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The Commission consists of 13 members who were appointed by the President and the leaders of Congress. Twelve of the Commissions have served in the military. Nine members have combat experience. Combined, the members have over 260 years of military experience. The establishing statute requires that seven members have received combat decorations such as the Silver Star or higher. The Commission is charged to submit its report by October 1, 2007, to the President and Congress.

The Commission is looking forward to receiving expert advice from your Committee regarding the process by which presumptions of service connections are established. The Commission asks that you evaluate the current model used to determine diseases that qualify for service connection on a presumptive basis, and if appropriate, propose improvements in the model.

The Commission requests that your Committee assess the overall process used to establish a presumption. Currently, in determining if a herbicide disease should have a presumption established, the Secretary must determine that the results upon which the presumption is based are statistically significant, are capable of replication, and withstand peer review.

The Commission previously provided IOM an analysis of the history of presumptions completed by the VA Office of General Counsel in 1993. The Commission also provided an analysis completed this year by Mr. Donald Zeglin, legal consultant to the Commission, which summarized the General Counsel analysis and analyzed decisions on presumptions that occurred since the completion of the General Counsel analysis.

A presumptive condition is an injury or illness in which VA presumes a relationship exists between service and the conditions being claimed. A recurring theme within the compensation program has been the expansion of the definition of service connection, mainly under the presumption basis.

In general terms, presumptions shift the burden of proof from the veteran to the Government. Among the earliest presumptions, not dealing with service connection, are the presumption of sound condition upon entry on active military duty, the presumption relating to aggravation of pre-existing conditions during service, and the presumption of death after an absence of seven years.

In many instances, presumptions of service connection have been created when the manifestation of disability is remote from the veteran’s service. This could be because medical science could not determine the origin or cause of some disabilities such as multiple sclerosis or how long the time period should be between exposure to the origin and initial diagnosis. In some cases, delayed onset is recognized as a feature of a disability such as posttraumatic stress disorder. In other cases, evidence supporting the need for a presumption can only be obtained through epidemiological studies

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