Improving the Presumptive Disability Decision-Making Process for Veterans (2008) / Chapter Skim
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Pages 237-297
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. The regulations that interpreted the World War I law declared that secrets could be kept Prepublication Copy – Uncorrected Proof 11-1
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. In view of these two chemical exam Prepublication Copy – Uncorrected Proof
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These include DoD Special Access Programs, Department of Energy (DOE) Special Access Programs, Director of Prepublication Copy – Uncorrected Proof
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The ACHRE Report (ACHRE, 1995) enu Prepublication Copy – Uncorrected Proof
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In some instances where national security and secrecy issues cannot be resolved, DoD and VA may need to establish mechanisms involving experts with appropriate security clearances to monitor affected registry cohorts for potential health outcomes and define surveillance or re Prepublication Copy – Uncorrected Proof
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that may adversely affect the health of mili Prepublication Copy – Uncorrected Proof 12-1
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The accumulating evidence would undergo periodic review in a transparent and uniform fashion to gauge the strength of evidence in support of general causation and for determination of individual causation, drawing on the exposure data and perhaps other information. Prepublication Copy – Uncorrected Proof
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The Committee recommends giving more consideration to toxicological investigation in general and Prepublication Copy – Uncorrected Proof
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The Committee recommends that VA establish ongoing monitoring and evaluation to allow the decision-making process to be refined and improved. An information-gathering process would be needed for this purpose; consideration might also be given to appointment of an external committee to provide Prepublication Copy – Uncorrected Proof
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102d Cong., 1st Sess.) led the VA to provide the following charge to IOM in making scientific determinations: Prepublication Copy – Uncorrected Proof
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would be nominated for review and given sufficient information and numbers of veterans affected, formally evaluated to Prepublication Copy – Uncorrected Proof
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The process of proposal review Prepublication Copy – Uncorrected Proof
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It is essential that the process be objective, transparent, and of the highest scientific quality, reflecting sci Prepublication Copy – Uncorrected Proof
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The evidence gathered and reviewed would be similar in nature to Prepublication Copy – Uncorrected Proof
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Soldiers with TBI should be identified and tracked, for example, for level of Prepublication Copy – Uncorrected Proof
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This Prepublication Copy – Uncorrected Proof
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Washington, DC: National Academy Press. Prepublication Copy – Uncorrected Proof
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The Committee concluded that improvements are needed throughout the presumptive disability decision-making process. The recommendations that follow are based on the Committee's proposed Prepublication Copy – Uncorrected Proof 13-1
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operating with a well-defined process which will use evaluation criteria as outlined in this Committee's recommendations to evaluate sci entific evidence for VA's use in considering future service-connected presumptions. Prepublication Copy – Uncorrected Proof
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The Committee recommends that the goal of the presumptive disability decision-making process be to ensure compensation for veterans whose dis eases are caused by military service and that this goal must serve as the foundation for the work of the Science Review Board. The Committee recommends that the Science Review Board implement its proposed 2-step process.
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Groupings for registries can be based on Prepublication Copy – Uncorrected Proof
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DoD and VA should begin to work together immediately to assess the available systems and to define and construct appropriate interfaces for these systems. The Committee recommends that the Commission work through Congress to establish Prepublication Copy – Uncorrected Proof
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Combined, the members have over 260 years of military experience. The establishing statute requires that seven members have received combat decorations such as Prepublication Copy – Uncorrected Proof A-1
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Currently, in determining if a herbicide disease should have a presumption established, the Secretary must Prepublication Copy – Uncorrected Proof
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The Commission will consider the Committee's findings and suggestions in framing its response to the charge from Congress and the President. Prepublication Copy – Uncorrected Proof
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APPENDIX A A-5 We look forward to hearing the results of your Committee's deliberations in the coming months. Prepublication Copy – Uncorrected Proof
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3:00 p.m. Adjourn Prepublication Copy – Uncorrected Proof
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1:20 p.m. Deployment Health Surveillance: Past, Current and Future Operations Prepublication Copy – Uncorrected Proof
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6:00 p.m. Adjourn Prepublication Copy – Uncorrected Proof
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6:00 p.m. Adjourn Prepublication Copy – Uncorrected Proof
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CDC Centers for Disease Control and Prevention CDVA Commonwealth Department of Veterans' Affairs CERHR Center for the Evaluation of Risks to Human Reproduction CES-D Centers for Epidemiological Studies-Depression Scale CFR Code of Federal Regulations CHD Coronary heart disease CHF Congestive heart failure CHPPM Center for Health Promotion and Preventive Medicine (Army) CI Confidence interval CIA Central Intelligence Agency CIRRPC Committee on Interagency Radiation Research and Policy Coordination Prepublication Copy – Uncorrected Proof C-1
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C-2 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS CLL Chronic lymphocytic leukemia CNS Central nervous system COPD Chronic obstructive pulmonary disease C&P Service Compensation and Pension Service CRDP Concurrent Retirement and Disability Payments CRS Congressional Research Service CRSC Combat-Related Special Compensation CSMs Cerebrospinal malformations CSP Cooperative Studies Program CVD Cardiovascular disease DALY Disability-adjusted life years DCI SCI Director of Central Intelligence Sensitive Compartmented Information Programs DECC-D Defense Enterprise Computing Center-Detachment DHHS Department of Health and Human Services DISA Defense Information Systems Agency DMDC Defense Manpower Data Center DMSS Defense Medical Surveillance System DNBI Disease and nonbattle injury DoA Department of the Army DoD Department of Defense DoDI Department of Defense Instruction DOE Department of Energy DOEHRS Defense Occupational and Environmental Health Readiness System DOL Department of Labor DSM-III-R Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised DTAS Defense Theater Accountability Software EA Exposure Assessment EAR Excess absolute risk EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000 EESOH-MIS Enterprise Environmental Safety and Occupational Health-Management Information System EO Executive Order EPA Environmental Protection Agency EPCRA Emergency Planning and Community Right-to-Know Act ERIC Epidemiological Research and Information Center ERR Excess relative risk FECA Federal Employees' Compensation Act FERS Federal Employees Retirement System FHIE Federal Health Information Exchange FHP Force Health Protection fMRI functional magnetic resonance imaging FNR False negative rate FN False negative Prepublication Copy – Uncorrected Proof
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IOM Institute of Medicine IREP Interactive Radiation Epidemiology Program IQ Intelligence quotient IU Individual unemployability LIMDIS Limited Dissemination LMF Lovelace Medical Foundation MDS Myelodysplastic syndrome MFUA Medical Follow-up Agency MMPI Minnesota Multiphasic Personality Inventory MOA Memorandum of Agreement MOS Military occupational specialty MRI Magnetic resonance imaging MS Multiple Sclerosis MTF Military Treatment Facility NAS National Academy of Science NCEH National Center for Environmental Health NCHS National Center for Health Statistics NCI National Cancer Institute NEHC Navy Environmental Health Center NESHAP National Emission Standard for Hazardous Air Pollutants NHANES National Health and Nutrition Examination Survey NHL Non-Hodgkin's Lymphoma Prepublication Copy – Uncorrected Proof
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C-4 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS NHLBI National Heart, Lung, and Blood Institute NHS Nurses Health Study NIH National Institutes of Health NIOSH National Institute for Occupational Safety and Health NOCONTRACT Not releasable to contractors NOED Navy Occupational Exposure Database NOFORN Not releasable to foreign nationals NPV Negative predictive value NRC National Research Council NTP National Toxicology Program NTS Nevada Test Site OEF Operation Enduring Freedom OEH Occupational and environmental health OEHHA Office of Environmental Health Hazard Assessment OEHS Occupational environmental health and safety OEL Occupational exposure limit OGC Office of the General Counsel OH Occupational health OHMIS Occupational Health Medical Information System OIF Operation Iraqi Freedom OMB Office of Management and Budget OPHEH Office of Public Health and Environmental Hazards OPM Office of Personnel Management OR Odds ratio ORCON Originator controlled dissemination and extraction of information ORD Office of Research and Development OSHA Occupational Safety and Health Administration OSTP Office of Science and Technology Policy PAF Population attributable fraction PAR Population attributable risk PC Probability of causation PCB Polychlorinated biphenyls PDDM Presumptive disability decision-making PHA Periodic health assessments PKDL Post-kala-azar dermal leishmaniasis PL Public Law POM Program Objectives Memorandum POW Prisoners of War PPB Parts per billion PPG Pacific Proving Grounds PPM Parts per million PPV Positive predictive value PSA Prostate-specific-antigen PSG II Professional Staff Group II PTF Presidential Task Force PTSD Post traumatic Stress Disorder Prepublication Copy – Uncorrected Proof
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C-5 APPENDIX C PY Person-years RADS Reactive airways dysfunction syndrome RCT Randomized Controlled/Clinical Trial ReA Reactive arthritis RECA Radiation Exposure Compensation Act of 1990 RECAC Radiation Exposure Compensation Act Committee REVCA Radiation Exposed Veterans Compensation Act RD Restricted data RO Rey-Osterreith Test ROC Receiver Operator Characteristic RR Relative risk / risk ratio RTI Research Triangle Institute SADs Service-Attributable Diseases SAF Service-attributable fraction SANG Saudi Arabia National Guard SAP Special Access Program SCI Sensitive Compartmented Information SCID Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised SCL Symptoms Checklist SEER Surveillance Epidemiology and End Results SEG Similar exposure groups SES Socioeconomic status SF Standard Form SFFWG Shared Functions Focus Working Group SGR General's report on Smoking SHAD Shipboard Hazard and Defense SMITREC Serious Mental Illness Treatment Research and Evaluation Center SMR Standardized mortality ratio SSA Social Security Administration SSDI Social Security Disability Insurance SSI Supplemental Security Income TCDD Tetrachlorodibenzo-p-dioxin TBI Traumatic Brain Injuries TN True negative TNR Truenegativerate TPR True positive rate TP True positive UNSCEAR United Nations Scientific Committee on the Effects of Atomic Radiation USC United States Code USPSTF US Preventive Health Services Task Force VA Department of Veterans Affairs VAO Veterans and Agent Orange VASRD Veterans Administration's Schedule for Rating Disabilities VBA Veterans Benefits Administration Prepublication Copy – Uncorrected Proof
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VHA Veterans Health Administration VHI Veterans Health Initiative VISTA Veterans Health Information Systems and Technology Architecture VOC Volatile organic compound VSO Veteran Service Organizations WAIS-R Wechseler Adult Intelligence Scale-Revised WEIISC War-Related Illness and Injury Centers WNINTEL Warning notice, intelligence sources, and methods WWI World War I WWII World War II YLD Years of life lived with disability YLL Years of life lost Prepublication Copy – Uncorrected Proof
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(Stedman's medical dictionary 28th ed., 2005) Active duty for training – (A)
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, due to the failure of absorption of vitamin B12, usually resulting from a defect of the stomach accompanied by mucosal atrophy and associated with lack of secretion of "intrinsic" factor; characterized by numbness and tingling, weakness, and a sore smooth tongue, as well as dyspnea after slight exertion, faintness, pallor of the skin and mucous membranes, anorexia, diarrhea, loss of weight, and fever; laboratory studies usually reveal greatly decreased red blood cell counts, low levels of hemoglobin, numerous characteristically oval shaped macrocytic erythrocytes (color index greater than normal, but not truly hyperchromic) , and hypo- or achlorhydria, in association with a predominant number of megaloblasts and relatively few normoblasts in the bone marrow; the leukocyte count in peripheral blood may be less than normal, with relative lymphocytosis and hypersegmented neutrophils; a low level of vitamin B12 is found in peripheral red blood cells; administration of vitamin B12 results in a characteristic reticulocyte response, relief from symptoms, and an increase in erythrocytes, provided that pernicious anemia is not complicated by another disease; the condition is not actually "pernicious," as it was prior to the availability of therapy with vitamin B12.
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Angiosarcoma – A rare malignant neoplasm occurring most often in soft tissues; believed to originate from the endothelial cells of blood vessels; microscopically composed of spindle shaped cells, some of which line small spaces resembling vascular clefts. (Stedman's medical dictionary 28th ed., 2005)
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(Stedman's medical dictionary 28th ed., 2005) Prepublication Copy – Uncorrected Proof
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(Stedman's medical dictionary 28th ed., 2005) Bancroft[ian]
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(Stedman's medical dictionary 28th ed., 2005) Beriberi - A specific nutritional deficiency syndrome occurring in endemic form in eastern and southern Asia, sporadically in other parts of the world without reference to climate, and sometimes in alcoholic patients, resulting mainly from a dietary deficiency of thiamin; the "dry" form is characterized by painful polyneuropathy that involves both large and small somatic nerve fibers, as well as autonomic nerve fibers, the initial symptom is burning feet, and later symptoms consist of painful parathesias in the distal upper limbs as well, weakness and atrophy of the feet and hands, and distal atrophic skin and hair loss; the "wet" form is characterized by edema resulting from a high-output form of heart failure, but usually there is evidence of a coexisting polyneuropathy as well.
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– Clotting of the blood in a cerebral vessel (Stedman's medical dictionary 28th ed., 2005) Prepublication Copy – Uncorrected Proof
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