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From page 175... ... As discussed above, while the AF can clearly vary depending on level of exposure, in this case, it is the definition of exposure that strongly influences the AF. The Receiver Operator Characteristics Curve Prepublication Copy – Uncorrected Proof Read the entire page →
From page 176... ... to be directly compared. Prepublication Copy – Uncorrected Proof Read the entire page →
From page 177... ... One could argue, using an analogy from the battlefield, that it is intolerable to think of leaving any wounded behind on the battlefield. In the compensation context, this sentiment might translate into optimizing sensitivity to make sure that no one whose disease was in fact Prepublication Copy – Uncorrected Proof Read the entire page →
From page 178... ... , and so any limitations inherent to the estimation of the AF itself will also apply to these extensions of the AF.) Prepublication Copy – Uncorrected Proof Read the entire page →
From page 179... ... In the following section we explore ways in which the AF might be applied for VA compensation. Prepublication Copy – Uncorrected Proof Read the entire page →
From page 180... ... Prepublication Copy – Uncorrected Proof Read the entire page →
From page 181... ... This approach is shown in Figure 9-4. Prepublication Copy – Uncorrected Proof Read the entire page →
From page 182... ... Prepublication Copy – Uncorrected Proof Read the entire page →
From page 183... ... Prepublication Copy – Uncorrected Proof Read the entire page →
From page 184... ... FIGURE 9-6 A rational process for determining veterans' compensation. Prepublication Copy – Uncorrected Proof Read the entire page →
From page 185... ... A presumption might be used to deter Prepublication Copy – Uncorrected Proof Read the entire page →
From page 186... ... Prepublication Copy – Uncorrected Proof Read the entire page →
From page 187... ... These characteristics of this particular presumption therefore seem to be reasonable. Prepublication Copy – Uncorrected Proof Read the entire page →
From page 188... ... These are issues on which VA and Congress deliberate. It is hoped, however, that the framework outlined can be used in these deliberations to Prepublication Copy – Uncorrected Proof Read the entire page →
From page 189... ... OSTP Prepublication Copy – Uncorrected Proof Read the entire page →
From page 190... ... :718-719. Prepublication Copy – Uncorrected Proof Read the entire page →
From page 191... ... . Detailed health status data collected throughout an individual's active duty and veteran experience, coupled with individual exposure data collected during that period, would provide the data needed to make better decisions about an individual's likelihood of service-related disease Prepublication Copy – Uncorrected Proof 10-1 Read the entire page →
From page 192... ... . Defining and developing the mechanisms and systems to implement these goals has been an iterative process that has taken years -- largely due to the magnitude and complexity of the issues Prepublication Copy – Uncorrected Proof Read the entire page →
From page 193... ... Additional surveillance may precede or follow specific deployments with assessments tailored to the particular hazards of a deployment. Prepublication Copy – Uncorrected Proof Read the entire page →
From page 194... ... Exposure data f rom Occupational and post-deploy ment health Env ironmental Health assessment and Site Assessment reassessment Routine industrial hy giene and env ironmental exposure assessments by operation and/or job/task Service FIGURE 10-1 Timeline for medical surveillance and exposure data collection Prepublication Copy – Uncorrected Proof 10-4 Read the entire page →
From page 195... ... Prepublication Copy – Uncorrected Proof 10-5 Read the entire page →
From page 196... ... 10-6 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS TABLE 10-1 Timeline for Medical Surveillance and Exposure Data Collection In Service Accession After Training Throughout Pre-deployment Deployment Post- Post-deployment Separation/ Before Service Service deployment reassessment Retirement Routine Medical Surveillance Dataa Self-Administered Questionnaire Family history of chronic diseases x x Personal habits x Past medical history x Medications x x x x Allergies x General health status x x x x Significant events since last periodic health assessment x x On a profile, light duty, or undergoing a medical board x Medical or dental problems x x Pregnancy x Counseling or care for mental health in past year x Questions or concerns about health x Health changes during deployment x x In sick call during deployment x x Nights spent as a patient in a hospital during deployment x x x Vaccinations x Symptoms now or developed anytime during this deploymentb x x See anyone wounded, killed or dead during this deployment x Engaged in direct combat where discharged weapon x During deployment, feel like in great danger of being killed x Interested in receiving help for a stress, emotional, alcohol, or family problem x x x Little interest or pleasure in doing things x x Feeling down, depressed, or hopeless x x Thoughts that you would be better off dead or hurting yourself in some way x Nightmares due to an experience so frightening, horrible, or upsetting x x Constantly on guard, watchful, or easily startled x x Numb or detached from others, activities, or your surroundings x x Concerns of serious conflicts with spouse, family members, or close friends x x Concerns of hurting or lose control with someone x Having problems if wounded, injured, or assaulted during deployment x Alcohol use x Difficulty working, taking care of things at home, or getting along with other people x x Illnesses or injuries that caused you to miss duty for longer than 3 days x Treated by a healthcare provider, admitted to a hospital, or had surgery x Injuries or illnesses while on active duty for which you did not seek medical care x Other questions or concerns about your health x Intend to seek Department of Veterans Affairs disability x Laboratory Tests Urinalysis (albumin, sugar, HCG) x x x H/H x x x Blood type x x x Drugs and alcohol x x x Serum sample x x x x HIV testing x x CBC x Hemoglobin x Hematocrit x Vaccination status x Clinical Screening and Measurements Height x x x Weight x x x Temperature x x x Pulse x x x Prepublication Copy – Uncorrected Proof Read the entire page →
From page 197... ... HEALTH AND EXPOSURE DATA 10-7 In Service Accession After Training Throughout Pre-deployment Deployment Post- Post-deployment Separation/ Before Service Service deployment reassessment Retirement Blood pressure x x x Distant vision, near vision x x x Refraction by autorefraction or manifest x x x Heterophoria x x x Color vision x x x Depth perception, field of vision, night vision x x x Intraocular tension x x x Audiometer x x x Pap smear x x x Allergies x Tobacco use x Alcohol abuse and stress management x Chronic illnesses x Medications x Cholesterol x Breast exam, mammogram x Fecal occult blood x Sigmoid x Colonscopy x Immunizations x Clinical Evaluations Head, face, neck, and scalp x x x Nose, sinuses x x x Mouth and throat x x x Heart x x x Lungs and chest, vascular system x x x Anus and rectum x x x Abdomen and viscera x x x External genitalia x x x Upper and lower extremities x x x Spine, musculoskeletal system x x x Body marks, scars, tattoos x x x Skin x x x Neurologic and psychiatric disorders x x x Pelvis x x x Endocrine system x x x Routine Exposure Dataa x Industrial Hygiene Exposure Assessment of Operations, Jobs/Tasks Qualitative Exposure Judgments x Occupational Exposure Monitoring x x Routine Environmental Health Programs Environmental Health Site Assessment (EHSA) c Current use of site, adjoining properties, and surrounding area x Past use of site, adjoining properties, and surrounding area x Geologic, hydrogeologic, hydrologic, meteorologic, and topographic conditions x General description of structures x Roads x Potable water supply x Sewage disposal system x Hazardous materials in connection with identified use x Storage tanks x Odors x Prepublication Copy – Uncorrected Proof Read the entire page →

From page 175...

... As discussed above, while the AF can clearly vary depending on level of exposure, in this case, it is the definition of exposure that strongly influences the AF. The Receiver Operator Characteristics Curve Prepublication Copy – Uncorrected Proof