Nov 2: VA denies many AO/AW/AP benefits

[ttweed@wildrockies.org (Tony Tweedale)]

tho I'm subsribed to all EPA's toxics/pollution listservs of FR
publications, I don't get stuff like this from VA.  Saw it by chance.
---

[Federal Register: November 2, 1999 (Volume 64, Number 211)]
[Notices]
[Page 59232-59243]
>From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02no99-101]

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DEPARTMENT OF VETERANS AFFAIRS


Diseases Not Associated With Exposure to Certain Herbicide Agents

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: As required by law, the Department of Veterans Affairs (VA)
hereby gives notice that the Secretary of Veterans Affairs, under the
authority granted by the Agent Orange Act of 1991, has determined that
a presumption of service connection based on exposure to herbicides
used in the Republic of Vietnam during the Vietnam era is not warranted
for the following conditions: Hepatobiliary cancers, nasal/
nasopharyngeal cancer, bone cancer, breast cancer, female reproductive
cancers, urinary bladder cancer, renal cancer, testicular cancer,
leukemia, abnormal sperm parameters and infertility, motor/coordination
dysfunction, chronic peripheral nervous system disorders, metabolic and
digestive disorders (other than diabetes mellitus), immune system
disorders, circulatory disorders, respiratory disorders (other than
certain respiratory cancers), skin cancer, cognitive and
neuropsychiatric effects, gastrointestinal tumors, brain tumors, and
any other condition for which the Secretary has not specifically
determined a presumption of service connection is warranted.

FOR FURTHER INFORMATION CONTACT: Donald England, Chief, Regulations
Staff, Compensation and Pension Service, Veterans Benefits
Administration, 810 Vermont Avenue, NW., Washington, DC 20420,
telephone (202) 273-7210.

SUPPLEMENTARY INFORMATION: Section 3 of the Agent Orange Act of 1991,
Pub. L. 102-4, 105 Stat. 11, directed the Secretary to seek to enter
into an agreement with the National Academy

[[Page 59233]]

of Sciences (NAS) to review and summarize the scientific evidence
concerning the association between exposure to herbicides used in
support of military operations in the Republic of Vietnam during the
Vietnam era and each disease suspected to be associated with such
exposure. Congress mandated that NAS determine, to the extent possible:
(1) Whether there is a statistical association between the suspect
diseases and herbicide exposure, taking into account the strength of
the scientific evidence and the appropriateness of the methods used to
detect the association; (2) the increased risk of disease among
individuals exposed to herbicides during service in the Republic of
Vietnam during the Vietnam era; and (3) whether there is a plausible
biological mechanism or other evidence of a causal relationship between
herbicide exposure and the suspect disease. Section 3 of Pub. L. 102-4
also required that NAS submit reports on its activities every two years
(as measured from the date of the first report) for a ten-year period.
    Section 2 of Pub. L. 102-4 provides that whenever the Secretary
determines, based on sound medical and scientific evidence, that a
positive association (i.e., the credible evidence for the association
is equal to or outweighs the credible evidence against the association)
exists between exposure of humans to an herbicide agent (i.e., a
chemical in an herbicide used in support of the United States and
allied military operations in the Republic of Vietnam during the
Vietnam era) and a disease, the Secretary will publish regulations
establishing presumptive service connection for that disease. If the
Secretary determines that a presumption of service connection is not
warranted, he is to publish a notice of that determination, including
an explanation of the scientific basis for that determination. The
Secretary's determination must be based on consideration of the NAS
reports and all other sound medical and scientific information and
analysis available to the Secretary.
    Although Pub. L. 102-4 does not define ``credible,'' it does
instruct the Secretary to ``take into consideration whether the results
[of any study] are statistically significant, are capable of
replication, and withstand peer review.'' Simply comparing the number
of studies which report a positive relative risk to the number of
studies which report a negative relative risk for a particular
condition is not a valid method for determining whether the weight of
evidence overall supports a finding that there is or is not a positive
association between herbicide exposure and the subsequent development
of the particular condition. Because of differences in statistical
significance, confidence levels, control for confounding factors, bias,
and other pertinent characteristics, some studies are clearly more
credible than others, and the Secretary has given the more credible
studies more weight in evaluating the overall weight of the evidence
concerning specific diseases.
    NAS issued its initial report, entitled ``Veterans and Agent
Orange: Health Effects of Herbicides Used in Vietnam,'' (VAO) on July
27, 1993. The Secretary subsequently determined that a positive
association exists between exposure to herbicides used in the Republic
of Vietnam and the subsequent development of Hodgkin's disease,
porphyria cutanea tarda, multiple myeloma, and certain respiratory
cancers; and that there was no positive association between herbicide
exposure and any other condition, other than chloracne, non-Hodgkin's
lymphoma, and soft-tissue sarcomas, for which presumptions already
existed. A notice of the diseases that the Secretary determined were
not associated with exposure to herbicide agents was published on
January 4, 1994 (See 59 FR 341-46).
    NAS issued its second report, entitled ``Veterans and Agent Orange:
Update 1996'' (Update 1996), on March 14, 1996. The Secretary
subsequently determined that a positive association exists between
exposure to herbicides used in the Republic of Vietnam and the
subsequent development of prostate cancer and acute and subacute
peripheral neuropathy in exposed persons. The Secretary further
determined that there was no positive association between herbicide
exposure and any other condition, other than those for which
presumptions already existed. A notice of the diseases that the
Secretary determined were not associated with exposure to herbicide
agents was published on August 8, 1996 (See 61 FR 41442-49).
    NAS issued a third report, entitled ``Veterans and Agent Orange:
Update 1998'' (Update 1998), on February 11, 1999. The focus of this
updated review was on new scientific studies published since the
release of Update 1996 and updates of scientific studies previously
reviewed.
    Shortly after NAS issued Update 1998, the Secretary formed a VA
task force to review the report and pertinent studies and to make
recommendations to assist him in determining whether a positive
association exists between herbicide exposure and any condition. The
task force has completed that review and submitted its recommendations
to the Secretary. This notice, pursuant to Pub. L. 102-4, conveys the
Secretary's determination that there is no positive association between
herbicide exposure and hepatobiliary cancers, nasal/nasopharyngeal
cancer, bone cancer, breast cancer, female reproductive cancers,
urinary bladder cancer, renal cancer, testicular cancer, leukemia,
abnormal sperm parameters and infertility, motor/coordination
dysfunction, chronic peripheral nervous system disorders, metabolic and
digestive disorders (other than diabetes mellitus), immune system
disorders, circulatory disorders, respiratory disorders (other than
certain respiratory cancers), skin cancer, cognitive and
neuropsychiatric effects, gastrointestinal tumors, brain tumors, and
any other condition for which the Secretary has not specifically
determined a presumption of service connection is warranted.
    This notice also conveys the Secretary's determination that a new
study concerning the possible association between exposure to
herbicides and diabetes mellitus that was published since NAS completed
Update 1998, is potentially significant. The Secretary has requested,
and the NAS is currently reviewing that new study and will determine
whether a positive association exists between herbicide exposure and
diabetes mellitus after their review.
    NAS, in Update 1998, assigns hepatobiliary cancers, nasal/
nasopharyngeal cancer, bone cancer, breast cancer, female reproductive
cancers, urinary bladder cancer, renal cancer, testicular cancer,
leukemia, abnormal sperm parameters and infertility, motor/coordination
dysfunction, chronic peripheral nervous system disorders, metabolic and
digestive disorders (including diabetes mellitus), immune system
disorders, circulatory disorders, respiratory disorders (other than
certain respiratory cancers), and skin cancer to a category labeled
inadequate/insufficient evidence to determine whether an association
exists. This is defined as meaning that the available studies are of
insufficient quality, consistency, or statistical power to permit a
conclusion regarding the presence or absence of an association with
herbicide exposure.

Hepatobiliary Cancers

    Hepatobiliary cancers are cancers of the liver and intrahepatic
bile ducts. There are a variety of known risk

[[Page 59234]]

[snip]