Improving the Presumptive Disability Decision-Making Process for Veterans (2008) / Chapter Skim
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Pages 70-82
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From page 70... ...
Concerned that World War II POWs might lack official medical records and have difficulties establishing the conditions of their internment, Congress first instructed VA to give special consideration and apply liberal evidentiary standards to POWs' claims. As details of the harsh nature of the POW experience became more widely known, and as members received complaints from some former POWs having difficulties establishing disability benefit claims, Congress began to enact statutory presumptions for certain nutritionally related conditions and mental illness.
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From page 71... ...
As one author observed of his 1992 study of POWs, the "descriptive" data obtained had "uses beyond the scientific," specifically in the "discussion of military service-connected disabilities." He added, "[d] espite 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" [Emphasis added]
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From page 72... ...
to make certain that previous scientific observations hold and to assess if the establishment of additional presumptions are needed. Prepublication Copy – Uncorrected Proof
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From page 73... ...
Arguably, the only site that might be excluded on this basis would be chronic lymphatic leukemia. Prepublication Copy – Uncorrected Proof
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From page 74... ...
. The second presumptive service-connection rule Prepublication Copy – Uncorrected Proof
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From page 75... ...
Consequently, a precedent was established by VA for causal health consequences associated with specific chemical agents as recommended by IOM. Lastly, this case Prepublication Copy – Uncorrected Proof
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From page 76... ...
The majority of the scientific findings from the IOM Gulf War committees and subsequent decisions by the VA Secretary to presumptively service connect or not service connect have not yet appeared in the Federal Register as required by statute, and VA has not yet presumptively connected any health conditions with Gulf War service. Lessons Learned Compensation presumptions mandated by Congress in the absence of certain scientific evidence which link Gulf War service to adverse health outcomes, while well intentioned, may have contributed to confusion and suspicion around the presumptive process.
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From page 77... ...
Absent research, the presumption may have strengthened the belief that some candidate toxicants or a mixture of environmental hazards known or unknown, existed in the Gulf War theater and were pervasively present at sufficient concentration to affect the thousands of veterans with symptoms of Unexplained Illness. Despite acknowledging preventable exposures to environmental chemicals in the Gulf War theater, after several IOM in Prepublication Copy – Uncorrected Proof
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From page 78... ...
Because the Committee did not have documentation of the rationale for VA's decision beyond the Federal Register notice, the basis for making a presumption given the particular IOM conclusion and scope of evidence was unclear to the Committee. Prepublication Copy – Uncorrected Proof
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From page 79... ...
Finally, as a consequence of this presumption, all veterans who served in Vietnam receive compensation for their Type 2 diabetes, as well as the associated complications of this morbid, chronic condition. This presumption will continue to have important financial consequences for VA as diabetes incidence generally in Prepublication Copy – Uncorrected Proof
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From page 80... ...
Some IOM Agent Orange reports have commented on the extent that Agent Orange exposure may contribute to diabetes rates observed among Vietnam veterans: "It must be noted, however, that these studies indicate that the increased risk, if any, from herbicide or dioxin exposure appears to be small. The known predic tors of diabetes risk – family history, physical inactivity, and obesity – continue to greatly outweigh any suggested increased risk from wartime exposure to herbi cides" (IOM, 2000b, pp.
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From page 81... ...
The interplay of these multiple factors and their relative weighting by VA were not described in any of the materials available to the Committee. SPINA BIFIDA PROGRAM Description This case study examines the 1996 and 2003 decisions to grant monetary compensation and health benefits to children of Vietnam and Korean War veterans with spina bifida based on the scientific evidence suggesting an association between herbicide exposure in Vietnam and Korea and spina bifida in the children of exposed veterans.
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From page 82... ...
However, in maximizing the sensitivity of presumptive decision-making for particular groups of veterans, substantial numbers of false positives may have resulted, as in the examples of Agent Orange and Gulf War. Additionally, because no systematic process for approaching presumptive decision-making exists, important omissions in this coverage remain without a clear mechanism for expanding coverage, as Prepublication Copy – Uncorrected Proof
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