Improving the Presumptive Disability Decision-Making Process for Veterans (2008) / Chapter Skim
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Pages 570-591
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From page 570... ...
. THE 1950S Growing concern by members of Congress about the well being of POWs and the privations they experienced, particularly in the Pacific theater, led to the introduction of legislation and hearings in 1948.
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By contrast, returned European theater POWs did not have a significant difference in mortality compared with control groups. Some 64 percent of Pacific theater POW deaths were attributable to either tuberculosis or accidents.
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enables the government, if medical knowledge is what the Bradley Commission says that it is, to rebut the presumption." He concluded that until American medicine can "determine with more than a reasonable degree of accuracy" whether or not certain types of diseases had their inception in service, the veteran should be entitled "to a presumption that his disease or disability, within reasonable periods now or to be specified, was the result of his service" (emphasis added)
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From page 573... ...
The report did note, however, that mortality experience for a small group of European prisoners hospitalized for malnutrition immediately after release suggested causes similar to Pacific theater POWs (Bard, 1994)
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In justifying the statutory presumptions, the accompanying report said that due to the conditions of captivity and the "kinds of long-range harm that may have been caused," it was "sometimes difficult for a former prisoner of war to establish some time after completion of military service" that a disability is related to military service (U.S. Congress, Senate, Committee on Finance, 1970, p.
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From page 575... ...
. Data obtained supported a finding that many Pacific theater and Korean War POWs had "permanent psychologic impairments." But he also noted that European theater POWs did not go "unscathed" with respect to psychoneurosis hospitalization (Beebe, 1975, p.
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From page 576... ...
For Pacific theater veterans the principal cause for the mortality increase was tuberculosis and trauma, while for former Korean War POWs it was trauma. As to trauma, the report found that for Pacific theater POWs, suicide was responsible for two-thirds and accidents one-third of the excess deaths.
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From page 577... ...
. Finally, the study did not find excess POW deaths from malignant neoplasms or chronic and degenerative diseases, concluding that there was "no evidence to support the hypothesis that the stresses of captivity have accelerated degenerative changes in former prisoners" (Keehn, 1980, p.
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From page 578... ...
. The study also confirmed that "systemic and malnutrition related diseases -- malaria, beriberi, pellagra -- are prevalent among former POWs, especially those interned in Asia." Among former World War II Pacific theater and Korean War POWs there were also statistically significant service-connected disabilities with respect to eye diseases, respiratory diseases, and gastrointestinal diseases.
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compared to 48.8 percent of Pacific theater, 20.1 percent European theater, and 34.7 percent Korean War POWs. Veterans on the disability compensation rolls who are rated at 60 percent or more are entitled to be paid at the total disability rate if they are determined to be individually unemployable.
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VA added that an analysis of anxiety neurosis with length of internment disclosed that it remained a "statistically significant service-connected disability among former POWs regardless of the amount of time in prison camp," (emphasis added)
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It also statutorily established an Advisory Committee on Former Prisoners of War which, among other things, was directed to submit an annual report to the VA Secretary containing an assessment of the needs of former POWs and any administrative or legislative recommendations the committee considered to be appropriate. The VA Secretary, in turn, was required to furnish his comments and intentions concerning these recommendations in an annual report to Congress (VA, 1993)
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From page 582... ...
, irritable bowel syndrome, and peptic ulcer disease. Senator Cranston, who sponsored the presumptions, cited a 1986 VA study of former Pacific and European theater POWs as well as a 1985 Australian study which found higher incidence of duodenal ulcers among POWs than controls (VA, 1993, p.
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Despite the fact that sound inferences about the group of all former POWs cannot be drawn from the exam data in this report, policymakers who must deal with such issues should be able to review this descriptive information…Not to report the findings of the examinations would surely raise more questions than the report, with its careful docu mentation of the study's limitations, would raise. The results of this examination study are thus discussed below, and we urge a maximum of reasonable caution in their inter pretation" (emphasis added)
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From page 584... ...
It was observed that there was much interest in heart disease among former POWs, but cautioned that the "lack of a clear biologic mechanism linking nutritional deprivation and subsequent chronic heart disease" together with the study's low response rate required that one "remain somewhat skeptical of this finding of association" (emphasis added)
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From page 585... ...
A 1994 study by Page and Ostfeld examined why a specific marker of malnutrition (lower limb edema related to vitamin B deficiency) in former POWs of World War II and the Korean War was associated with a three-fold increase in subsequent death attributed to ischemic heart disease.
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From page 586... ...
A report that attracted much attention was a 2000 study of cirrhosis mortality among former World War II and Korean War POWs by Page and Miller. The authors conducted a 50-year follow-up study of World War II and Korean War former POWs to compare increased cirrhosis mortality found after a previous 30-year follow-up period with that of controls.
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From page 587... ...
cited the Page and Miller (2000) study that found the risk of cirrhosis mortality for Pacific and European theater former POWs was 1.5 times the rate for the control group.
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The Secretary of Veterans Affairs will establish presumptions of service connection for former prisoners of war when necessary to prevent denials of benefits in significant numbers of meritorious claims.
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It first noted that statutory and regulatory standards currently existed to guide VA in identifying diseases associated with exposure to herbicide agents, hazards of service in the Gulf War, and ionizing radiation, and that it would be helpful to establish standards to guide VA in identifying diseases associated with service involving detention or internment as a POW. The POW guidelines were characterized as substantially similar to the existing guidelines noted above, with "minor differences necessary to reflect considerations unique to former POWs" (VA, 2004a)
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From page 590... ...
. On the recommendation of the Expert Panel on Strokes in Former Prisoners of War, VA's Environmental Epidemiology Service conducted a study in 2003 using medical and death data from VA and the Health Care Financing Administration (HCFA)
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From page 591... ...
. A series of older studies did not find consistent evidence of an association, as summarized in Page and Ostfeld's 1994 study titled Malnutrition and Subsequent Ischemic Heart Disease in Former Prisoners of War of World War II and the Korean Conflict.
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