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Presumptive Disability Decision-Making Hearing

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Presumptive Disability Decision-Making Hearing S. HRG. 111–881 VA DISABILITY COMPENSATION: PRESUMPTIVE DISABILITY DECISION-MAKING HEARING BEFORE THE COMMITTEE ON VETERANS’ AFFAIRS UNITED STATES SENATE ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION SEPTEMBER 23, 2010 Printed for the use of the Committee on Veterans’ Affairs ( Available via the World Wide Web: http://www.fdsys.gov/ U.S. GOVERNMENT PRINTING OFFICE 64–754 PDF WASHINGTON : 2011 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 17:19 Mar 08, 2011 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 H:\ACTIVE\092310.TXT SVETS PsN: PAULIN COMMITTEE ON VETERANS’ AFFAIRS DANIEL K. AKAKA, Hawaii, Chairman JOHN D. ROCKEFELLER IV, West Virginia RICHARD BURR, North Carolina, Ranking PATTY MURRAY, Washington Member BERNARD SANDERS, (I) Vermont LINDSEY O. GRAHAM, South Carolina SHERROD BROWN, Ohio JOHNNY ISAKSON, Georgia JIM WEBB, Virginia ROGER F. WICKER, Mississippi JON TESTER, Montana MIKE JOHANNS, Nebraska MARK BEGICH, Alaska SCOTT P. BROWN, Massachusetts ROLAND W. BURRIS, Illinois ARLEN SPECTER, Pennsylvania WILLIAM E. BREW, Staff Director LUPE WISSEL, Republican Staff Director (II) VerDate Nov 24 2008 17:19 Mar 08, 2011 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 H:\ACTIVE\092310.TXT SVETS PsN: PAULIN CONTENTS SEPTEMBER 23, 2010 SENATORS Page Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 Isakson, Hon. Johnny, U.S. Senator from Georgia ............................................... 2 Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia ........................ 3 Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 4 Murray, Hon. Patty, U.S. Senator from Washington ........................................... 5 Brown, Hon. Scott, U.S. Senator from Massachusetts ......................................... 6 Sanders, Hon. Bernard, U.S. Senator from Vermont ........................................... 7 Brown, Hon. Sherrod, U.S. Senator from Ohio ..................................................... 9 Webb, Hon. Jim, U.S. Senator from Virginia ........................................................ 10 Tester, Hon. Jon, U.S. Senator from Montana ...................................................... 12 Burris, Hon. Roland W., U.S. Senator from Illinois ............................................. 13 Begich, Hon. Mark, U.S. Senator from Alaska ..................................................... 14 WITNESSES Shinseki, Hon. Eric K., Secretary of U.S. Department of Veterans Affairs; accompanied by Robert L. Jesse, MD, Ph.D., Principal Deputy Under Sec- retary for Health; Victoria Cassano, MD, MPH, FACPM, Director, Radi- ation and Physical Exposures Service; Thomas J. Pamperin, Associate Dep- uty Under Secretary for Policy and Program Management; and John H. Thompson, Deputy General Counsel .................................................................. 16 Prepared statement .......................................................................................... 19 Response to pre-hearing questions submitted by Hon. Jim Webb ............... 23 Response to post-hearing questions submitted by: Hon. Daniel K. Akaka .................................................................................. 25 Hon. Jim Webb .............................................................................................. 35 Response to request arising during the hearing by Hon. Jim Webb ............ 44 Principi, Hon. Anthony J., Former Secretary, U.S. Department of Veterans Affairs .................................................................................................................... 49 Prepared statement .......................................................................................... 52 Response to pre-hearing questions submitted by Hon. Jim Webb ............... 54 Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 56 Samet, Jonathan M., MD, MS, Chair, Committee on Evaluation of the Pre- sumptive Disability Decision-Making Process for Veterans, Institute of Med- icine of the National Academies ......................................................................... 61 Prepared statement .......................................................................................... 62 Attachment ................................................................................................ 67 Response to pre-hearing questions submitted by Hon. Jim Webb ............... 88 Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 93 Bild, Diane, MD, MPH, Associate Director, Prevention and Population Sciences Program, National Heart, Lung, and Blood Institute, National Institutes of Health .............................................................................................. 99 Prepared statement .......................................................................................... 100 Response to pre-hearing questions submitted by Hon. Daniel K. Akaka .... 101 Response to post-hearing questions submitted by Hon. Daniel K. Akaka ... 105 Birnbaum, Linda, Ph.D., DABT, ATS, Director, National Institute of Environ- mental Health Sciences, National Institutes of Health, and Director, Na- tional Toxicology Program, U.S. Department of Health and Human Serv- ices ......................................................................................................................... 107 Prepared statement .......................................................................................... 108 (III) VerDate Nov 24 2008 17:19 Mar 08, 2011 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 H:\ACTIVE\092310.TXT SVETS PsN: PAULIN IV Page Birnbaum, Linda, Ph.D., DABT, ATS, Director, National Institute of Environ- mental Health Sciences, National Institutes of Health, and Director, Na- tional Toxicology Program, U.S. Department of Health and Human Serv- ices—Continued Response to pre-hearing questions submitted by Hon. Daniel K. Akaka .... 110 APPENDIX Reserve Officers Association of the United States and Reserve Enlisted Asso- ciation of the United States; prepared statement ............................................. 119 Figure 1 ............................................................................................................. 123 Attachment 1 .................................................................................................... 124 VerDate Nov 24 2008 17:19 Mar 08, 2011 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 H:\ACTIVE\092310.TXT SVETS PsN: PAULIN VA DISABILITY COMPENSATION: PRESUMPTIVE DISABILITY DECISION-MAKING THURSDAY, SEPTEMBER 23, 2010 U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. The Committee met, pursuant to notice, at 9:30 a.m., in room G50, Dirksen Senate Office Building, Hon. Daniel K. Akaka, Chair- man of the Committee, presiding. Present: Senators Akaka, Rockefeller, Murray, Brown of Ohio, Webb, Tester, Begich, Burris, Sanders, Isakson, Johanns, and Brown of Massachusetts. OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, U.S. SENATOR FROM HAWAII Chairman AKAKA. This hearing of the U.S. Senate Committee on Veterans’ Affairs will come to order. Welcome and aloha to today’s hearing on the VA Presumptive Disability Decision-Making Process. Today much of our focus will be on Vietnam veterans and Agent Orange. However, this discussion also extends the presumptions from the first Gulf War. We are just beginning to hear about expo- sures to potential toxins connected to the wars in Iraq and Afghan- istan. This Committee is also addressing exposures at military in- stallations. This is why it is so important that the presumptions created are appropriate and transparent for past and future wars. One issue we will look at this morning is the VA Secretary’s role in creating presumptions under the Agent Orange Act. The Sec- retary is called on to determine, on the basis of sound medical and scientific evidence, whether there is a positive association between exposure for all herbicides and occurrence of a disease. The law sets up a balancing test between exposure and disease. A positive association exists when the evidence or an association is equal to or greater than evidence against association. In making the determination, the Secretary has to take into ac- count reports from IOM and all other sound medical and scientific information. As we look at the recent Agent Orange decision, we must be satisfied that all scientific evidence was made available to the Secretary and we must understand how it was weighed and considered. For my part, I must be satisfied that the law enacted almost 20 years ago now, is working today. While it is clear that there are real and substantial costs associ- ated with this new presumption, that is not the motivation for this hearing or for our larger work of evaluating the process put in (1) VerDate Nov 24 2008 17:19 Mar 08, 2011 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\ACTIVE\092310.TXT SVETS PsN: PAULIN 2 place pursuant to the Agent Orange Act. We made a promise to care for and compensate veterans for service-connected injuries. I will never stop fighting for veterans, especially when the issue is directly related to the consequences of service. Keeping our promise to veterans will cause us to look closely at the current presumption process. We must be sure the process gives VA appropriate authority
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