The four categories used in the IOM reports under both laws are “sufficient evidence of an association,” “limited/suggestive evidence of an association,” “inadequate/insufficient evidence to determine whether an association exists,” and “limited/suggestive evidence of no association.” The IOM reports under the Persian Gulf War Veterans Act include a fifth category, “sufficient evidence of a causal relationship.” The IOM categories intentionally do not address the central issue in the Secretary’s determination, i.e., the existence of a “positive association.” Accordingly, the Secretary is ultimately responsible for determining how the IOM’s findings, together with any other evidence available to the Secretary, bear upon the resolution of that ultimate question.
This paper describes the process by which the Department of Veterans Affairs (VA) evaluates the IOM reports in order to assist the Secretary in making the determinations described above.
VA ordinarily receives an embargoed copy of the IOM report a short period (about one week) prior to the date of the report’s public release. On or about the day of the public release, a representative of the IOM committee ordinarily provides VA a briefing on the report. The briefing typically identifies any significant findings in the report, any changes in the IOM’s categorization of specific diseases in comparison to prior reports, and any significant changes in the scope or methodology of the IOM’s investigation in comparison to prior reports, and responds to any questions from VA participants. The briefing is ordinarily attended by the members of VA’s Working Group (described below) and other interested VA personnel.
VA has not adopted formal procedures governing its internal review of IOM reports under the two statutes discussed above. However, a general practice has developed that VA usually, though not always, follows in conducting its internal review. The general practice involves a three-tiered review. In the first tier, a “Working Group” of VA employees from different operational elements of VA reviews the IOM report and any other relevant evidence and prepares a summary of its assessment and a statement of recommendations or options. This summary is intended for the benefit of a “Task Force” composed of high-level VA officials. In the second tier, the Task Force, based on the Working Group’s input, provides recommendations to the Secretary, usually in the form of a separate written report. In the third tier, the Secretary determines, based on the Task Force’s input, whether a presumption of service connection is warranted for any disease.
The Working Group ordinarily consists of members of the Office of Public Health and Environmental Hazards (OPHEH) of the Veterans Health Administration (VHA), the Compensation and Pension Service (C&P Service) of the Veterans Benefits Administration (VBA), and Professional Staff Group II (PSG II) of the Office of the General Counsel (OGC). Additionally, the Working Group often includes other VHA personnel with specialized medical training or experience concerning a health issue implicated by a particular IOM report. The members generally are assigned to the Working Group by supervisory personnel within VHA, VBA, and OGC.