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Improving the Presumptive Disability Decision-Making Process for Veterans (2008)
Board on Military and Veterans Health (BMVH)

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. "Appendix A: Statement of the Veterans' Disability Benefits Commission to the Institute of Medicine's Committee on the Presumptive Disability Decision-Making Process, May 31, 2006." Improving the Presumptive Disability Decision-Making Process for Veterans. Washington, DC: The National Academies Press, 2008.

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Improving the Presumptive Disability Decision-Making Process for Veterans

all legislative and committee reports. We also encourage you to review published research on and medical studies of disease exposure and the subsequent development of those diseases.

Requesting your Committee to study these issues underlining the research question should not be taken as directing any disposition or finding with respect to the research question. Rather the Commission is asking that particular attention be focused on the issue.

SUMMARY

The Commission recognizes the challenges that the Committee on Presumptive Disability Decision Making Process faces in dealing with this issue. Your Committee has been asked to help ensure that future veterans are granted service connection under a presumption basis based on the best scientific evidence available. Your advice is crucial. The Commission anticipates that you will provide suggestions that will improve the processes that establish future presumptions. Presumptions are intended to protect a service member from being denied service connection for a disease or injury because he/she is unable to confirm the incurrence of the injury during combat or exposure to the disease through no fault of his or her own. To the extent possible, suggestions that will avoid the necessity for many future presumptions by ensuring that exposure of service members is documented and scientific evidence is made available would be important.

Having a method of granting service connection quickly and fairly based on a presumption is of critical importance to our disabled veterans and their surviving spouses. A through review of the present processes is needed. The presumptions must also be understandable to raters to allow for uniform and equitable application to veterans’ claims regardless of where the rating is prepared. Ensuring that future presumption processes reflect the then current medical knowledge about the causal relationship would benefit entire veteran community.

Your suggestions will be considered by the Commission in determining the appropriateness of benefits, the appropriateness of the level of such benefits, and the appropriate standard or standards for determining whether a disability or death of a veteran should be compensated.

The Commission will consider the Committee’s findings and suggestions in framing its response to the charge from Congress and the President.

We look forward to hearing the results of your Committee’s deliberations in the coming months.

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Front Matter (R1-R32)
General Summary (1-6)
Summary (7-26)
1 Introduction (27-35)
2 A Brief History of Presumptive Disability Decisions for Veterans (36-51)
3 The Presumptive Disability Decision-Making Process (52-69)
4 Legislative Background on Presumptions (70-82)
5 Case Studies Summary Chapter (83-135)
6 Establishing an Evidence-Based Framework (136-149)
7 Scientific Evidence for Causation in the Population (150-174)
8 Synthesizing the Evidence for Causation (175-197)
9 Applying Population-Based Results to Individuals: From Observational Studies to Personal Compensation (198-236)
10 Health and Exposure Data Infrastructure to Improve the Scientific Basis of Presumptions (237-297)
11 Governmental Classification and Secrecy (298-308)
12 The Way Forward (309-328)
13 Recommendations (329-338)
Appendix A: Statement of the Veterans' Disability Benefits Commission to the Institute of Medicine's Committee on the Presumptive Disability Decision-Making Process, May 31, 2006 (339-343)
Appendix B: Committee on Evaluation of the Presumptive Disability Decision-Making Process for Veterans Open Session Meeting Agendas (344-348)
Appendix C: Glossary (349-408)
Title Page (409-409)
Appendix D: Historical Background (410-423)
Appendix E: Arguments Favoring and Opposing Presumptions (424-433)
Appendix F: Tables: Summary of Presumptive Disability Decision-Making Legislative History (434-565)
Appendix G: VA's White Paper on the Presumptive Disability Decision-Making Process (566-569)
Appendix H: IOM's Statements of Task and Conclusions for Agent Orange and Gulf War Reports (570-591)
Appendix I: Case Studies (592-709)
Appendix J: Causation and Statistical Causal Methods (710-719)
Appendix K: Sources of Health and Exposure Data for Veterans (720-763)
Appendix L: Additional Classification and Secrecy Information (764-773)
Appendix M: Biographical Sketches of Committee Members, Consultants, and Staff (774-781)