years after the Emirates, Oman, • Menstrual disorders date the veteran last the Gulf of Aden, • Muscle pain performed active the Gulf of Oman, • Neurologic signs or service in the the Persian Gulf, symptoms Southwest Asia the Arabian Sea, • Neuropsychological theater of the Red Sea, and signs or symptoms operations during the airspace above • Signs or symptoms the Persian Gulf these locations involving skin War • Signs or symptoms involving the respiratory system Final rule for (upper or lower)
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disabilities would 38 CFR Part 3 be denied compensation (no specific dates) • Veterans December Military Service Extension of Persian Gulf Persian Gulf Chronic multisymptom Prepublication Copy – Uncorrected Proof
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107th associated with Irritable bowel Asia theatre of 2011" Exposure: Cong., 1st Sess. herbicide exposure syndrome Persian Gulf War operations during and Persian Gulf service active military, the Persian Gulf exposure naval, or air service War Amended list of diseases associated with military service, Persian Gulf War Undiagnosed illness Extension of Veteran who Persian Gulf War active November 9, Extension of the manifest to a degree presumptive period served on active military, naval, or air 2001 presumptive for compensation of 10 percent or duty in the service period for for Gulf War more through Southwest Asia compensation for December 31, 2006 Veteran's theater during the gulf war veterans' undiagnosed Persian Gulf War undiagnosed illnesses illnesses.
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:34539 34543. 38 CFR Parts 3 and 13 Through December Extends the period December Southwest Asia Extension of the 31, 2011 within which 18, 2006 theater of presumptive disabilities must operations during period for become manifest the Persian Gulf compensation for for entitlement for War Gulf War veterans.
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that is Armed Forces in 2/27/06 exposure to a biological, prescribed in a the Southwest chemical, or other toxic regulation Asia theater of agent, environmental or operations during wartime hazard, or the Persian Gulf preventive medicine or War vaccine Chronic Manifest either 38 CFR 3.317 Southwest Asia disabilities for a during active Theater during the period of 6 months military, naval, or Persian Gulf War or more or air service or to a intermittent degree of 10 Southwest Asia episodes of percent or more not Theater includes improvement and later than Iraq, Kuwait, worsening over a December 31, 2006 Saudi Arabia, 6-month period neutral zone between Iraq and Saudi Arabia, Prepublication Copy – Uncorrected Proof
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105th Southwest Asia service connection for Persian Gulf War theater during the illnesses associated with Cong., 2d Sess., Persian Gulf War service in the Persian Gulf Diseases having an Sec. 1601, 1602, War association with 1603 exposure to a biological, chemical, or other toxic agent, environmental or wartime hazard, or preventive medicine or vaccine Diseases Associated with Radiation-Risk Activity Prepublication Copy – Uncorrected Proof
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; or underground internment as a prisoner nuclear tests of war in Japan or service on active duty in Japan following such internment during WWII with opportunity for exposure to ionizing radiation Veterans Benefits December Radiation-risk activity Amended Improvement Act 10, 2004 "radiation-risk of 2004. Public Ionizing activity" to include Prepublication Copy – Uncorrected Proof
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306. employee of the 118 STAT 3598 DOE would qualify inclusion as a member of the Special Exposure Cohort Diseases or Death NOT Associated with Military Service April 6, 2001 Active military, naval, Veterans' use of Disease attributable to use Claims based on or air service tobacco products of tobacco products the effects of are NOT tobacco products.
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F-156 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Presumptive Legislation or Date Etiology of Location/Date Presumptive Additional Disease Regulation Disease of Service Period Information Active duty for training Inactive duty training Active military, naval, or air service Former prisoner of war Reserve Vietnam era Persian Gulf war Death 38 USC §108 Approved Seven year absence 2/27/06 Secretary has authority to 38 USC § 501 Approved prescribe rules and 2/27/06 regulations to carry out laws administered by the Department of VA 38 USC §1110 Approved Entitlement to 2/27/06 compensation for disability resulting from diseases contracted in line of duty in the active military, naval, or air service, during a period of war 38 USC § 1111 Approved Presumption of sound 2/27/06 condition at the time of examination, acceptance, and enrollment into service Aggravation to a 38 USC §1153 Approved Increase in disability Prepublication Copy – Uncorrected Proof
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F-157 SUMMARY OF PDDM LEGISLATIVE HISTORY (BY HEALTH OUTCOME) Presumptive Legislation or Date Etiology of Location/Date Presumptive Additional Disease Regulation Disease of Service Period Information preexisting injury or 2/27/06 during active military, disease naval, or air service, unless the increase is due to the natural progress of the disease Veteran's service 38 USC §1521 Approved Active military, naval, Service requirements for non- 2/27/06 or air service requirements: • 90 days or more service connected disability during a period of war • Period of war and was discharged or released for a service connected disability • 90 consecutive days or more and began or ended during a period of war • Aggregate of 90 days or more in two or more separate periods of service during more than one period of war Guidelines for establishing 38 CFR 1.18 Former prisoners of war May give a Secretary may presumptions of service minimum duration establish a Prepublication Copy – Uncorrected Proof
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F-158 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Presumptive Legislation or Date Etiology of Location/Date Presumptive Additional Disease Regulation Disease of Service Period Information presumption of connection for former of detention or service connection prisoners of war internment for for a disease when application of the there is at least presumption limited/suggestive evidence that an Defines "evidence" increased risk of such disease is associated with service involving detention or internment as a prisoner of war and an association between the two is biological plausible Secondary condition 38 CFR 3.310 Service-connected established as service amputation of one lower connection of the original extremity at or above condition the knee or service • Cardiovascular connected amputations of both lower disease for service extremities at or above connected amputation the ankles Prepublication Copy – Uncorrected Proof
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Additionally, in evaluating any study for this purpose, the Secretary is directed to consider "whether the results are statistically significant, are capable of replication, and withstand peer review." Prepublication Copy – Uncorrected Proof G-1
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In the third tier, the Secretary determines, Prepublication Copy – Uncorrected Proof
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The Working Group will discuss the decisional options available to the Secretary and may also discuss the factors that may be relevant to the Secretary's decision among those options. To this extent, the Working Group may discuss Prepublication Copy – Uncorrected Proof
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VBA staff will prepare an Prepublication Copy – Uncorrected Proof
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Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides Prepublication Copy – Uncorrected Proof H-1
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The committee also addressed the following specific areas of interest as identified by VA: Prepublication Copy – Uncorrected Proof
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Washington, DC: The National Acad emies Press. Prepublication Copy – Uncorrected Proof
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Washington, DC: The National Acad emies Press. Prepublication Copy – Uncorrected Proof
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The committee's spe cific charge was to review, evaluate, and summarize the peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans. The committee reviewed epide miologic studies to draw conclusions regarding long-term health outcomes (such as cancer, cardiovascular disease, and nervous system disorders)
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For example, studies fail to control for confounding, have inadequate exposure assessment, or fail to address Prepublication Copy – Uncorrected Proof
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e Prepublication Copy – Uncorrected Proof
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Washington, DC: The National Acad emies Press. Prepublication Copy – Uncorrected Proof
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Washington, DC: The National Acad emies Press. Prepublication Copy – Uncorrected Proof
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• Brucellosis and ° arthritis and spondylitis (2007) Prepublication Copy – Uncorrected Proof
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• West Nile virus infection and variable physical, functional, or cognitive disability, which may persist for months or years or be permanent (2007) Limited/Suggestive Evidence of an Association Evidence is suggestive of an association between exposure to a specific agent and a specific health outcome, but the body of evidence is limited by the inability to rule out Prepublication Copy – Uncorrected Proof
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(2003) Prepublication Copy – Uncorrected Proof
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• Combustion products and Prepublication Copy – Uncorrected Proof
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° prostatic cancer (2005) Prepublication Copy – Uncorrected Proof
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° neurobehavioral effects (2005) Prepublication Copy – Uncorrected Proof
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Spina Bifida Prepublication Copy – Uncorrected Proof I-1
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. To emphasize the difficulty in particular for veterans with neuropsychiatric disease he added: Prepublication Copy – Uncorrected Proof CS1-1
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In its place the president was given broad authority to prescribe rules concerning eligibility for disability compensation including "the nature and extent of proofs, and presumptions" (emphasis added) for various classes of veterans (Economy Act of 1933 ch.
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Additional legislation concerning psychiatric presumptions has been confined to former prisoners of war (POWs)
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. Data obtained supported a finding that many Pacific theater and Korean War POWs had "permanent psychologic impairments." Beebe also noted that European theater POWs did not go "unscathed" with respect to psychoneurosis hospitalization (Beebe, 1975, p.
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This is especially apparent among former European theater POWs, in which those POWs interned less as well as more than 6 months exhibit significantly higher rates of anxiety neurosis compared to other service-connected World War II veter ans" (VA, 1980, p.
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First, forthcoming guidelines on "post-traumatic stress neurosis" would have "explicit reference to former POWs as well as other combat veterans." Post-traumatic stress neurosis was a term scheduled on October 1, 1980, to become part of VA's official diagnostic classification system to describe this anxiety neurosis. The guidelines would "specifically be used to diagnose, treat, and rate former POWs with anxiety neurosis or similar neurotic disorders" (emphasis added)
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VA also added that an analysis comparing anxiety neurosis and length of internment demonstrated that it remained a "statistically significant service-connected disability among former POWs regardless of the amount of time in prison camp" (emphasis added)
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produced a report entitled The Health of Former Prisoners of War. This longitudinal study focused on morbidity and was initiated in 1986 and Prepublication Copy – Uncorrected Proof
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Prevalence rates for over 20 different medical conditions were discussed, with key results including the following: • Pacific theater POWs had higher prevalence rates of PTSD, ulcer, schizophrenia, and generalized anxiety than European theater and Korean War POWs. • Visual symptoms were associated with higher prevalence rates of cerebrovascular disease, ulcers, asthma, and PTSD.
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. LESSONS LEARNED Presumptive decisions for mental disorders have been established for veterans who are former POWs and for veterans who developed chronic mental problems during or shortly after military service.
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1992. The health of former prisoners of war: Results from the medical ex amination survey of former POWs of World War II and the Korean Conflict.
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1997. Persistence of PTSD in former prisoners of war.
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The rationale for this order was that these conditions were: Of "‘such an insidious nature' that the disease did not become manifest to a ten-percent degree immediately upon inception but required as much as a year from the date of incep Prepublication Copy – Uncorrected Proof
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Key Terms
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