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will be needed to implement some of these recommendations and will require investment in tracking the exposures and health of current military service men and women as well as veterans. Progress depends on greater research capacity and changes in the evaluation and use of scientific evidence in making compensation decisions. The Committee finds that there are sufficient remediable shortcomings within the current process to warrant immediate action as Congress and VA move toward implementation of a new approach. The Committee concluded that improvements are needed throughout the presumptive disability decision-making process. The recommendations that follow are based on the Committee’s proposed framework for making presumptive decisions (see Chapter 12). We list the recommendations in relation to the appropriate body. In recommending the organizational structure below, the Committee recognizes that Congress and VA might pursue alternative structures to achieve the Committee’s overall goal of having an evidence-based presumptive disability decision-making process. However, the Committee believes that its proposal is feasible and practical over time, 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.

CONGRESS

Recommendation 1. Congress should create a formal advisory committee (Advisory Committee) to VA to consider and advise the VA Secretary on disability-related questions requiring scientific research and review to assist in the consideration of possible presumptions.

The investigation and evaluation of the relationships of exposures during military service and subsequent disabilities experienced by veterans have not been sufficiently prompt and comprehensive. To assure that research and review are timely and on target, the Committee recommends creation of an Advisory Committee to VA composed of veterans and recognized experts in disciplines such as epidemiology, toxicology, exposure assessment and biostatistics to identify and assess issues for referral to the VA Secretary and then to the Science Review Board, which would carry out the subsequent full, comprehensive scientific evaluation of the evidence (see Recommendation 2).

In the Committee’s recommended approach, the Advisory Committee has two key roles: screening exposures and illnesses proposed for review for possible presumptive compensation, and providing guidance to VA on research needs and planning. The multidisciplinary Advisory Committee



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