Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations

On September 11, 2020 the National Academies of Sciences, Engineering and Medicine, Committee on Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations, released the subject Report. In part, the Report said that:

“Southwest Asia theater veterans were exposed to a broad range of potentially hazardous airborne agents. These include such regional environmental exposures as air pollution from dusts; local point and area sources such as traffic, waste management, and local industries; and the aeroallergens and microbial agents present in the theater. Exposures related to military operations are also contributors, such as exhaust from heaters, military vehicles, and aircraft as well as smoke from structural fires, explosions, burning oil wells, or burn pits.” Continuing,


The health effects of these airborne hazards were likely influenced by factors common to military operations in Southwest Asia. These effect modifiers include temperature extremes, psychosocial stress, sleep deprivation, and noise.

The committee formulated a list of 27 health outcomes for their literature review, delineated in Box S-2 [below]. The list included the conditions explicitly listed in the Statement of Task and those that the committee believed to be “of great concern to veterans.”

Of these outcomes, none met the criteria for sufficient evidence of an association. The evidence for respiratory symptoms—which included chronic persistent cough, shortness of breath (dyspnea), and wheezing—met the criteria for limited or suggestive evidence of an association for both veterans who served in the 1990–1991 Gulf War and those who served in the post-9/11 conflicts. Studies considered in previous National Academies reports were relatively consistent in reporting associations between deployment and more prevalent self-reported respiratory symptoms in theater veterans, and outcomes from more recent studies are largely in line with those findings. Importantly, a recent study that compared symptom reporting before, during, and after deployment found that the self-reported frequency of symptoms was increased both during and after deployment relative to pre-deployment. Many of the studies considered, however, were weakened by bias induced by the self-selection of their participants (which may have led to people being more likely to participate if they had respiratory symptoms than if they did not) and by the lack of control for cigarette smoking, which is known to exacerbate symptoms. These concerns, while serious, were consistent with a classification in the limited or suggestive category. Lastly, the committeepage21image1971788224

Respiratory Health Outcomes Addressed

Non-Cancer Respiratory Disorders

Upper Airway Disorders

Rhinitis Sinusitis

Non-Infectious Lower Airway

Chronic bronchitis
Chronic obstructive pulmonary disease

Interstitial Lung Diseases

Acute eosinophilic pneumonia Hypersensitivity pneumonitis Idiopathic interstitial pneumonia

Infectious Lower Airway

Acute bronchitis Pneumonia

Respiratory Symptoms

Chronic persistent cough Shortness of breath (dyspnea)

Respiratory Cancers

Esophageal cancer Laryngeal cancer

Other Outcomes

Sleep apnea
Vocal cord dysfunction

Constrictive bronchiolitis Emphysema

Idiopathic pulmonary fibrosis Pulmonary alveolar proteinosis Sarcoidosis



Lung cancer
Oral, nasal, and pharyngeal cancers

Changes in pulmonary function
Mortality due to diseases of the respiratory system

concluded that there is limited or suggestive evidence of no association between deployment to the 1990–1991 Gulf War and changes in lung function.

The committee found that there was inadequate or insufficient information to evaluate the association between service in the Southwest Asia theater and all of the remaining respiratory health outcomes it examined. While there are a variety of reasons for this that vary by the outcome under consideration, one prominent cause was the lack of good exposure characterization. Many studies used deployment to the theater as their only metric of exposure, and this undoubtedly led to people with widely different exposure experiences being grouped together for analysis purposes. Such grouping would be expected to diminish the possibility of observing an effect if one existed if there were large numbers of those with relatively low exposure compared with those with relatively high exposure.

Agency Information Collection Activity: Authorization For VA To Disclose Personal Information to a Third Party

On May 7, 2019 the Department of Veterans Affairs published in the Federal Register, notice of the opportunity for public comment on the proposed collection of certain information by the agency [Under the Paperwork Reduction Act (PRA) of 1995].

The VA Form 21–0845 is used to release information in its custody or control in the following circumstances: Where the individual identifies the particular information and

consents to its use; for the purpose for which it was collected or a consistent purpose (i.e., a purpose which the individual might have reasonably expected).  In part, with respect to the following collection of information, VBA invites comments on: (1) Whether the proposed collection of information is necessary for the proper performance of VBA’s functions, including whether the information will have practical utility.

Written comments and recommendations on the proposed collection of information should be received on or before July 8, 2019.




VA Proposed Rule – Active Service Pay

On April 19, 2019 the Department of Veterans Affairs (VA) proposed to amend its adjudication regulations, to permit VA to suspend disability compensation payments upon receipt of notice from the Department of Defense (DoD) that the veteran has received, is receiving, or will begin to receive active service pay. This proposed change would reduce the financial impact on veterans associated with receipt of VA disability compensation and active service pay by allowing VA to make necessary adjustments as close in time to the receipt of active service pay as possible.

This proposed change would only apply to compensation payments, not pension. In order to reduce hardships for veterans and improve processing of benefits, VA proposes to amend the current procedural requirements related to the 60-day notice period and take immediate action to suspend compensation payments upon notice of receipt of active service pay from DoD when the veteran has received prior notice that the law prevents concurrent receipt of certain VA benefits and active service pay or VA has received a statement from the veteran indicating knowledge that concurrent receipt of VA benefits and active service pay is prohibited.

Comments must be received on or before June 18, 2019.

Federal Register /Vol. 84, No. 76 / Friday, April 19, 2019


Agency Information Collection Activity Under OMB Review: Application for Disability Compensation and Related Compensation Benefits

Today, April 10, 2019, VA published a Notice in the Federal Register in compliance with the Paperwork Reduction Act (PRA) of 1995; this notice announces that the Veterans Benefits Administration, Department of Veterans Affairs, will submit the collection of information abstracted below to the Office of Management and Budget (OMB) for review and comment.

The VA collection of information concerns VA Form 21–526EZ, which is used to collect the information needed to process a fully developed claim for disability compensation and/or related compensation benefits.

A Federal Register Notice with a 60-day comment period soliciting comments on this collection of information was published at 83 FR 224 on November 20, 2018, pages 58690 and 58691. Affected Public: Individuals or Households. Estimated Annual Burden: 498,667 hours. Estimated Average Burden per Respondent: 22 minutes. Frequency of Response: One time. Estimated Number of Respondents 1,360,000

Click to access 2019-07106.pdf

VA Increases Rates For Disability Compensation

Effective December 1, 2018, as required by the Veterans’ Compensation Cost-of-Living Adjustment Act of 2018, the Department of Veterans Affairs (VA), adjusted certain benefit rates, that affect the compensation program.

VA is required to increase these benefit rates by the same percentage as increases in the benefit amounts payable under title II of the Social Security Act. The Social Security Administration has announced that there will be a 2.8 percent cost-of-living increase in Social Security benefits for 2019. Therefore, applying the same percentage, the rates for VA’s compensation program, that became effective on December 1, 2018, are found at:


New Access to VA Hospital and Outpatient Care for Medal of Honor Veterans

Today, VA published in the Federal Register, a new final rule that increased access to VA Hospital and Outpatient Care for Medal of Honor Veterans.  VA stated,

“The Department of Veterans Affairs (VA) is amending its medical regulations governing eligibility for VA health care and copayment requirements to conform to recent statutory changes. VA is changing its enrollment criteria to move Medal of Honor recipients from priority category three to priority category one, and exempting recipients of the Medal of Honor from copayments for inpatient care, outpatient care, medications, and extended care services.

DATES: This final rule is effective on March 5, 2019.”

VA Withdraws Regulation that Changed Schedule for Rating Disabilities – The Genitourinary Diseases and Conditions

In Today’s Federal Register, The Department of Veterans Affairs (VA) published that it ,”is withdrawing a document published in the Federal Register on July 28, 2017, proposing to amend the portion of its Schedule for Rating Disabilities that addresses the genitourinary system.”  VA stated,

“On July 28, 2017, VA published in the Federal Register the proposed rule for Schedule for Rating Disabilities; The Genitourinary Diseases and Conditions. See 82 FR 35140. During the internal review process of the final rule, VA found that an erroneous value and unit of measure were inadvertently included in the albumin/creatinine ratio (ACR) in the renal dysfunction rating criteria under proposed 38 CFR 4.115a. The erroneous proposed value would have resulted in erroneous disability evaluations for multiple renal disabilities. Accordingly, VA is withdrawing the proposal and is developing a new proposal, to include correct ACR values, which VA intends to publish at a later date.”


VA Proposes New Regulation For Rating Infectious Diseases

Today VA published in the Federal Register a proposed regulation to amend the VA Schedule for Rating Disabilities [VASRD] in connection with Infectious Diseases, Immune Disorders, and Nutritional Deficiencies.

Here is the link to the Federal Register:

The purpose of these changes is to incorporate medical advances, update medical terminology, and clarify evaluation criteria. The proposed rule considers  comments from experts and the public during a forum held from January 31 to February 1, 2011, on revising this section of the VASRD.

Comments must be received by VA on or before April 8, 2019.

Easier Access to Health Care For Veterans: NEW Veterans Affairs Proposed Rulemaking – election of private urgent medical care

“The Department of Veterans Affairs (VA) is proposing to amend its regulations that govern VA health care. This rule would grant eligible veterans access to urgent care from qualifying non-VA entities or providers without prior approval from VA. This rulemaking would implement the mandates of the VA MISSION Act of 2018 and increase veterans’ access to health care in the community.” 


Comments must be sent to VA by March 9, 2019.  This proposed regulation will likely become final summer 2019.

Please contact me with any questions, at 646-343-7785

Agent Orange Presumption Applies To Territorial Waters – Federal Circuit

January 29, 2019

Click to access 17-1821.Opinion.1-29-2019.pdf


United States Court of Appeals For The Federal Circuit – Washington DC

Today the Federal Circuit rejected VA’s long-standing interpretation of  38 USC 1116, that grants a presumption of service connection for certain diseases for veterans who “served in the Republic of Vietnam.”

Appellant – Veteran Mr. Procopio served aboard the U.S.S. Intrepid from November 1964 to July 1967. In July 1966, the Intrepid was deployed in the waters offshore the landmass of the Republic of Vietnam, including its territorial sea. Mr. Procopio sought entitlement to service connection for diabetes mellitus in October 2006 and for prostate cancer in October 2007 but was denied service connection for both in April 2009.

The Board of Veterans’ Appeals likewise denied him service connection in March 2011 and again in July 2015, finding “[t]he competent and credible evidence of record is against a finding that the Veteran was present on the landmass or the inland waters of Vietnam during service and, therefore, he is not presumed to have been exposed to herbicides, including Agent Orange,” under § 1116. The Veterans Court affirmed.

The Court reversed and mandated, “Here, we determine at Chevron [Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 842–43 (1984)]step one that Congress has spoken directly to the question of whether Mr. Procopio, who served in the territorial sea of the“Republic of Vietnam,” “served in the Republic of Vietnam.” He did.”

The Court continued, “we see no basis for incorporating a foot-on-land requirement into Regulation 311 [38 CFR 3.311].”  Concluding the Federal Circuit ruled, “international law uniformly confirms that the “Republic of Vietnam” included its territorial sea.”

Contact me with any questions: P: 646-343-7785