Pass this on to all your contacts…Put in Post newsletters.. Many Veterans, and widows, will never hear about this.
Contact a VSO or an attorney and file, refile, etc for benefits. If you served in Vietnam or other places that AO was used. File…file…
Amyloidosis is a rare and potentially fatal disease that occurs when substances called amyloid proteins build up in your organs. Amyloid is an abnormal protein usually produced by cells in your bone marrow that can be deposited in any tissue or organ.
Amyloidosis can affect different organs in different people, and there are many types of amyloid. Amyloidosis frequently affects the heart, kidneys, liver, spleen, nervous system and gastrointestinal tract.
Question
allan
Pass this on to all your contacts…Put in Post newsletters.. Many Veterans, and widows, will never hear about this.
Contact a VSO or an attorney and file, refile, etc for benefits. If you served in Vietnam or other places that AO was used. File…file…
Amyloidosis is a rare and potentially fatal disease that occurs when substances called amyloid proteins build up in your organs. Amyloid is an abnormal protein usually produced by cells in your bone marrow that can be deposited in any tissue or organ.
Amyloidosis can affect different organs in different people, and there are many types of amyloid. Amyloidosis frequently affects the heart, kidneys, liver, spleen, nervous system and gastrointestinal tract.
http://edocket.access.gpo.gov/2009/E9-10627.htm
[Federal Register: May 7, 2009 (Volume 74, Number 87)]
[Rules and Regulations]
[Page 21258-21260]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07my09-8]
=======================================================================
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 3
RIN 2900-AN01
Presumptive Service Connection for Disease Associated With
Exposure to Certain Herbicide Agents: AL Amyloidosis
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This document amends the Department of Veterans Affairs (VA)
adjudication regulations concerning presumptive service connection for
a certain disease based on the most recent National Academy of Sciences
(NAS) Institute of Medicine committee report, ``Veterans and Agent
Orange: Update 2006'' (Update 2006). This amendment is necessary to
implement a decision of the Secretary of Veterans Affairs that there is
a positive association between exposure to herbicides used in the
Republic of Vietnam during the Vietnam era and the subsequent
development of
[[Page 21259]]
AL amyloidosis. The intended effect of this amendment is to establish
presumptive service connection for AL amyloidosis based on herbicide
exposure.
DATES: Effective Date: This amendment is effective May 7, 2009.
Applicability Date: The provisions of this regulation amendment
apply to all applications for benefits pending before VA on or received
after May 7, 2009. They also apply to review of certain previously
denied claims to the extent provided in 38 CFR 3.816.
FOR FURTHER INFORMATION CONTACT: Maya Ferrandino, Regulations Staff
(211D), Compensation and Pension Service, Veterans Benefits
Administration, Department of Veterans Affairs, 810 Vermont Avenue,
NW., Washington, DC 20420, (727) 319-5847. (This is not a toll-free
number.)
SUPPLEMENTARY INFORMATION: On November 3, 2008, VA published in the
Federal Register at 73 FR 65280 a proposal to amend 38 CFR 3.309(e) to
add AL amyloidosis to the list of diseases presumed service connected
based on exposure to herbicide agents. Interested persons were invited
to submit written comments on or before January 2, 2009. We received
one comment.
Comment
The commenter stated that the proposed rule represents an
ideological shift in disease categorization. The commenter stated that
the proposed rule does not reflect the current criteria for causality
contained in 38 U.S.C. 1116(b), which he stated requires direct
evidence between exposure to an herbicide agent and the occurrence of a
disease in humans. The commenter stated that the evidence that multiple
myeloma and other lymphomas were connected to herbicide exposure was
used by the Secretary to connect AL amyloidosis with herbicide exposure
and that this process by the Secretary reflects a policy of providing
service connection for disease groups rather than for separate
diseases. He noted that section 1116(b) allows for service connection
for a specific disease rather than for a group of diseases. The
commenter stated that should the proposed rule go forward, section
1116(b) and Sec. 3.309(e) should be revised to include service
connection for disease entities and that regulations that refer to
individual diseases should be reviewed and revised. He stated that the
proposed rule could be revised to reflect a presumption of service
connection for all diseases characterized by clonal hyperproliferation
of B-cell derived plasma cells and production of abnormal amounts of
immunoglobulins. The commenter stated that, in the alternative, the
proposed rule should be withdrawn because there is no evidence that
this disease entity is associated with exposure to herbicides.
Response
As stated in the proposed rule, the Secretary's determination
regarding establishing presumptive service connection for AL
amyloidosis is based on NAS' evaluation and its conclusion that there
is limited or suggestive evidence of an association between herbicide
exposure and AL amyloidosis. The Secretary did not make any
determination concerning any disease other than AL amyloidosis. In this
regard, the Secretary has followed the standards in section 1116(b)
regarding establishing presumptive service connection for a disease
associated with herbicide exposure. The comment states that this rule
amends the ``causality'' criteria of section 1116(b). However, as shown
in Update 2006, after quoting the criteria from section 1116(b), ``[the
NAS committee's] congressional mandate and its statement of task are
phrased in such a way that the target of evaluation is `association,'
not `causality,' between exposure and health outcomes.'' Update 2006,
p. 2.
The commenter's suggestion that this rule is contrary to section
1116(b) rests on the premise that the rule implicitly establishes a
presumption for a group of related diseases, rather than for a specific
disease. We do not agree with that premise. As noted above, the NAS and
VA each made a finding specific to AL amyloidosis. As the commenter
noted, the NAS relied primarily upon studies showing that AL
amyloidosis is pathophysiologically related to other diseases that are
currently presumed to be associated with herbicide exposure. That
analysis, however, should not be interpreted to mean that an
association between herbicide exposure and a particular disease
justifies a finding of such an association for all similar or related
diseases. Rather, the NAS and VA necessarily evaluate the body of
relevant evidence for each disease.
The NAS noted that, because AL amyloidosis is a rare condition,
``it is not likely that population-based epidemiology will ever provide
substantial direct evidence regarding its causation.'' Update 2006, p.
474. By statute, the NAS is directed to assess not only statistical
associations based on epidemiologic studies, but also other factors
such as ``whether there exists a plausible biological mechanism or
other evidence of a causal relationship between herbicide exposure and
the disease.'' Public Law 102-4, section 3(d)(1)©. It appears that
the NAS may have placed significant weight on the evidence of biologic
plausibility in this instance in part because it is unlikely that other
forms of relevant evidence for or against an association will ever
become available. However, the determinations by NAS and VA concerning
Al amyloidosis cannot reasonably be construed to reflect a shift in
policy deviating from the requirements of section 1116(b), or to
suggest that epidemiologic evidence is irrelevant to determinations
concerning other diseases.
To the extent the commenter suggests an amendment to section
1116(b), such action would require legislation and is beyond the scope
of this rule. We therefore make no change based on this comment.
VA appreciates the comment submitted in response to the proposed
rule. Based on the rationale set forth in the proposed rule and the
rationale contained in this document, we are adopting the provisions of
the proposed rule as a final rule without change.
Administrative Procedures Act
Substantive changes made by this final rule are required to be
effective the date of issuance pursuant to 38 U.S.C. 1116©(2).
Accordingly, we are dispensing with the delayed effective date
provisions of 5 U.S.C. 553.
Paperwork Reduction Act
This document contains no provisions constituting a collection of
information under the Paperwork Reduction Act (44 U.S.C. 3501-3521).
Regulatory Flexibility Act
The Secretary hereby certifies that this final rule will not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. This final rule will not affect any small entities. Only VA
beneficiaries could be directly affected. Therefore, pursuant to 5
U.S.C. 605(b), this final rule is exempt from the initial and final
regulatory flexibility analysis requirements of sections 603 and 604.
Executive Order 12866
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety,
and other advantages;
[[Page 21260]]
distributive impacts; and equity). The Executive Order classifies a
``significant regulatory action,'' requiring review by the Office of
Management and Budget (OMB), as any regulatory action that is likely to
result in a rule that may: (1) Have an annual effect on the economy of
$100 million or more or adversely affect in a material way the economy,
a sector of the economy, productivity, competition, jobs, the
environment, public health or safety, or State, local, or tribal
governments or communities; (2) create a serious inconsistency or
otherwise interfere with an action taken or planned by another agency;
(3) materially alter the budgetary impact of entitlements, grants, user
fees, or loan programs or the rights and obligations of recipients
thereof; or (4) raise novel legal or policy issues arising out of legal
mandates, the President's priorities, or the principles set forth in
the Executive Order.
The economic, interagency, budgetary, legal, and policy
implications of this final rule have been examined and it has been
determined to be a significant regulatory action under the Executive
Order because it is likely to result in a rule that may raise novel
legal or policy issues arising out of legal mandates, the President's
priorities, or the principles set forth in the Executive Order.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in the expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more (adjusted annually for
inflation) in any year. This final rule would have no such effect on
State, local, and tribal governments, or on the private sector.
Catalog of Federal Domestic Assistance Numbers and Titles
The Catalog of Federal Domestic Assistance program numbers and
titles for this rule are 64.109, Veterans Compensation for Service-
Connected Disability, and 64.110, Veterans Dependency and Indemnity
Compensation for Service-Connected Death.
List of Subjects in 38 CFR Part 3
Administrative practice and procedure, Claims, Disability benefits,
Health care, Veterans, Vietnam.
Approved: April 3, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
0
For the reasons set forth in the preamble, 38 CFR part 3 is amended as
follows:
PART 3--ADJUDICATION
0
1. The authority citation for part 3, subpart A, continues to read as
follows:
Authority: 38 U.S.C. 501(a), unless otherwise noted.
Subpart A--Pension, Compensation, and Dependency and Indemnity
Compensation
Sec. 3.309 [Amended]
0
2. In Sec. 3.309(e), the listing of diseases is amended by adding ``AL
amyloidosis'' immediately preceding ``Chloracne or other acneform
disease consistent with chloracne.''
[FR Doc. E9-10627 Filed 5-6-09; 8:45 am]
__._,_.___
"Keep on, Keepin' on"
Dan Cedusky, Champaign IL "Colonel Dan"
See my web site at:
http://www.angelfire.com/il2/VeteranIssues/
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