Notice2023-15624
Notice of Plans for the Department of Veterans Affairs To Assess the Current Scientific Literature and Historical Detailed Claims Data Regarding Certain Medical Conditions Associated With Military Environmental Exposures and To Solicit Public Comment
Primary source
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Published
July 26, 2023
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) announces its plan to assess the scientific literature and historical claims data regarding certain medical conditions associated with military environmental exposures. This assessment will consider the possibility of a relationship between the following medical conditions--acute leukemias, chronic leukemias and multiple myeloma--and exposure to fine particulate matter (PM<INF>2.5</INF>) from airborne hazards and open burn pits for service members who were deployed in the Southwest Asia theater of operations, Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan. Multiple myeloma, when it originates in the head or neck, is considered a presumptive condition pursuant to the PACT Act. However, cases of multiple myeloma originating outside of the head and neck have not yet been evaluated for association with exposure to PM<INF>2.5</INF> from airborne hazards and open burn pits in the Southwest Asia theater of operations, Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan. Additionally, a scientific review of acute leukemias, chronic leukemias, and multiple myeloma and exposure to PM<INF>2.5</INF> and its associated chemical composition from airborne hazards and open burn pits in the Southwest Asia theater of operations, Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan would provide an opportunity to review an organ system (blood) not included in the PACT Act. VA solicits public comment on the importance of completing this assessment of scientific literature and historical claims data for these conditions or others. Once the conclusions of this scientific assessment have been peer reviewed, they may be used to inform decisions regarding veteran's qualifying period of service, such as those who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, as well as Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, or Uzbekistan from September 11, 2001, until the present time.
Full Text
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<title>Federal Register, Volume 88 Issue 142 (Wednesday, July 26, 2023)</title>
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[Federal Register Volume 88, Number 142 (Wednesday, July 26, 2023)]
[Notices]
[Pages 48291-48292]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-15624]
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DEPARTMENT OF VETERANS AFFAIRS
Notice of Plans for the Department of Veterans Affairs To Assess
the Current Scientific Literature and Historical Detailed Claims Data
Regarding Certain Medical Conditions Associated With Military
Environmental Exposures and To Solicit Public Comment
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: The Department of Veterans Affairs (VA) announces its plan to
assess the scientific literature and historical claims data regarding
certain medical conditions associated with military environmental
exposures. This assessment will consider the possibility of a
relationship between the following medical conditions--acute leukemias,
chronic leukemias and multiple myeloma--and exposure to fine
particulate matter (PM<INF>2.5</INF>) from airborne hazards and open
burn pits for service members who were deployed in the Southwest Asia
theater of operations, Somalia, Afghanistan, Djibouti, Egypt, Jordan,
Lebanon, Syria, Yemen, and Uzbekistan. Multiple myeloma, when it
originates in the head or neck, is considered a presumptive condition
pursuant to the PACT Act. However, cases of multiple myeloma
originating outside of the head and neck have not yet been evaluated
for association with exposure to PM<INF>2.5</INF> from airborne hazards
and open burn pits in the Southwest Asia theater of operations,
Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen,
and Uzbekistan. Additionally, a scientific review of acute leukemias,
chronic leukemias, and multiple myeloma and exposure to
PM<INF>2.5</INF> and its associated chemical composition from airborne
hazards and open burn pits in the Southwest Asia theater of operations,
Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen,
and Uzbekistan would provide an opportunity to review an organ system
(blood) not included in the PACT Act. VA solicits public comment on the
importance of completing this assessment of scientific literature and
historical claims data for these conditions or others. Once the
conclusions of this scientific assessment have been peer reviewed, they
may be used to inform decisions regarding veteran's qualifying period
of service, such as those who served on active military, naval, or air
service in the Southwest Asia theater of operations during the Persian
Gulf War, as well as Somalia, Afghanistan, Djibouti, Egypt, Jordan,
Lebanon, Syria, Yemen, or Uzbekistan from September 11, 2001, until the
present time.
DATES: Comments must be received on or before August 25, 2023.
ADDRESSES: Comments must be submitted through <a href="http://www.regulations.gov">www.regulations.gov</a>.
Except as provided below, comments received before the close of the
comment period will be available at <a href="http://www.regulations.gov">www.regulations.gov</a> for public
viewing, inspection, or copying, including any personally identifiable
or confidential business information that is included in a comment. We
post the comments received before the close of the comment period on
the following website as soon as possible after they have been
received: <a href="http://www.regulations.gov">http://www.regulations.gov</a>. VA will not post on
<a href="http://Regulations.gov">Regulations.gov</a> public comments that make threats to individuals or
institutions or suggest that the commenter will take actions to harm
the individual. VA encourages individuals not to submit duplicative
comments. We will post acceptable comments from multiple unique
commenters even if the content is identical or nearly identical to
other comments. Any public comment received after the comment period's
closing date is considered late and will not be considered in any
potential future rulemaking.
FOR FURTHER INFORMATION CONTACT: Health Outcomes Military Exposures,
Director of Policy, Peter D. Rumm, MD, Master of Public Health, at 202-
461-7297.
SUPPLEMENTARY INFORMATION: In accordance with 38 U.S.C. 1172, as
created by section 202 of the Sergeant First Class Heath Robinson
Honoring our Promise to Address Comprehensive Toxics Act of 2022 (also
known as the PACT Act), VA is publishing this notice about its planned
scientific assessment of the possibility of a relationship between the
following medical conditions--acute leukemias, chronic leukemias and
multiple myeloma outside of the head and neck--and exposure to
PM<INF>2.5</INF> from airborne hazards and open burn pits in the
Southwest Asia theater of operations, Somalia, Afghanistan, Djibouti,
Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan. VA is also
soliciting public comment about other conditions that would benefit
from review of the possible association, the conditions, and health
outcomes related to them.
The rationale for the selection of acute leukemias, chronic
leukemias, and multiple myeloma outside of the head and neck is based
on their biological properties that may suggest correlation between
these diseases and the described exposures. Lymphomas already are
included in the PACT Act, and leukemias. Leukemias and multiple myeloma
represent the remaining types of cancer of blood forming tissues. The
latest classifications of these cancer types recognize that some
leukemias and lymphomas are different forms of the same disease, as
chronic lymphocytic leukemia and small lymphocytic lymphoma. The bone
marrow can be sensitive to the toxicity of specific chemicals including
waste that may have been disposed of in open burn pits, including,
among others, arsenic, lead, and mercury. Acute leukemias, chronic
leukemias, and multiple myeloma outside of the head and neck have not
been previously evaluated for association with exposure to
PM<INF>2.5</INF> from airborne hazards and open burn pits in the
Southwest Asia theater of operations, Somalia, Afghanistan, Djibouti,
Egypt, Jordan, Lebanon, Syria, Yemen, and Uzbekistan.
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 continues. VA's involvement in surveillance,
monitoring, and research covers a wide variety of areas from garrison
specific, such as Karshi Khanabad (K-2) Air Base, to exposure specific,
such as perfluoroalkyl and polyfluoroalkyl substances, to military
occupation specific, such as missileers. Additional information is
available at Military Exposures--Public Health (<a href="http://va.gov">va.gov</a>). When the
scientific review concludes that there is a statistically significant
signal or possible association of military environment exposure and
health outcomes, this may trigger an investigation that may lead to
additional research or may be subject to a Federal Register notice and
comment process required under section 202 of the PACT Act. Additional
notices of this type will be published as VA moves forward in the
review of conditions and their possible association with military
[[Page 48292]]
environmental exposures for the purposes of providing health care,
services, and benefits to veterans entitled to them.
After reviewing comments received in response to this notice, VA
will conduct the scientific review of the specified conditions, taking
into account the latest scientific classification schemes for blood
cancers and scientific evidence regarding shared etiologies, and will
consider whether to conduct scientific reviews of any other conditions
in response to the comments received, as appropriate. VA will then
follow the procedures in 38 U.S.C. 1172-1174 for initiating and
conducting assessments and formal evaluations. If appropriate, the VA
will designate a Technical Working Group (TWG) to conduct an assessment
pursuant to 38 U.S.C. 1172(c), and 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 is commenced, a recommendation with
respect to establishing a presumption of service connection must be
submitted to the Secretary within 120 days, in accordance with 38
U.S.C. 1173(d). And within 160 days of receiving the recommendation
with respect to establishing a presumption of service connection, the
Secretary must determine whether a presumption is warranted in
accordance with 38 U.S.C. 1174(a). This may include commencing
rulemaking to establish new presumptions for some or all of the
conditions formally evaluated and/or publishing notice in the Federal
Register of any determination that a presumption or presumptions are
unwarranted for some or all of the conditions that were subject of the
formal evaluation.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved and signed
this document on July 19, 2023, 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. 2023-15624 Filed 7-25-23; 8:45 am]
BILLING CODE 8320-01-P
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