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