deal more now about disease processes because of recent research based in epidemiology, toxicology, and genetics. This report proposes a framework for presumptive disability decision making that would employ our best scientific understanding while protecting the interests of veterans and other stakeholders by including them in the decision-making process. It provides findings from a committee convened to assess the current approach of the presumptive disability decision-making process for veterans and to provide a framework for a future approach. The committee was appointed by the Institute of Medicine (IOM) of the National Academies at the request of a special congressional commission (see below).

The Veterans’ Disability Benefits Commission (Commission) was created by the National Defense Authorization Act of 2004 (Public Law 108-136. 108th Cong., 1st Sess.). The Commission is charged with “studying the benefits provided to compensate and assist veterans for disabilities attributable to military service. The Commission was mandated to consult with the Institute of Medicine (IOM) of the National Academy of Sciences with respect to the medical aspects of contemporary disability compensation policies” (VDBC, 2006, p. 1; as found in Appendix A). The Commission was asked to evaluate and assess the following:

• The appropriateness of benefits

• The appropriateness of the level of those benefits

• The appropriate standard(s) for determining whether the disability should be compensated (VDBC, 2006, p. 1; as found in Appendix A)

To meet its goals, “the Commission produced a list of 31 research questions to be answered during its investigation” (VDBC, 2006, p. 1; as found in Appendix A). The Commission requested two studies from IOM. This report will address the issue of presumptions. Another committee, the Committee on Medical Evaluation of Veterans for Disability Compensation, issued a report entitled A 21st Century System for Evaluating Veterans for Disability Benefits, in June 2007. That report made recommendations to the Commission on how several components of VA’s medical evaluation and disability rating process for veterans could be updated and improved.

The independent Commission “consists of 13 members who were appointed by the President and the leaders of Congress” (VDBC, 2006, p. 1; as found in Appendix A) and is funded by VA. Twelve of the commissioners have served in the military. Nine members have combat experience. “The Commission is charged to submit its report by October 1, 2007, to