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that proposed by the Committee. The Committee recognizes that specific elements of its proposal (e.g., the call for carrying out exposure assessments and making exposure estimates) are not fully practicable for all relevant exposures at present and would take time to develop and implement. However, feasibility of specific elements of its proposal should be enhanced with future methodologic developments. The Committee believes that its approach can be applied to the full range of factors (e.g., chemical, biological, infectious, physical, and psychological) that may adversely affect the health of military personnel and veterans. The Committee does not intend that its approach be applied retrospectively to existing presumptions. The Committee is aware that policy or other concerns could lead Congress or VA to modify or even reject some of the Committee’s recommendations. Congress and VA may find alternative processes to achieve the overall objective of the Committee’s recommendations: an evidence-based approach to making presumptive disability decisions. However, the Committee suggests that its proposal will prove feasible and practical over time, that many of the elements in its proposal can and should be implemented without delay, and that the Committee’s proposal would significantly improve the presumptive disability decision-making process for veterans.

Out of necessity, the Committee also makes some recommendations related to the implementation of its proposed approach. The Committee makes specific recommendations with regard to proposed advisory and review committees that will likely require congressional authorization, and the Committee recommends that VA would need to make adjustments in its overall approach to the presumptive disability decision-making process in order to follow the Committee’s recommendations.

The Committee’s recommended approach (Figure 12-1) has multiple new elements: a process for proposing exposures and illnesses for review; a systematic evidence review process incorporating a new evidence classification scheme and quantification of the extent of disease attributable to an exposure; a transparent decision-making process by VA; and an organizational structure to support the process. In using the term “exposure,” the Committee defines exposure in a broad manner to include chemical, biological, infectious, physical and psychological stressors. We also call for a comprehensive approach to tracking exposures of military personnel and monitoring their health while in service and subsequent to service. The tracking should cover the full spectrum of exposures relevant to future risk for disease, including chemical, biological, infectious, physical and psychological stressors. The Committee’s recommendations are based in a framework that sets out this evidence-based process (Figure 12-1).

The proposed process includes the engagement of two panels: An Advisory Committee and a Science Review Board. The Advisory Committee would be advisory to VA and would consider proposals for the review



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