Thursday, August 16, 2012

VA Proposing PN change and no additions to AO List

Today the VA announced a proposed change to its policy on Peripheral Neuropathy and the decision not to add any new conditions or diseases based on the last IoM report [Veterans and Agent Orange Update 2010]. Here is the information on Peripheral Neuropathy:
"VA proposes to remove the current requirement that acute and subacute peripheral neuropathy appear “within weeks or months” after exposure and remove the requirement that the condition resolve within two years of the date of onset in order for the presumption to apply. For purposes of consistency, VA further proposes to replace the terms “acute and subacute” with “early-onset” in 38 CFR 3.307(a)(6)(ii) requiring peripheral neuropathy to become manifest to a degree of 10 percent or more within one year after the last date of herbicide exposure in order to be subject to presumptive service connection under 38 CFR 3.309(e). This amendment would clarify that presumptive service connection for early-onset peripheral neuropathy will not be denied solely because the peripheral neuropathy persisted for more than two years after the date of last herbicide exposure. However, this amendment would not change the current requirement that peripheral neuropathy must have become manifest to a degree of 10 percent or more within one year after the date of last exposure in order to qualify for the presumption of service connection. In Update 2010, the NAS found that evidence did not indicate an association between herbicide exposure and delayed-onset peripheral neuropathy, which NAS defined as peripheral neuropathy having its onset more than one year after exposure.
and....
Additionally, we propose to revise 38 CFR 3.816(b)(2), the regulation governing retroactive awards for certain diseases associated with herbicide exposure as required by court orders in the class action litigation in the case of Nehmer v. U.S. Department of Veterans Affairs. Currently § 3.816(b)(2) states that the Nehmer court orders apply to presumptions established before October 1, 2002, and lists the diseases covered by those presumptions, including “acute and subacute peripheral neuropathy.” Rather than revising this list, we propose to remove the list of conditions and the October 1, 2002, date and insert language clarifying that the Nehmer court orders apply to the presumptions listed in § 3.309(e). This change is necessary because the district court and the U.S. Court of Appeals for the Ninth Circuit in Nehmer found the date restriction and the corresponding listing of presumptive conditions based on herbicide exposure found at § 3.816(b)(2) to be invalid as it is not inclusive of all conditions the Secretary has determined to be presumptively service connected based on herbicide exposure under the Agent Orange Act of 1991. Therefore, VA proposes to remove paragraphs (b)(2)(i)-(ix) and the phrase “before October 1, 2002” and to add a reference to § 3.309(e) that reflects the inclusive listing in the introduction to paragraph (b)(2). The above information can be reviewed for comment at: https://www.federalregister.gov/articles/2012/08/10/2012-19635/determinations-concerning-illnesses-discussed-in-national-academy-of-sciences-report-veterans-and#p-34
No great change here. Additionally, the VA declined to add any new diseases or conditions to the list of Agent Orange Diseases. Here are the important sections.
Limited or Suggestive Evidence of an Association NAS has defined this category of association to mean that the “evidence suggests an association between exposure to herbicides and the outcome, but a firm conclusion is limited because chance, bias, and confounding could not be ruled out with confidence.” Hypertension VA has reviewed this additional information in relation to the information in prior NAS reports analyzing studies concerning hypertension. Based on this review, the Secretary has determined that the available evidence presented in Update 2010 is not sufficient to establish a new presumption of service connection for hypertension in veterans exposed to herbicides. As noted in VA's evaluation of prior NAS reports, 75 FR 32540 (Jun. 8, 2010), the evidence overall includes a wide variety of results. While some veteran studies have reported increased incidence of hypertension, others have found no increase. Similarly, numerous environmental and occupational studies have found no significant increased risk of hypertension. The consistently negative findings of occupational studies are of interest because, at least in studies of chemical-production workers, the magnitude and duration of exposures in occupational studies generally would be greater than in Vietnam veteran studies. Further, as noted above, several of the studies that provide evidence of an increased risk are limited by the failure to control for significant confounders or by other methodological concerns. Accordingly, the Secretary has determined that the available evidence does not at this time establish a positive association between herbicide exposure and hypertension that would warrant a presumption of service connection.
Now we take this to rule out Hypertension by itself. However, as a secondary to Diabetes Mellitus Type II, or Ischemic Heart Disease, it still would go into an approved claim’s mix for rating percentage of disability.
Inadequate or Insufficient Evidence To Determine an Association Based on the analysis in Update 2010, the Secretary has determined that the available studies generally do not provide credible evidence of an association between exposure to an herbicide agent and an increased risk of hearing loss, eye problems, or bone conditions. The Secretary therefore finds that a positive association does not currently exist between herbicide exposure and those conditions and that no presumption of service connection is warranted for those conditions at this time.
Limited or Suggestive Evidence of No Association NAS has previously concluded that there is limited or suggestive evidence of no association between paternal herbicide exposure and spontaneous abortion. In Update 2010, NAS identified no new studies relevant to that health outcome. Accordingly, the Secretary has determined that there is no positive association between paternal herbicide exposure and spontaneous abortion.
Detailed information on NAS' findings may be found at http://www.iom.edu/Reports/2011/Veterans-and-Agent-Orange-Update-2010.aspx. After selecting the link titled: “Read Report Online for Free,” report findings, organized by category, may be found under the heading, “Table of Contents.”
To read the entire posting and/or make a comment go to this website: https://www.federalregister.gov/articles/2012/08/10/2012-19634/disease-associated-with-exposure-to-certain-herbicide-agents-peripheral-neuropathy#h-16
Again, no real surprises here. Nothing much changes except for Peripheral Neuropathy.

VNVets

”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

"The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Obama Administration and his Department of Veterans Affairs?"--VNVets

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

"It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

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