Frequent Questions and Answers

Transcription

1 Frequent Questions and Answers What does presumptive service connection mean? VA presumes that specific disabilities diagnosed in certain Veterans are related to their military service. VA does this because of the unique circumstances of their military service. In this case, exposure to contaminants in the drinking water at Camp Lejeune, N.C., from August 1, 1953, through December 31, 1987, has been scientifically linked to eight diseases. VA is amending its regulations to presume service connection for Veterans who served at Camp Lejeune during the period of contamination who have been diagnosed with one or more of the eight diseases. What are the eight presumptive diseases included under the rule? adult leukemia aplastic anemia and other myelodysplastic syndromes bladder cancer kidney cancer liver cancer multiple myeloma non-hodgkin s lymphoma Parkinson s disease What satellite areas are included in the definition of Camp Lejeune? VA defined service at Camp Lejeune as any service within the borders of the entirety of the United States Marine Corps Base Camp Lejeune and Marine Corps Air Station New River, N.C., during the period beginning on August 1, 1953, and ending on December 31, To ensure accurate and consistent application of the definition of service at Camp Lejeune, VA will administratively provide claims processors with all necessary factual and background information to process claims in accordance with this regulation. Marine Corps Air Station (MCAS) New River, while located within the borders of the entirety of Camp Lejeune, falls under a separate command from Camp Lejeune itself. VA identified MCAS New River as a separate location as military orders or other official service department records may specifically denote service at or assignment to MCAS New River; failure to specify this location may result in improper denials of claims or create confusion for otherwise eligible veterans. VA notes that service at MCAS Cherry Point, which is geographically separate from Camp Lejeune (approximately 55 miles away), has a separate water source, and is under a separate command structure, does not meet the definition of service at Camp Lejeune for purposes of this rulemaking. The proposed rule included a 30-day cumulative service requirement at Camp Lejeune. Is that requirement included in the final rule? Yes. In order to be eligible for benefits, Veterans must have been at Camp Lejeune for 30 days (cumulative) between August 1, 1953 and December 31, This is consistent with health care eligibility in the 2012 Camp Lejeune Act. Your news release dated December 17, 2015, included scleroderma as a presumptive condition. Why isn t scleroderma included as a condition in the rule? Although scleroderma was initially considered for inclusion in this rule, additional scientific and health reviews by VA s Technical Workgroup (TWG) concluded that at this time the evidence is not sufficient to establish a positive association between the contaminants found in the water supply at Camp Lejeune and the development of scleroderma.

2 Why hasn t VA given those who served at Camp Lejeune and were diagnosed with one of these eight diseases presumptive status before? We have a responsibility to ensure that regulations establishing presumptions of service connection for disability benefits are based on scientific and medical findings. VA subject matter experts completed a thorough review of all of the available scientific and medical evidence to determine if any of the 15 conditions listed in the Camp Lejeune Act, or any other conditions, were appropriate for presumptions of service connection. How do affected Veterans apply for disability benefits for a presumptive disease determined to be associated with service at Camp Lejeune? Veterans meeting these criteria should file a VA Form EZ with information showing that they have a current diagnosis of one or more of the eight conditions, and their service information showing an assignment at Camp Lejeune or MCAS New River. Veterans Service Organizations can help Veterans file for benefits, or they can file a claim electronically through ebenefits. Add Camp Lejeune after the related disability (block 13, VA Form EZ, Application for Disability Compensation and Related Compensation Benefits). Where are the Camp Lejeune benefits being evaluated? All Camp Lejeune claims are evaluated at the Louisville Regional Office (RO), including claims for presumptive diseases. Camp Lejeune claims will automatically be routed to the Louisville RO. Currently, denials of service connection for the eight presumptive conditions are stayed pending implementation of VA s rulemaking on Camp Lejeune. What if a Veteran already filed a claim for disability benefits based on Camp Lejeune water contamination? Beginning in December 2015, VA began holding any claim filed that was related to Camp Lejeune service and the presumptive diseases. As of January 1, 2017, there were 1,419 claims related to Camp Lejeune in a stayed status. These claims will be rated after this rule becomes effective. Veterans who filed a claim earlier and have been denied service connection will need to file a new claim. Are those who were in the National Guard or reserve, and who served at Camp Lejeune, eligible for the presumption if they are diagnosed with one of these conditions? Yes, as long as they meet the service and disability requirements. National Guard and reserve members are not considered Veterans for VA disability purposes unless they are injured and disabled on duty (38 U.S.C. 101(24)). However, when the law was enacted in 1958, we do not believe Congress took into account situations like long-term effects of exposure to chemicals in drinking water. In this situation, diseases will not show up until years later. Therefore, VA determined it is reasonable to include reservists and Guard members, provided they meet the requirements for service at Camp Lejeune of the rule. What scientific research was used to determine the presumptive diseases for this rule? Environmental health experts on the VA Technical Work Group (TWG) conducted a comprehensive review of the scientific evidence, which included a collaborative analysis between the Agency for Toxic Substances and Disease Registry (ATSDR) and VA. Additional studies were reviewed from the Environmental Protection Agency (EPA), the International Agency for Research on Cancer (IARC), the National Toxicology Program (NTP), and the National Academies of Science (NAS).

3 Why did VA use adult leukemia instead of just leukemia in the rule? Does this term include or exclude certain types of leukemia? The term adult leukemia clarifies that the types of leukemia covered under this rulemaking must have their onset in adulthood. The distinction between adult and non-adult leukemia is necessary, as the disability compensation provided by this rulemaking applies only to disabilities arising in Veterans, reservists or National Guard members, as a result of their exposure to contaminants in the water supply at Camp Lejeune. As such, the presumptions of this rulemaking do not apply to Servicemembers who develop leukemia prior to qualifying service at Camp Lejeune. The use of the term adult leukemia does not restrict the sub-types of leukemia covered by the rulemaking. Does this rule provide compensation benefits for family members who were exposed to contaminants at Camp Lejeune? No. VA has no authority to provide disability benefits to family members. This rule applies only to active duty, reserve, and National Guard Servicemembers who meet the requirements to establish service at Camp Lejeune as defined in the rule. Family members who spent at least 30 days at Camp Lejeune from August 1, 1953, to December 31, 1987 are eligible for reimbursement of medical expenses for 15 conditions in accordance with The Honoring America s Veterans and Caring for Camp Lejeune Families Act of What is the effective date for the claims? The final rule will be effective either 60 days after publication in the Federal Register, or following conclusion of the 60-day Congressional Review, whichever is later. The final rule will apply to claims received by VA on or after the implementation date of the final rule and to claims pending before VA on that date. Under 38 CFR 3.160(c), a claim that has not been finally adjudicated (which includes claims where a final and binding decision has been issued but the appeal period has not expired) is still considered a pending claim. The rule does not apply retroactively to claims that are finally adjudicated. VA must adhere to the provisions of its change-of-law regulation, 38 CFR 3.114, which states, [w]here pension, compensation, dependency and indemnity compensation, is awarded or increased pursuant to a liberalizing law, or a liberalizing VA issue approved by the Secretary or by the Secretary s discretion, the effective date of such award or increase shall be fixed in accordance with the facts found, but shall not be earlier than the effective date of the act or administrative issue. See also 38 U.S.C. 5110(g) and 38 U.S.C. 501(a). Does the Secretary intend to propose any other presumptions related to Camp Lejeune? At this time, VA does not propose to establish presumptions of service connection for any other conditions. VA may consider future rulemaking based on future developments in the available scientific and medical literature and evidence. Does VA need a National Academies of Sciences study to amend the presumptive service connection rules? No. The Secretary has authority to propose creation of claims-related rules under any number of circumstances.

4 There were a number of other military installations with contamination at the same levels or higher than Camp Lejeune. Will this presumption be extended to drinking water contamination at other military installations? The presumption applies to service within the borders of the entirety of Marine Corps Base Camp Lejeune, N.C. VA has been made aware of reports of contaminated water at other military installations and is working with the Department of Defense to learn more about these potential exposures and how they may have impacted the health of Veterans. VA health benefits are provided for 15 health conditions related to Camp Lejeune water exposure. Why are only 8 conditions presumptive for claiming VA disability? The Camp Lejeune Act of 2012 noted that medical care is being afforded notwithstanding that there is insufficient medical evidence to conclude that such illnesses or conditions are attributable to such service or residence. Congress is not bound to follow scientific evidence when establishing laws but the Department of Veterans Affairs must consider this evidence when proposing and creating presumptions. VA s recent review of the scientific and medical literature determined that the evidence is not sufficient to create a presumption of service connection for breast cancer, lung cancer, esophageal cancer, and scleroderma. Other health conditions identified in the 2012 law, such as renal toxicity, hepatic steatosis, and miscarriage, are not included because they are not disabilities for the purposes of VA compensation benefits. Why are liver cancer and Parkinson s disease, included on the list of presumptive health conditions for disability, but not on the list for VA healthcare benefits? After reviewing the latest scientific evidence and studies, including the World Health Organization s International Agency for Research on Cancer (2012), and the National Institute of Health s National Toxicology Program (2014), the VA Technical Workgroup concluded there is strong evidence supporting a positive association between liver cancer and vinyl chloride exposure. In 2015, the Institute of Medicine (IOM) identified four new studies that address solvent exposure and concluded that a positive relationship exists between Parkinson s disease and the contaminants previously found in the water supply at Camp Lejeune. Is Parkinsonism included in the presumptions? Parkinsonism and related neurodegenerative diseases are not included in the presumption. Parkinson s disease is medically distinguishable and separately diagnosable from a variety of Parkinsonian syndromes. The studies that have established a relationship between the contaminants in the water supply at Camp Lejeune and Parkinson's disease reported specifically on Parkinson s disease, not Parkinsonism or other Parkinsonian syndromes. At this time, the evidence does not establish that Parkinsonism and other manifestations of small fiber nerve damage are associated with exposure to the contaminants formerly in the water supply at Camp Lejeune. If a Veteran is deceased, can his or her dependents receive survivor s and/or burial benefits? An eligible dependent of a deceased Veteran, who served at least 30 cumulative days at Camp Lejeune during the specified timeframe, and had any of the eight diseases that was a direct or contributory cause of the Veteran s death, may be entitled to survivor s and/or burial benefits. For more information on survivor benefits and how to apply, please visit For more information on burial benefits and how to apply, please visit

5 How many military members were stationed at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987? The Department of Navy estimated that during the period of contamination, there were about 720,000 active duty Veterans stationed at Camp Lejeune. VA is also including about 123,000 reservists and National Guard in this rule-making, and making them Veterans for purposes of this regulation. So estimated potential population affected is approximately 900,000. If a Veteran is deceased, can his or her dependents receive survivor s and/or burial benefits? An eligible dependent of a deceased Veteran, who served at least 30 cumulative days at Camp Lejeune during the specified timeframe, and had any of the eight diseases that was a direct or contributory cause of the Veteran s death, may be entitled to survivor s and/or burial benefits. For more information on survivor benefits and how to apply, please visit For more information on burial benefits and how to apply, please visit How many military members were stationed at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987? The Department of Navy estimated that during the period of contamination, there were about 720,000 active duty Veterans stationed at Camp Lejeune. VA is also including about 123,000 reservists and National Guard in this rule-making, and making them Veterans for purposes of this regulation. So estimated potential population affected is approximately 900,000. What is the estimated cost of the disability benefits related to contaminants in the water at Camp Lejeune? Benefit costs are estimated to be $379.8 million during the first year and $2.2 billion over a five year period. For purposes of regulatory impact analysis conducted pursuant to Executive Orders and 13563, these effects are categorized as transfers from the federal government to veterans, reservists and survivors. Total Veterans, Reservists, and Survivors FY Caseload Obligations (in 000's) ,514 $379, ,597 $411, ,569 $441, ,441 $471, ,225 $499,920 5-year Total $2,203,808