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TABLE 5-1 List of Case Studies (in chronological order of when presumptions were established by Congress or VA)

Mental Disorders’ Presumptions

Multiple Sclerosis Presumption

Prisoners of War (POWs) Presumptions

Amputees and Cardiovascular Disease Presumption

Radiation Presumptions

Mustard Gas and Lewisite Presumptions

Gulf War Presumptions

Agent Orange and Prostate Cancer Presumption

Agent Orange and Type 2 Diabetes Presumption

Spina Bifida Program*

*Because spina bifida is a condition that affects the children of veterans, it is not a presumptive decision for veterans; however, the children of Vietnam and Korean War veterans are covered by a VA program.

The case studies were based on detailed review of public laws, legislative background, research reports, National Academies’ IOM and NRC committees’ reports, and VA materials. However, as described in Chapter 1, the case studies were limited by VA’s response to the Committee’s request for information, documents, and responses to the Committee’s written questions. The case studies synthesize a large body of information. This body of information is summarized in Annex 5-1 at the end of this chapter, and the full case study series is in Appendix I. Additional materials on individual case studies and cost estimates are also referenced at the end of this chapter in Annexes 5-2 and 5-3. This chapter synthesizes the “lessons learned” from each of the case studies. We begin by summarizing each of the case studies and the particular lessons learned and then look across the case studies as a group for more general conclusions. The case studies are presented in chronological order as to when presumptions were established by Congress or VA. In drawing out these lessons as a basis for moving forward, the Committee’s commentary should not be construed as a critique of past activities and processes of Congress, VA, and National Academies’ IOM and NRC committees. This Committee recognizes that these activities took place over decades during which scientific research and evidence review processes were evolving and that tremendous efforts from all participants in the process went into producing all of the work that we summarize as follows.

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