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The Task Force ordinarily consists of the Under Secretary for Health, the Under Secretary for Benefits, the General Counsel, and the Assistant Secretary for Policy and Planning. There is no generally established procedure for the Task Force’s deliberations. Task Force members generally receive a copy of the Working Group report and, based on that report, provide advice to the Secretary concerning the Secretary’s determination, which may include recommendations based upon the options, if any, outlined by the Working Group. The Task Force often, though not always, provides a separate report to the Secretary, which is based largely upon the Working Group’s report and is usually similar to the Working Group’s report in format and content. As a practical matter, these Task Force reports are usually drafted by members of the Working Group, based on guidance from members of the Task Force. Once the report is drafted, it is circulated to the Task Force members for signature and is then transmitted to the Secretary.


Based on the Task Force’s report, the Secretary determines whether to establish presumptions for any diseases discussed in the IOM report and directs appropriate action to implement the decision.


If the Secretary determines that a presumption of service connection is warranted for any disease, VBA (through the C&P Service staff) will prepare proposed rules to establish such presumptions. The preamble to the proposed rule will explain the scientific and legal basis for the presumption and will invite comments from the public on the rule. VBA staff will prepare an estimate of the costs associated with the rule, as required by executive order. Once drafted, the proposed rule will be circulated to appropriate VA offices, including VHA and OGC, for review and concurrence. Once all offices concur, VA will transmit the proposed rule and cost estimate to the Office of Management and Budget (OMB) for review. If OMB approves the proposed rule, it will be transmitted to the Secretary for signature. VA will then transmit the rule to the Federal Register for publication. Once the period for providing public comments on the rule has ended, VBA will prepare a final rule. Subject to the same process described above for internal concurrence, OMB review, and the Secretary’s signature, VA will submit the final rule to the Federal Register for publication.

In certain circumstances, additional review procedures may be required. For example, if a proposed or final rule would have an annual budgetary impact of $100 million or more, VA must provide a copy of the rule to Congress for review prior to publication of the rule.


If the Secretary determines that a presumption of service connection is not warranted for certain diseases, VBA will prepare a notice explaining the scientific basis for that decision with respect to each such disease. The notice is circulated for concurrence within VA in the same manner as a proposed rule, although VA does not prepare cost estimates with respect to the diseases concerned in this notice. The notice also may be subject to review by OMB prior to publication. Once the Secretary has signed the notice, VA will transmit it to the Federal Register for publication.

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