Response To Comments for The Department of Veterans Affairs To Assess the Scientific Literature and Claims Data Regarding Certain Medical Conditions Associated With Military Environmental Exposures, 33471-33472 [2024-09164]
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information collection, and TTB is
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only. As for adjustments, due to changes
in agency estimates, TTB is increasing
the estimated number of annual
respondents, responses, and burden
hours associated with this information
collection.
Type of Review: Extension of a
currently approved collection.
Affected Public: Businesses and other
for-profits.
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Average Responses per Respondent: 5
per year.
Number of Responses: 215.
Average per-Response Burden: 1 hour.
Total Burden: 240 hours.
Authority: 44 U.S.C. 3501 et seq.
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[FR Doc. 2024–09133 Filed 4–26–24; 8:45 am]
BILLING CODE 4810–31–P
DEPARTMENT OF VETERANS
AFFAIRS
Response To Comments for The
Department of Veterans Affairs To
Assess the Scientific Literature and
Claims Data Regarding Certain Medical
Conditions Associated With Military
Environmental Exposures
Department of Veterans Affairs.
Response to comments.
AGENCY:
ACTION:
On July 26, 2023, the
Department of Veterans Affairs (VA)
published a notice soliciting public
comment on its plan to assess the
scientific literature and historical claims
data regarding certain medical
conditions (multiple myeloma, acute
leukemias, and chronic leukemias)
associated with military environmental
exposures. On October 24, 2023, VA
published a second notice announcing
its intent to host a virtual public
listening session on this topic on
November 7, 2023. This third notice
provides responses to the public
comments received during the open
comment period and public listening
session.
SUMMARY:
FOR FURTHER INFORMATION CONTACT:
Peter Rumm, MD, Director of Policy,
Health Outcomes Military Exposures,
Veterans Health Administration,
Department of Veterans Affairs, 810
Vermont Avenue NW, Washington, DC
20420, 202–461–7297. (This is not a
toll-free number.)
SUPPLEMENTARY INFORMATION: VA
provided a 30-day comment period,
which ended on August 25, 2023.
Individuals or organizations submitted
PO 00000
Frm 00160
Fmt 4703
Sfmt 4703
33471
26 comments to this first Federal
Register Notice (FRN). Participation in
the public listening session included 12
comments presented by speakers and 13
comments submitted using the chat
feature during the meeting. The
Veterans Health Administration’s
(VHA’s) HOME Program Office received
and responded to 357 emails from
Veterans and made 8 telephone calls to
address individual Veterans’ potential
military environmental exposure
concerns for those who were unable to
speak during the listening session due
to time constraints.
Overall, comments supported VA’s
plan to assess the scientific literature
and historical claims data regarding
multiple myeloma, acute leukemias, and
chronic leukemia associated with
military environmental exposures
although some discussed additional
concerns. The 26 formal comments
received during the 30-day comment
period on the first FRN were grouped
into 3 main categories, with some
comments falling into more than one
category:
• Category 1—Comments directly
related to multiple myeloma, acute
leukemias, and chronic leukemia: 18 out
of 26 (69%). Notably, of the 18, 17 out
of 18 (94%) of these comments
expressed support for VA’s plan to
assess the scientific literature and
historical claims data regarding certain
medical conditions (multiple myeloma,
acute leukemias, and chronic
leukemias) associated with military
environmental exposures.
Æ More comments were received
specifically supportive of multiple
myeloma versus the leukemias.
Æ There was only 1 non-supportive
comment out of 18 (under 6%).
• Category 2—Comments pertaining
to additional locations: 8 out of 26
(31%) comments suggested VA consider
presumptions for locations outside Gulf
War and southwest Asia locations that
are covered by the Sergeant First Class
Heath Robinson Honoring our Promise
to Address Comprehensive Toxics
(PACT) Act.
• Category 3—Comments pertaining
to additional conditions: 7 out of 26
(27%) comments suggested various
conditions for future review.
VA thanks the commenters and
attendees for their support and
comments. To expand upon the
comments in more detail, participants
suggested that VA include additional
conditions (e.g., neurologic conditions,
sleep apnea, hypertension, chronic
multi-symptom illness, and immune
disorders) to be considered for
association with exposure from burn
pits and other toxic substances (e.g.,
E:\FR\FM\29APN1.SGM
29APN1
33472
Federal Register / Vol. 89, No. 83 / Monday, April 29, 2024 / Notices
khammond on DSKJM1Z7X2PROD with NOTICES
benzene, formaldehyde, dioxin, and
heavy metals) present on post-9/11
deployments in addition to the PACT
Act established categories of
presumptive conditions. Other
deployments, including burn pits or
other toxins in Vietnam (see also below)
were mentioned. Commenters also
noted a preference for additional
locations (e.g., Naval Air Facility Atsugi,
Japan, Vietnam, Haiti, Honduras,
Panama, and Bosnia) to be considered
for toxic exposure, as well as various
military bases or garrisons. Finally,
some participants expressed a desire for
more public input into the VA decisionmaking process.
Senior VA leadership attended the
November 7, 2023, WEBEX virtual
public listening session. After Mr. Josh
Jacobs, Under Secretary for Benefits
(USB), provided opening remarks, Dr.
Patricia Hastings, Chief Consultant
HOME, delivered a presentation on the
revised presumptive decision process.
Twelve representatives from Veterans
Service Organizations, academia, and
the Veteran community expressed their
views and comments during the session.
In addition to the 12 speakers, the chat
feature within WEBEX recorded an
additional 13 comments. Dr. Shereef
Elnahal, Under Secretary for Health
(USH), provided closing remarks and
emphasized VA and Congress’ interest
in responding to the public’s instructive
and important comments. USB Jacobs
and USH Elnahal expressed
appreciation for the public’s
participation in this process.
The listening session allowed VA to
be proactive in its approach to improve
care, treatment, and benefits for toxicexposed Veterans, and consider areas of
public interest regarding current or
planned research of potential
presumptive conditions. During the
listening session, most comments fell
into the additional location and
conditions categories. Several comments
supported future study and potential
recognition of sleep apnea as a
presumptive condition. Listeners were
assured that additional locations and
VerDate Sep<11>2014
20:54 Apr 26, 2024
Jkt 262001
conditions are continuously monitored
and may be presented for a formal
review in the future. HOME and
Veterans Benefits Administration (VBA)
Military Exposures Team staff members
communicated with participants who
raised specific questions during the
session.
VBA’s compensation disability
evaluation and rating system is
complex, as is the arena of military
environmental exposures. Some
comments indicated misunderstandings
of the VA’s benefits system and
decision-making process. Additional
evidence of misunderstandings
regarding VHA in areas such as the
impact of vaccines and chemical
exposures were also expressed. To limit
misunderstanding, VBA and VHA are
expanding outreach efforts each year to
enhance understanding of Veteran
health and benefits systems.
Moving Forward
VA continues to review and assess
information about military
environmental exposure incidents,
emerging scientific evidence regarding
toxic substances, and health outcomes
in deployed and non-deployed cohorts.
Additionally, active epidemiological
surveillance and ongoing monitoring of
military exposures in collaboration with
the Department of Defense is ongoing.
VA’s involvement in surveillance,
monitoring, and research covers a wide
variety of areas. When a scientific
review concludes that there is a
statistically significant signal or possible
association between military
environment exposure and health
outcomes, this may trigger an
investigation that may lead to additional
research or may be subject to an FRN
and comment process required under
section 202 of the PACT Act. Additional
notices of this type will be published as
VA reviews conditions and their
possible association with military
environmental exposures to provide
health care, services, and benefits to
Veterans entitled to them. VA has
considered the issues presented by
commenters and decided to conduct a
PO 00000
Frm 00161
Fmt 4703
Sfmt 9990
scientific review of multiple myeloma
and chronic and acute leukemias, taking
into account the latest scientific
classification schemes for blood cancers
and scientific evidence regarding shared
etiologies. VA will follow the
procedures in 38 U.S.C. 1172–1174 for
initiating and conducting assessments
and formal evaluations. VA has
designated a Technical Working Group
(TWG) to assess cases of the toxic
exposure of Veterans and their
dependents pursuant to 38 U.S.C.
1172(c). The TWG may develop a
recommendation for formal evaluation
under 38 U.S.C. 1173, pursuant to 38
U.S.C. 1172(d). Once a formal
evaluation begins, a recommendation to
establish or modify a presumption of
service connection must be submitted to
the Secretary within 120 days per 38
U.S.C. 1173(d). Within 160 days of
receiving the recommendation to
establish or modify a presumption of
service connection, the Secretary must
determine whether a presumption is
warranted per 38 U.S.C. 1174(a). This
may include commencing rulemaking to
establish or modify presumptions for
some or all of the conditions formally
evaluated and/or publishing notice in
the FRN of any determination that
establishment or modification of a
presumption or presumptions are
unwarranted for some or all of the
conditions that were subject to the
formal evaluation.
Signing Authority
Denis McDonough, Secretary of
Veterans Affairs, approved and signed
this document on April 17, 2024, and
authorized the undersigned to sign and
submit the document to the Office of the
Federal Register for publication
electronically as an official document of
the Department of Veterans Affairs.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy
& Management, Office of General Counsel,
Department of Veterans Affairs.
[FR Doc. 2024–09164 Filed 4–26–24; 8:45 am]
BILLING CODE 8320–01–P
E:\FR\FM\29APN1.SGM
29APN1
Agencies
[Federal Register Volume 89, Number 83 (Monday, April 29, 2024)]
[Notices]
[Pages 33471-33472]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-09164]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
Response To Comments for The Department of Veterans Affairs To
Assess the Scientific Literature and Claims Data Regarding Certain
Medical Conditions Associated With Military Environmental Exposures
AGENCY: Department of Veterans Affairs.
ACTION: Response to comments.
-----------------------------------------------------------------------
SUMMARY: On July 26, 2023, the Department of Veterans Affairs (VA)
published a notice soliciting public comment on its plan to assess the
scientific literature and historical claims data regarding certain
medical conditions (multiple myeloma, acute leukemias, and chronic
leukemias) associated with military environmental exposures. On October
24, 2023, VA published a second notice announcing its intent to host a
virtual public listening session on this topic on November 7, 2023.
This third notice provides responses to the public comments received
during the open comment period and public listening session.
FOR FURTHER INFORMATION CONTACT: Peter Rumm, MD, Director of Policy,
Health Outcomes Military Exposures, Veterans Health Administration,
Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC
20420, 202-461-7297. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: VA provided a 30-day comment period, which
ended on August 25, 2023. Individuals or organizations submitted 26
comments to this first Federal Register Notice (FRN). Participation in
the public listening session included 12 comments presented by speakers
and 13 comments submitted using the chat feature during the meeting.
The Veterans Health Administration's (VHA's) HOME Program Office
received and responded to 357 emails from Veterans and made 8 telephone
calls to address individual Veterans' potential military environmental
exposure concerns for those who were unable to speak during the
listening session due to time constraints.
Overall, comments supported VA's plan to assess the scientific
literature and historical claims data regarding multiple myeloma, acute
leukemias, and chronic leukemia associated with military environmental
exposures although some discussed additional concerns. The 26 formal
comments received during the 30-day comment period on the first FRN
were grouped into 3 main categories, with some comments falling into
more than one category:
Category 1--Comments directly related to multiple myeloma,
acute leukemias, and chronic leukemia: 18 out of 26 (69%). Notably, of
the 18, 17 out of 18 (94%) of these comments expressed support for VA's
plan to assess the scientific literature and historical claims data
regarding certain medical conditions (multiple myeloma, acute
leukemias, and chronic leukemias) associated with military
environmental exposures.
[cir] More comments were received specifically supportive of
multiple myeloma versus the leukemias.
[cir] There was only 1 non-supportive comment out of 18 (under 6%).
Category 2--Comments pertaining to additional locations: 8
out of 26 (31%) comments suggested VA consider presumptions for
locations outside Gulf War and southwest Asia locations that are
covered by the Sergeant First Class Heath Robinson Honoring our Promise
to Address Comprehensive Toxics (PACT) Act.
Category 3--Comments pertaining to additional conditions:
7 out of 26 (27%) comments suggested various conditions for future
review.
VA thanks the commenters and attendees for their support and
comments. To expand upon the comments in more detail, participants
suggested that VA include additional conditions (e.g., neurologic
conditions, sleep apnea, hypertension, chronic multi-symptom illness,
and immune disorders) to be considered for association with exposure
from burn pits and other toxic substances (e.g.,
[[Page 33472]]
benzene, formaldehyde, dioxin, and heavy metals) present on post-9/11
deployments in addition to the PACT Act established categories of
presumptive conditions. Other deployments, including burn pits or other
toxins in Vietnam (see also below) were mentioned. Commenters also
noted a preference for additional locations (e.g., Naval Air Facility
Atsugi, Japan, Vietnam, Haiti, Honduras, Panama, and Bosnia) to be
considered for toxic exposure, as well as various military bases or
garrisons. Finally, some participants expressed a desire for more
public input into the VA decision-making process.
Senior VA leadership attended the November 7, 2023, WEBEX virtual
public listening session. After Mr. Josh Jacobs, Under Secretary for
Benefits (USB), provided opening remarks, Dr. Patricia Hastings, Chief
Consultant HOME, delivered a presentation on the revised presumptive
decision process. Twelve representatives from Veterans Service
Organizations, academia, and the Veteran community expressed their
views and comments during the session. In addition to the 12 speakers,
the chat feature within WEBEX recorded an additional 13 comments. Dr.
Shereef Elnahal, Under Secretary for Health (USH), provided closing
remarks and emphasized VA and Congress' interest in responding to the
public's instructive and important comments. USB Jacobs and USH Elnahal
expressed appreciation for the public's participation in this process.
The listening session allowed VA to be proactive in its approach to
improve care, treatment, and benefits for toxic-exposed Veterans, and
consider areas of public interest regarding current or planned research
of potential presumptive conditions. During the listening session, most
comments fell into the additional location and conditions categories.
Several comments supported future study and potential recognition of
sleep apnea as a presumptive condition. Listeners were assured that
additional locations and conditions are continuously monitored and may
be presented for a formal review in the future. HOME and Veterans
Benefits Administration (VBA) Military Exposures Team staff members
communicated with participants who raised specific questions during the
session.
VBA's compensation disability evaluation and rating system is
complex, as is the arena of military environmental exposures. Some
comments indicated misunderstandings of the VA's benefits system and
decision-making process. Additional evidence of misunderstandings
regarding VHA in areas such as the impact of vaccines and chemical
exposures were also expressed. To limit misunderstanding, VBA and VHA
are expanding outreach efforts each year to enhance understanding of
Veteran health and benefits systems.
Moving Forward
VA continues to review and assess information about military
environmental exposure incidents, emerging scientific evidence
regarding toxic substances, and health outcomes in deployed and non-
deployed cohorts. Additionally, active epidemiological surveillance and
ongoing monitoring of military exposures in collaboration with the
Department of Defense is ongoing. VA's involvement in surveillance,
monitoring, and research covers a wide variety of areas. When a
scientific review concludes that there is a statistically significant
signal or possible association between military environment exposure
and health outcomes, this may trigger an investigation that may lead to
additional research or may be subject to an FRN and comment process
required under section 202 of the PACT Act. Additional notices of this
type will be published as VA reviews conditions and their possible
association with military environmental exposures to provide health
care, services, and benefits to Veterans entitled to them. VA has
considered the issues presented by commenters and decided to conduct a
scientific review of multiple myeloma and chronic and acute leukemias,
taking into account the latest scientific classification schemes for
blood cancers and scientific evidence regarding shared etiologies. VA
will follow the procedures in 38 U.S.C. 1172-1174 for initiating and
conducting assessments and formal evaluations. VA has designated a
Technical Working Group (TWG) to assess cases of the toxic exposure of
Veterans and their dependents pursuant to 38 U.S.C. 1172(c). The TWG
may develop a recommendation for formal evaluation under 38 U.S.C.
1173, pursuant to 38 U.S.C. 1172(d). Once a formal evaluation begins, a
recommendation to establish or modify a presumption of service
connection must be submitted to the Secretary within 120 days per 38
U.S.C. 1173(d). Within 160 days of receiving the recommendation to
establish or modify a presumption of service connection, the Secretary
must determine whether a presumption is warranted per 38 U.S.C.
1174(a). This may include commencing rulemaking to establish or modify
presumptions for some or all of the conditions formally evaluated and/
or publishing notice in the FRN of any determination that establishment
or modification of a presumption or presumptions are unwarranted for
some or all of the conditions that were subject to the formal
evaluation.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved and signed
this document on April 17, 2024, and authorized the undersigned to sign
and submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
General Counsel, Department of Veterans Affairs.
[FR Doc. 2024-09164 Filed 4-26-24; 8:45 am]
BILLING CODE 8320-01-P