Presumptions of Service Connection for Diseases Associated With Service Involving Detention or Internment as a Prisoner of War, 37040-37042 [05-12760]

Download as PDF 37040 Federal Register / Vol. 70, No. 123 / Tuesday, June 28, 2005 / Rules and Regulations direct effect on one or more Indian tribes, on the relationship between the Federal Government and Indian tribes, or on the distribution of power and responsibilities between the Federal Government and Indian tribes. Energy Effects We have analyzed this rule under Executive Order 13211, Actions Concerning Regulations That Significantly Affect Energy Supply, Distribution, or Use. We have determined that it is not a ‘‘significant energy action’’ under that order because it is not a ‘‘significant regulatory action’’ under Executive Order 12866 and is not likely to have a significant adverse effect on the supply, distribution, or use of energy. The Administrator of the Office of Information and Regulatory Affairs has not designated it as a significant energy action. Therefore, it does not require a Statement of Energy Effects under Executive Order 13211. Technical Standards The National Technology Transfer and Advancement Act (NTTAA) (15 U.S.C. 272 note) directs agencies to use voluntary consensus standards in their regulatory activities unless the agency provides Congress, through the Office of Management and Budget, with an explanation of why using these standards would be inconsistent with applicable law or otherwise impractical. Voluntary consensus standards are technical standards (e.g., specifications of materials, performance, design, or operation; test methods; sampling procedure; and related management system practices) that are developed or adopted by voluntary consensus standards bodies. This rule does not use technical standards. Therefore, we did not consider the use of voluntary consensus standards. Environment We have analyzed this proposed rule under Commandant Instruction M16475.1D, which guides the Coast Guard in complying with the National Environmental Policy Act of 1969 (NEPA) (42 U.S.C. 4321–4370f), and have made a preliminary determination that there are no factors in this case that would limit the use of categorical exclusion under Section 2.B.2 of the Instruction. Therefore, we believe this rule should be categorically excluded under figure 2–1, paragraph 34(g) of the Instruction, from further environmental documentation. A preliminary ‘‘Environmental Analysis Check List’’ is available in the docket where indicated under VerDate jul<14>2003 15:51 Jun 27, 2005 Jkt 205001 Comments on this section will be considered before we make the final decision on whether the rule should be categorically excluded from further environmental review. ADDRESSES. List of Subjects in 33 CFR Part 165 Harbors, Marine safety, Navigation (water), Reporting and recordkeeping requirements, Waterways. For the reasons discussed in the preamble, the Coast Guard amends 33 CFR part 165 as follows: I PART 165—REGULATED NAVIGATION AREAS AND LIMITED ACCESS AREAS 1. The authority citation for part 165 continues to read as follows: I Authority: 33 U.S.C. 1226, 1231; 46 U.S.C. Chapter 701; 50 U.S.C. 191, 195; 33 CFR 1.05–1(g), 6.04–1, 6.04–6, and 160.5; Pub. L. 107–295, 116 Stat. 2064; Department of Homeland Security Delegation No. 0170.1. I 2. Add § 165.T09–026 to read as follows: § 165.T09–026 Safety Zone; 2005 Mentor Harbor Offshore Classic, Mentor, OH. (a) Location. The following area is a safety zone: All waters located within 400 yards of the triangular race course as drawn by a line from position 41°43′49″ N, 081°21′18″ W to position 41°46′02″ N, 081°20′51″ W and to 41°45′34″ N, 081°18′04″ W. (b) Effective Period. This section is effective from noon (local) until 4 p.m. (local) on Sunday July 10, 2005. (c) Regulations. Entry into, transit through, or anchoring within this safety zone is prohibited unless authorized by the Captain of the Port Cleveland or his designated on-scene representative. The designated on-scene representative will be the Coast Guard Patrol Commander. The Coast Guard Patrol Commander may be contacted via VHF Channel 16. Dated: June 21, 2005. Lorne W. Thomas, Commander, U.S. Coast Guard, Captain of the Port Cleveland. [FR Doc. 05–12726 Filed 6–27–05; 8:45 am] BILLING CODE 4910–15–P DEPARTMENT OF VETERANS AFFAIRS 38 CFR Parts 1 and 3 RIN 2900–AM09 Presumptions of Service Connection for Diseases Associated With Service Involving Detention or Internment as a Prisoner of War AGENCY: PO 00000 Department of Veterans Affairs. Frm 00032 Fmt 4700 Sfmt 4700 Affirmation of interim final rule as final rule. ACTION: SUMMARY: This document affirms as final, without change, an interim final rule that established presumptions of service connection for atherosclerotic heart disease, hypertensive vascular disease, and stroke in former prisoners of war; set forth guidelines to govern future actions by the Department of Veterans Affairs (VA) to establish presumptions of service connection for other diseases associated with service involving detention or internment as a prisoner of war; and revised VA’s regulations to conform to statutory changes made by the Veterans Benefits Act of 2003. DATES: The interim final rule became effective on October 7, 2004. FOR FURTHER INFORMATION CONTACT: Maya Ferrandino, Consultant, Compensation and Pension Service, Policy and Regulations Staff, Veterans Benefits Administration, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 273–7232. SUPPLEMENTARY INFORMATION: Background In a document published in the Federal Register on October 7, 2004 (69 FR 60083), VA issued an interim final rule that set forth guidelines to govern VA’s determinations as to whether presumptions of service connection are warranted for any disease based on a finding that the disease may be associated with service involving detention or internment as a prisoner of war (POW). The interim final rule also established presumptions of service connection, pursuant to those guidelines, for atherosclerotic heart disease, hypertensive vascular disease, stroke, and their complications in former POWs. Finally, the interim final rule revised VA’s regulations to reflect statutory changes made by section 201 of the Veterans Benefits Act of 2003, Public Law No. 108–183, which revised 38 U.S.C. 1112(b) to remove, for certain POW presumptive diseases, the previous requirement that the former POW must have been detained or interned for at least 30 days in order to qualify for the presumption. We solicited public comments on the interim final rule and we received comments from one individual. In the October 7, 2004, Federal Register notice, we explained that VA generally employs evidentiary presumptions of service connection to assist claimants who face unusually difficult evidentiary burdens in demonstrating entitlement to VA E:\FR\FM\28JNR1.SGM 28JNR1 Federal Register / Vol. 70, No. 123 / Tuesday, June 28, 2005 / Rules and Regulations disability and death benefits, due to circumstances such as the complexity of the medical issues involved in the claim or the lack of contemporaneous medical records during periods of service. We explained that Congress had previously established guidelines for determining whether new presumptions of service connection are warranted for disabilities associated with certain hazards of service, but had not established any guidelines for determining whether presumptions were warranted for diseases associated with service involving detention or internment as a prisoner of war. Accordingly, the interim final rule established such guidelines in 38 CFR 1.18, which, among other things, states that the Secretary of Veterans Affairs may establish a presumption of service connection for a disease when the Secretary finds that there is ‘‘limited/ suggestive’’ evidence that an increased risk of such disease is associated with service involving detention or internment as a POW and the association is biologically plausible. Applying the new guidelines in § 1.18, the Secretary determined that presumptions of service connection were warranted for atherosclerotic heart disease, hypertensive vascular disease, stroke, and their complications based on medical evidence indicating that those diseases are associated with service involving detention or internment as a POW. Accordingly, the interim final rule revised 38 CFR 3.309(c) to add those diseases to the list of diseases presumed to be associated with such service. Analysis of Public Comment We received comments from an epidemiologist with experience in veterans’ health studies. Based on several medical studies, the commenter states that veterans who have a longterm history of post-traumatic stress disorder (PTSD) have a high risk of developing cardiovascular disease and myocardial infarction, particularly if such veterans suffer from other major psychiatric disorders or inflammatory diseases in addition to PTSD. The commenter states that, because former POWs have a relatively high rate of PTSD incurrence, they would presumably have an increased risk of cardiovascular disease. As noted above, the interim final rule established presumptions of service connection for atherosclerotic heart disease, hypertensive vascular disease, and their complications, including myocardial infarction, in former POWs. This action was based on the Secretary’s determination that there was at least VerDate jul<14>2003 15:51 Jun 27, 2005 Jkt 205001 limited/suggestive evidence of an association between cardiovascular disease and POW experience and that such an association is biologically plausible. We noted that medical studies had detected an increased risk of cardiovascular disease among former POWs. We further noted that the evidence of an association between PTSD and cardiovascular disease lends support to our conclusion that cardiovascular disease is associated with POW experience. Accordingly, we believe the commenter’s statement that former POWs have a higher risk of cardiovascular disease is consistent with our interim final rule. To the extent the comment might be viewed as suggesting that we should use the term ‘‘cardiovascular disease’’ rather than the terms ‘‘atherosclerotic heart disease’’ and ‘‘hypertensive vascular disease’’ to describe the presumptive diseases, we make no change based on that comment. As explained in our October 7, 2004, Federal Register notice, the terms ‘‘atherosclerotic heart disease’’ and ‘‘hypertensive vascular disease’’ are broad terms encompassing a wide variety of cardiovascular diseases that may be described by more specific diagnoses in individual cases. We have concluded that those terms are sufficiently broad to cover the cardiovascular diseases for which there is evidence suggestive of an association with POW experience and, moreover, for which there is a biologically plausible relationship to circumstances of POW experience such as malnutrition and stress. We do not have sufficient evidence at this time to conclude that there is a sufficiently demonstrated and biologically plausible association between POW experience and certain other types of cardiovascular disease such as those of viral or bacterial origin. Accordingly, we believe that the term ‘‘atherosclerotic heart disease’’ most aptly describes the range of heart diseases for which current medical evidence supports a presumption of service connection, and that the term ‘‘hypertensive vascular disease’’ most aptly describes the range of peripheral vascular diseases for which current medical evidence supports a presumption of service connection. The commenter also states that veterans with chronic PTSD have been found to have a significant risk of developing autoimmune diseases, such as rheumatoid arthritis, psoriasis, insulin-dependent diabetes, and hypothyroidism, and asserts that former POWs are therefore likely to have a higher risk of autoimmune diseases. We make no change based on this comment because it involves matters beyond the PO 00000 Frm 00033 Fmt 4700 Sfmt 4700 37041 scope of the interim final rule. Although the interim final rule established presumptions of service connection for certain diseases, it should not be construed to reflect a determination by VA concerning the strength of any evidence that may exist for a possible association between other diseases, such as autoimmune diseases, and POW experience. In order to ensure the prompt delivery of benefits to the aging POW population, VA necessarily focused on certain diseases for which it was aware of the compelling evidence of an association with POW service. The issue of whether presumptions may be established for other specific diseases is beyond the scope of this final rule. However, the purpose of establishing guidelines in new § 1.18 was to provide a framework for VA, on an ongoing basis, to evaluate scientific and medical evidence pertaining to diseases possibly associated with POW experience as well as policy issues pertaining to the need for particular presumptions. Accordingly, evidence such as that cited by the commenter with respect to autoimmune diseases may be the subject of subsequent review and deliberation under the newly established guidelines. We note further that existing VA regulations may provide a basis for granting service connection to former POWs who incur autoimmune diseases as a result of PTSD. Currently, 38 CFR 3.309(c) establishes a presumption of service connection for anxiety disorders, including PTSD, in former POWs. A separate regulation at 38 CFR 3.310 provides that service connection may be granted for any disability arising as a proximate result of a service-connected condition. Pursuant to those regulations, a former POW who has PTSD may be able to establish service connection for an autoimmune disease if medical evidence shows that the veteran’s disease proximately resulted from the veteran’s PTSD. Administrative Procedure Act In the October 7, 2004, Federal Register notice, we determined that there was a basis under the Administrative Procedure Act for issuing the interim final rule with immediate effect. We invited and received public comment on the interim final rule. This document merely affirms the interim final rule as a final rule without change. Unfunded Mandates The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 1532, that agencies prepare an assessment of anticipated costs and benefits before developing any rule that may result in E:\FR\FM\28JNR1.SGM 28JNR1 37042 Federal Register / Vol. 70, No. 123 / Tuesday, June 28, 2005 / Rules and Regulations an expenditure by State, local, or tribal governments, in the aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any given year. This rule will have no such effect on State, local, or tribal governments, or the private sector. Paperwork Reduction Act This document contains no new collections of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501–3521). The Office of Management and Budget (OMB) previously has approved the VA application forms governing claims for benefits based on service-connected disability or death. Those forms specify the requirements for submitting information and evidence in support of such claims and would govern any claims for benefits based on the presumptions established by this rule. By establishing presumptions of service connection, this rule will relieve some claimants of the need to submit evidence directly establishing that a cardiovascular disease was incurred in or aggravated by service. The OMB approval numbers for the relevant information collections are 2900–0001 (VA Form 21–526, Veterans’ Application for Compensation and/or Pension); 2900–0004 (VA Form 21–534, Application for DIC, Death Compensation, and Accrued Benefits by a Surviving Spouse or Child); and 2900– 0005 (VA Form 21–535, Application for DIC by Parent(s)). Regulatory Flexibility Act The Secretary hereby certifies that this regulatory action will not have a significant economic impact on a substantial number of small entities as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601–612. The reason for this certification is that these amendments will not directly affect any small entities. Only VA beneficiaries and their survivors will be directly affected. Catalog of Federal Domestic Assistance The Catalog of Federal Domestic Assistance program numbers are 64.109, Veterans Compensation for ServicesConnected Disability; and 64.110, Veterans Dependency and Indemnity Compensation for Service-Connected Death. List of Subjects 38 CFR Part 1 Administrative practice and procedure, Claims. VerDate jul<14>2003 15:51 Jun 27, 2005 Jkt 205001 38 CFR Part 3 Since the communities on the attached list have recently entered the NFIP, Administrative practice and subsidized flood insurance is now procedure, Claims, Disability benefits, available for property in the community. Health care, Veterans, Vietnam. In addition, the Federal Emergency Approved: May 10, 2005. Management Agency has identified the R. James Nicholson, special flood hazard areas in some of these communities by publishing a Secretary of Veterans Affairs. Flood Hazard Boundary Map (FHBM) or I Accordingly, the interim final rule Flood Insurance Rate Map (FIRM). The amending 38 CFR parts 1 and 3 which was published at 69 FR 60083 is adopted date of the flood map, if one has been published, is indicated in the fourth as a final rule without change. column of the table. In the communities [FR Doc. 05–12760 Filed 6–27–05; 8:45 am] listed where a flood map has been BILLING CODE 8320–01–P published, Section 202 of the Flood Disaster Protection Act of 1973, as amended, 42 U.S.C. 4016(a), requires DEPARTMENT OF HOMELAND the purchase of flood insurance as a SECURITY condition of Federal or federally related financial assistance for acquisition or Federal Emergency Management construction of buildings in the special Agency flood hazard areas shown on the map. The Administrator finds that delayed 44 CFR Part 64 effective dates would be contrary to the public interest and that notice and [Docket No. FEMA–7778] public procedure under 5 U.S.C. 553(b) are impracticable and unnecessary. List of Communities Eligible for the National Environmental Policy Act. Sale of Flood Insurance This rule is categorically excluded from AGENCY: Federal Emergency the requirements of 44 CFR Part 10, Management Agency, Emergency Environmental Considerations. No Preparedness and Response Directorate, environmental impact assessment has Department of Homeland Security. been prepared. ACTION: Final rule. Regulatory Flexibility Act. The Administrator certifies that this rule SUMMARY: This rule identifies will not have a significant economic communities participating in the impact on a substantial number of small National Flood Insurance Program entities in accordance with the (NFIP) and suspended from the NFIP. Regulatory Flexibility Act, 5 U. S. C. 601 These communities have applied to the et seq., because the rule creates no program and have agreed to enact additional burden, but lists those certain floodplain management communities eligible for the sale of measures. The communities’ flood insurance. participation in the program authorizes Regulatory Classification. This final the sale of flood insurance to owners of rule is not a significant regulatory action property located in the communities under the criteria of section 3(f) of listed. Executive Order 12866 of September 30, 1993, Regulatory Planning and Review, DATES: Effective Dates: The dates listed under the column headed Effective Date 58 FR 51735. Paperwork Reduction Act. This rule of Eligibility. does not involve any collection of ADDRESSES: Flood insurance policies for information for purposes of the property located in the communities listed can be obtained from any licensed Paperwork Reduction Act, 44 U.S.C. 3501 et seq. property insurance agent or broker Executive Order 12612, Federalism. serving the eligible community or from This rule involves no policies that have the NFIP at: (800) 638–6620. federalism implications under Executive FOR FURTHER INFORMATION CONTACT: Order 12612, Federalism, October 26, Michael M. Grimm, Mitigation Division, 1987, 3 CFR, 1987 Comp., p. 252. 500 C Street, SW.; Room 412, Executive Order 12778, Civil Justice Washington, DC 20472, (202) 646–2878. Reform. This rule meets the applicable SUPPLEMENTARY INFORMATION: The NFIP standards of section 2(b)(2) of Executive enables property owners to purchase Order 12778, October 25, 1991, 56 FR flood insurance which is generally not 55195, 3 CFR, 1991 Comp., p. 309. otherwise available. In return, List of Subjects in 44 CFR Part 64 communities agree to adopt and Flood insurance, Floodplains. administer local floodplain management measures aimed at protecting lives and I Accordingly, 44 CFR part 64 is new construction from future flooding. amended as follows: PO 00000 Frm 00034 Fmt 4700 Sfmt 4700 E:\FR\FM\28JNR1.SGM 28JNR1

Agencies

[Federal Register Volume 70, Number 123 (Tuesday, June 28, 2005)]
[Rules and Regulations]
[Pages 37040-37042]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-12760]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Parts 1 and 3

RIN 2900-AM09


Presumptions of Service Connection for Diseases Associated With 
Service Involving Detention or Internment as a Prisoner of War

AGENCY: Department of Veterans Affairs.

ACTION: Affirmation of interim final rule as final rule.

-----------------------------------------------------------------------

SUMMARY: This document affirms as final, without change, an interim 
final rule that established presumptions of service connection for 
atherosclerotic heart disease, hypertensive vascular disease, and 
stroke in former prisoners of war; set forth guidelines to govern 
future actions by the Department of Veterans Affairs (VA) to establish 
presumptions of service connection for other diseases associated with 
service involving detention or internment as a prisoner of war; and 
revised VA's regulations to conform to statutory changes made by the 
Veterans Benefits Act of 2003.

DATES: The interim final rule became effective on October 7, 2004.

FOR FURTHER INFORMATION CONTACT: Maya Ferrandino, Consultant, 
Compensation and Pension Service, Policy and Regulations Staff, 
Veterans Benefits Administration, 810 Vermont Avenue, NW., Washington, 
DC 20420, (202) 273-7232.

SUPPLEMENTARY INFORMATION:

Background

    In a document published in the Federal Register on October 7, 2004 
(69 FR 60083), VA issued an interim final rule that set forth 
guidelines to govern VA's determinations as to whether presumptions of 
service connection are warranted for any disease based on a finding 
that the disease may be associated with service involving detention or 
internment as a prisoner of war (POW). The interim final rule also 
established presumptions of service connection, pursuant to those 
guidelines, for atherosclerotic heart disease, hypertensive vascular 
disease, stroke, and their complications in former POWs. Finally, the 
interim final rule revised VA's regulations to reflect statutory 
changes made by section 201 of the Veterans Benefits Act of 2003, 
Public Law No. 108-183, which revised 38 U.S.C. 1112(b) to remove, for 
certain POW presumptive diseases, the previous requirement that the 
former POW must have been detained or interned for at least 30 days in 
order to qualify for the presumption. We solicited public comments on 
the interim final rule and we received comments from one individual.
    In the October 7, 2004, Federal Register notice, we explained that 
VA generally employs evidentiary presumptions of service connection to 
assist claimants who face unusually difficult evidentiary burdens in 
demonstrating entitlement to VA

[[Page 37041]]

disability and death benefits, due to circumstances such as the 
complexity of the medical issues involved in the claim or the lack of 
contemporaneous medical records during periods of service. We explained 
that Congress had previously established guidelines for determining 
whether new presumptions of service connection are warranted for 
disabilities associated with certain hazards of service, but had not 
established any guidelines for determining whether presumptions were 
warranted for diseases associated with service involving detention or 
internment as a prisoner of war. Accordingly, the interim final rule 
established such guidelines in 38 CFR 1.18, which, among other things, 
states that the Secretary of Veterans Affairs may establish a 
presumption of service connection for a disease when the Secretary 
finds that there is ``limited/suggestive'' evidence that an increased 
risk of such disease is associated with service involving detention or 
internment as a POW and the association is biologically plausible.
    Applying the new guidelines in Sec.  1.18, the Secretary determined 
that presumptions of service connection were warranted for 
atherosclerotic heart disease, hypertensive vascular disease, stroke, 
and their complications based on medical evidence indicating that those 
diseases are associated with service involving detention or internment 
as a POW. Accordingly, the interim final rule revised 38 CFR 3.309(c) 
to add those diseases to the list of diseases presumed to be associated 
with such service.

Analysis of Public Comment

    We received comments from an epidemiologist with experience in 
veterans' health studies. Based on several medical studies, the 
commenter states that veterans who have a long-term history of post-
traumatic stress disorder (PTSD) have a high risk of developing 
cardiovascular disease and myocardial infarction, particularly if such 
veterans suffer from other major psychiatric disorders or inflammatory 
diseases in addition to PTSD. The commenter states that, because former 
POWs have a relatively high rate of PTSD incurrence, they would 
presumably have an increased risk of cardiovascular disease. As noted 
above, the interim final rule established presumptions of service 
connection for atherosclerotic heart disease, hypertensive vascular 
disease, and their complications, including myocardial infarction, in 
former POWs. This action was based on the Secretary's determination 
that there was at least limited/suggestive evidence of an association 
between cardiovascular disease and POW experience and that such an 
association is biologically plausible. We noted that medical studies 
had detected an increased risk of cardiovascular disease among former 
POWs. We further noted that the evidence of an association between PTSD 
and cardiovascular disease lends support to our conclusion that 
cardiovascular disease is associated with POW experience. Accordingly, 
we believe the commenter's statement that former POWs have a higher 
risk of cardiovascular disease is consistent with our interim final 
rule.
    To the extent the comment might be viewed as suggesting that we 
should use the term ``cardiovascular disease'' rather than the terms 
``atherosclerotic heart disease'' and ``hypertensive vascular disease'' 
to describe the presumptive diseases, we make no change based on that 
comment. As explained in our October 7, 2004, Federal Register notice, 
the terms ``atherosclerotic heart disease'' and ``hypertensive vascular 
disease'' are broad terms encompassing a wide variety of cardiovascular 
diseases that may be described by more specific diagnoses in individual 
cases. We have concluded that those terms are sufficiently broad to 
cover the cardiovascular diseases for which there is evidence 
suggestive of an association with POW experience and, moreover, for 
which there is a biologically plausible relationship to circumstances 
of POW experience such as malnutrition and stress. We do not have 
sufficient evidence at this time to conclude that there is a 
sufficiently demonstrated and biologically plausible association 
between POW experience and certain other types of cardiovascular 
disease such as those of viral or bacterial origin. Accordingly, we 
believe that the term ``atherosclerotic heart disease'' most aptly 
describes the range of heart diseases for which current medical 
evidence supports a presumption of service connection, and that the 
term ``hypertensive vascular disease'' most aptly describes the range 
of peripheral vascular diseases for which current medical evidence 
supports a presumption of service connection.
    The commenter also states that veterans with chronic PTSD have been 
found to have a significant risk of developing autoimmune diseases, 
such as rheumatoid arthritis, psoriasis, insulin-dependent diabetes, 
and hypothyroidism, and asserts that former POWs are therefore likely 
to have a higher risk of autoimmune diseases. We make no change based 
on this comment because it involves matters beyond the scope of the 
interim final rule. Although the interim final rule established 
presumptions of service connection for certain diseases, it should not 
be construed to reflect a determination by VA concerning the strength 
of any evidence that may exist for a possible association between other 
diseases, such as autoimmune diseases, and POW experience. In order to 
ensure the prompt delivery of benefits to the aging POW population, VA 
necessarily focused on certain diseases for which it was aware of the 
compelling evidence of an association with POW service. The issue of 
whether presumptions may be established for other specific diseases is 
beyond the scope of this final rule. However, the purpose of 
establishing guidelines in new Sec.  1.18 was to provide a framework 
for VA, on an ongoing basis, to evaluate scientific and medical 
evidence pertaining to diseases possibly associated with POW experience 
as well as policy issues pertaining to the need for particular 
presumptions. Accordingly, evidence such as that cited by the commenter 
with respect to autoimmune diseases may be the subject of subsequent 
review and deliberation under the newly established guidelines.
    We note further that existing VA regulations may provide a basis 
for granting service connection to former POWs who incur autoimmune 
diseases as a result of PTSD. Currently, 38 CFR 3.309(c) establishes a 
presumption of service connection for anxiety disorders, including 
PTSD, in former POWs. A separate regulation at 38 CFR 3.310 provides 
that service connection may be granted for any disability arising as a 
proximate result of a service-connected condition. Pursuant to those 
regulations, a former POW who has PTSD may be able to establish service 
connection for an autoimmune disease if medical evidence shows that the 
veteran's disease proximately resulted from the veteran's PTSD.

Administrative Procedure Act

    In the October 7, 2004, Federal Register notice, we determined that 
there was a basis under the Administrative Procedure Act for issuing 
the interim final rule with immediate effect. We invited and received 
public comment on the interim final rule. This document merely affirms 
the interim final rule as a final rule without change.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 
1532, that agencies prepare an assessment of anticipated costs and 
benefits before developing any rule that may result in

[[Page 37042]]

an expenditure by State, local, or tribal governments, in the 
aggregate, or by the private sector, of $100 million or more (adjusted 
annually for inflation) in any given year. This rule will have no such 
effect on State, local, or tribal governments, or the private sector.

Paperwork Reduction Act

    This document contains no new collections of information under the 
Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521). The Office of 
Management and Budget (OMB) previously has approved the VA application 
forms governing claims for benefits based on service-connected 
disability or death. Those forms specify the requirements for 
submitting information and evidence in support of such claims and would 
govern any claims for benefits based on the presumptions established by 
this rule. By establishing presumptions of service connection, this 
rule will relieve some claimants of the need to submit evidence 
directly establishing that a cardiovascular disease was incurred in or 
aggravated by service. The OMB approval numbers for the relevant 
information collections are 2900-0001 (VA Form 21-526, Veterans' 
Application for Compensation and/or Pension); 2900-0004 (VA Form 21-
534, Application for DIC, Death Compensation, and Accrued Benefits by a 
Surviving Spouse or Child); and 2900-0005 (VA Form 21-535, Application 
for DIC by Parent(s)).

Regulatory Flexibility Act

    The Secretary hereby certifies that this regulatory action will not 
have a significant economic impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act, 5 
U.S.C. 601-612. The reason for this certification is that these 
amendments will not directly affect any small entities. Only VA 
beneficiaries and their survivors will be directly affected.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance program numbers are 
64.109, Veterans Compensation for Services-Connected Disability; and 
64.110, Veterans Dependency and Indemnity Compensation for Service-
Connected Death.

List of Subjects

38 CFR Part 1

    Administrative practice and procedure, Claims.

38 CFR Part 3

    Administrative practice and procedure, Claims, Disability benefits, 
Health care, Veterans, Vietnam.

    Approved: May 10, 2005.
R. James Nicholson,
Secretary of Veterans Affairs.

0
Accordingly, the interim final rule amending 38 CFR parts 1 and 3 which 
was published at 69 FR 60083 is adopted as a final rule without change.

[FR Doc. 05-12760 Filed 6-27-05; 8:45 am]
BILLING CODE 8320-01-P