Federal Register / Vol. 76, No. 9 / Thursday, January 13, 2011 / Notices 2447 

other railroad lines owned by Temple, 

to operate over the line. Temple states 

that its agreement with TCTR requires 

that TCTR solicit business over the line 

and to provide common carrier service 

for remunerative business. Temple 

states that in the event TCTR is unable 

to provide service over the line, Temple 

will assume the residual common 

carrier obligation to provide service. 

Temple requests expedited action on its 

petition. 

By issuance of this notice, the Board 

is instituting an exemption proceeding 

pursuant to 49 U.S.C. 10502(b). 

Decided: January 10, 2011. 

By the Board, Rachel D. Campbell, 

Director, Office of Proceedings. 

Andrea Pope-Matheson, 

Clearance Clerk. 

[FR Doc. 2011–639 Filed 1–12–11; 8:45 am] 

BILLING CODE 4915–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

Gulf War and Health, Volume 6, 

Physiologic, Psychologic, and 

Psychosocial Effects of DeploymentRelated Stress 

AGENCY: Department of Veterans Affairs. 

ACTION: Notice. 

SUMMARY: As required by law, the 

Department of Veterans Affairs (VA) 

hereby gives notice that the Secretary of 

Veterans Affairs, under the authority 

granted by the Persian Gulf War 

Veterans Act of 1998, Public Law 

105–277, title XVI, 112 Stat. 2681–742 

through 2681–749 (codified at 38 U.S.C. 

1118), has determined that there is no 

basis to establish any new presumptions 

of service connection at this time for 

any of the diseases, illnesses, or health 

effects discussed in the November 15, 

2007, National Academy of Sciences 

(NAS) report titled, ‘‘Gulf War and 

Health, Volume 6, Physiologic, 

Psychologic, and Psychosocial Effects of 

Deployment-Related Stress.’’ This 

determination does not in any way 

preclude VA from granting service 

connection on a direct basis for any 

disease, including those specifically 

discussed in this notice, nor does it 

change any existing rights or 

procedures. 

FOR FURTHER INFORMATION CONTACT: 

Gerald Johnson, Regulations Staff 

(211D), Compensation and Pension 

Service, Veterans Benefits 

Administration, Department of Veterans 

Affairs, 810 Vermont Avenue, NW., 

Washington, DC 20420, telephone (202) 

461–9727. (This is not a toll-free 

number.) 

SUPPLEMENTARY INFORMATION: 

I. Statutory Requirements 

The Persian Gulf War Veterans Act of 

1998, Public Law 105–277, title XVI, 

112 Stat. 2681–742 through 2681–749 

(codified at 38 U.S.C. 1118), and the 

Veterans Programs Enhancement Act of 

1998, Public Law 105–368, 112 Stat. 

3315, directed the Secretary to enter 

into an agreement with NAS to review 

and evaluate the available scientific 

evidence regarding associations between 

illnesses and exposure to toxic agents, 

environmental or wartime hazards, or 

preventive medicines or vaccines to 

which service members may have been 

exposed during service in the Southwest 

Asia theater of operations during the 

Persian Gulf War. Congress prescribed 

the inquiry it expected NAS to carry out 

in the event such an agreement was 

reached. Congress directed NAS to 

identify agents, hazards, medicines, and 

vaccines to which service members may 

have been exposed during the Persian 

Gulf War. Congress mandated that NAS 

determine, to the extent possible: (1) 

Whether there is a statistical association 

between exposure to the agent, hazard, 

medicine, or vaccine and the illness, 

taking into account the strength of the 

scientific evidence and the 

appropriateness of the scientific 

methodology used to detect the 

association; (2) the increased risk of 

illness among individuals exposed to 

the agent, hazard, medicine or vaccine; 

and (3) whether a plausible biological 

mechanism or other evidence of a causal 

relationship exists between exposure to 

the agent, hazard, medicine, or vaccine 

and the illness. Public Law 105–277, 

112 Stat. 2681–747. 

II. NAS Reports and VA Action 

In 1998, NAS began a program to 

examine the scientific and medical 

literature on the potential health effects 

of specific agents and hazards to which 

Gulf War veterans might have been 

exposed during their deployment. Five 

reports have examined health outcomes 

related to: Depleted uranium, 

pyridostigmine bromide, sarin, and 

vaccines (Volume 1); insecticides and 

solvents (Volume 2); fuels, combustion 

products, and propellants (Volume 3); 

health effects of serving in the Gulf War 

irrespective of exposure information 

(Volume 4); and infectious diseases 

(Volume 5). Among the 700,000 U.S. 

military personnel deployed to the 

theater, many veterans have reported 

chronic symptoms and illnesses that 

they have attributed to their service in 

the Gulf. 

Upon receipt of each NAS report, VA 

must determine whether a presumption 

of service connection is warranted for 

any disease or illness discussed in the 

report. The statute provides that a 

presumption of service connection is 

warranted if VA determines that there is 

a positive association (i.e., the credible 

evidence for an association is equal to 

or outweighs the credible evidence 

against an association) between 

exposure of humans or animals to a 

biological, chemical, or other toxic 

agent, environmental or wartime hazard, 

or preventive medicine or vaccine 

known or presumed to be associated 

with service in the Southwest Asia 

theater of operations during the Persian 

Gulf War and the occurrence of a 

diagnosed or undiagnosed illness in 

humans or animals. 38 U.S.C. 1118(b). 

If the Secretary determines that a 

presumption of service connection is 

not warranted, he is to publish a notice 

of that determination, including an 

explanation of the scientific basis for 

that determination. 38 U.S.C. 

1118(c)(3)(A). 

III. NAS Report: ‘‘Gulf War and Health, 

Volume 6, Physiologic, Psychologic, 

and Psychosocial Effects of 

Deployment-Related Stress 

In ‘‘Gulf War & Health, Volume 6, 

Physiologic, Psychologic, and 

Psychosocial Effects of DeploymentRelated Stress,’’ available at http:// 

www.nap.edu/ 

catalog.php?record_id=11922 (accessed 

September 2, 2010), NAS evaluated the 

association between deployment-related 

stress and long-term adverse health 

effects for veterans deployed to the 

Persian Gulf and the Middle East to 

include not only veterans of the 1990– 

1991 Gulf War, but also veterans 

returning from Operation Enduring 

Freedom (OEF) and Operation Iraqi 

Freedom (OIF). This study was 

conducted at the request of VA to 

determine the possibility of an 

association between exposure to 

deployment-related stressors in the Gulf 

War and long-term adverse health 

effects. 

The NAS committee reviewed 

published and peer-reviewed scientific 

and medical literature to characterize 

and weigh the strengths and limitations 

of the available evidence regarding the 

association between deployment to a 

war zone and specific adverse health 

effects. The committee considered 

studies of veterans of World War II, the 

Korean War, the Vietnam War, and the 

1991 Gulf War. 


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The NAS committee’s charge was to 

comprehensively review, evaluate, and 

summarize the peer-reviewed scientific 

and medical literature regarding the 

association between deployment-related 

stress and long-term adverse health 

effects in Gulf War veterans. 

Specifically, the committee was to study 

the physiologic, psychological and 

psychosocial effects of stress, and VA 

requested that the study’s findings not 

be limited to veterans of the Gulf War 

but be applicable to OEF and OIF. 

The NAS committee considered all 

studies that identified health effects 

found in military personnel deployed to 

a war zone in order to evaluate the 

associations between deploymentrelated stress and adverse health effects. 

The potential health effects considered 

included not only physiologic effects 

and psychiatric effects, but also 

depression and posttraumatic stress 

disorder (PTSD), and psychosocial 

effects, such as marital conflict and 

incarceration. In addition, the NAS 

committee also considered studies of 

deployed veterans with combat-related 

PTSD and associated health effects, 

because PTSD can result only after 

exposure to a traumatic stressor and 

potentially traumatic events are 

common in a war zone. The NAS 

committee relied entirely on 

epidemiologic studies to draw its 

conclusion about the strength of the 

evidence for an association between 

deployment to a war zone (stressor) and 

health effects. The challenge of 

epidemiologic studies is to isolate the 

risk factors that contribute to health 

effects in populations that are 

inherently uncontrollable in the 

experimental sense; therefore, statistical 

techniques are used to take in to 

account factors such as bias and 

confounding. 

Detailed information on the 

committee’s findings may be found at: 

http://www.nap.edu/ 

catalog.php?record_id=11922 (accessed 

September 2, 2010). The report findings 

are organized by category and can be 

found under Table of Contents. 

In its report, NAS organized its 

conclusions into five categories, 

representing different degrees of 

association between illness and 

exposure to deployment-related 

stressors. The categories NAS used are 

‘‘Sufficient Evidence of a Causal 

Relationship,’’ ‘‘Sufficient Evidence of 

an Association,’’ ‘‘Limited but 

Suggestive Evidence of an Association,’’ 

‘‘Inadequate/Insufficient Evidence to 

Determine Whether an Association 

Exists,’’ and ‘‘Limited/Suggestive 

Evidence of No Association.’’ These are 

the same categories of association that 

have been used by previous NAS 

committees in their reports. 

IV. VA’s Determination 

This notice conveys the Secretary’s 

determination that a presumption of 

service connection is not warranted at 

the present time for any disease, illness, 

or health effect discussed in the NAS 

report, based on association with any 

substance known or suspected to be 

associated with service in the Gulf War. 

The Secretary has determined that no 

new presumptions of service connection 

are warranted under 38 U.S.C. 1118 

because the report does not demonstrate 

that the standard set forth in section 

1118 for the creation of a presumption 

of service connection has been met. In 

particular, the report does not purport to 

link any health effects to exposure to ‘‘a 

biological, chemical, or other toxic 

agent, environmental or wartime hazard, 

or preventive medicine or vaccine 

known or presumed to be associated 

with service in the Armed Forces in the 

Southwest Asia theater of operations 

during the Persian Gulf War.’’ 38 U.S.C. 

1118(a)(2)(A). As explained in more 

detail below, the report investigated the 

effects of stressors associated with 

deployment to any war zone, not just 

the Gulf War zone. Furthermore, the 

report does not identify health effects 

associated with a ‘‘biological, chemical, 

or other toxic agent, environmental or 

wartime hazard, or preventive medicine 

or vaccine.’’ Id. As discussed below, the 

statutory reference to agents, hazards, 

medicines, or vaccines is most 

reasonably construed to refer to 

exposure to specific substances capable 

of causing illness and not to the general 

effects of service in a war zone as an 

‘‘exposure’’ in itself. Id. 

Under 38 U.S.C. 501, the Secretary 

has discretion to issue any regulations 

necessary or appropriate to the 

administration of Veterans benefits. VA 

evaluated the findings in the NAS report 

to determine whether any presumptions 

or other regulatory changes are 

warranted under that discretionary 

authority. As explained below, VA has 

decided not to propose to issue any 

regulatory changes under that general 

authority based on the findings in the 

NAS report. This decision is based on 

one or more of the following with 

respect to the health effects evaluated in 

the report: (1) The report did not find 

an association between the health 

effects studied and service in a war 

zone, (2) the health effects studied were 

not a disease, injury, or illness for 

which service connection can be 

granted (e.g. suicide or marital conflict), 

or (3) existing VA regulations are 

sufficient to ensure that benefits will be 

provided to veterans who incur the 

health effect as a result of service. 

A. New Presumptions Under 38 U.S.C. 

1118 Are Not Warranted 

Public Law 105–277 requires the 

Secretary to determine whether a 

presumption of service connection is 

warranted by reason of a disease ‘‘having 

a positive association with exposure to 

a biological, chemical, or other toxic 

agent, environmental or wartime hazard, 

or preventive medicine or vaccine 

known or presumed to be associated 

with service in the Armed Forces in the 

Southwest Asia theater of operations 

during the Persian Gulf War.’’ Public 

Law 105–277 § 1602 (codified in 

pertinent part at 38 U.S.C. 1118(a)(2)(A) 

and (b)(1)(B)). The statute does not 

explain the meaning of the phrase 

‘‘known or presumed to be associated 

with service in the Armed Forces in the 

Southwest Asia theater of operations 

during the Persian Gulf War,’’ and there 

is no legislative history explaining the 

meaning of that phrase. 

Consistent with VA’s past 

interpretation of section 1118, see 72 FR 

48734, 48739–41 (Aug. 24, 2007), we 

conclude that the statutory phrase 

‘‘associated with service in the Armed 

Forces in the Southwest Asia theater of 

operations during the Persian Gulf War’’ 

is most reasonably construed to refer to 

a relationship between the substance or 

hazard and the specific circumstance of 

service in the Southwest Asia theater of 

operations during the Persian Gulf War, 

as distinguished from features of 

military or civilian life in general that 

are not unique to service in the Gulf 

War. The phrase ‘‘associated with’’ 

clearly connotes a direct relationship, 

and the requirement that the substance 

or hazard be associated with service at 

a particular time and place indicates an 

intent to distinguish between substances 

and hazards associated with general 

military or civilian life and those unique 

to service at the specified time and 

place. If military populations of all eras 

of wartime experience the same or 

similar deployment-related stressors 

related to deployment to a war zone, we 

believe it would be unreasonable to 

conclude that such stressors are 

‘‘associated with’’ service in the Persian 

Gulf during the Gulf War. As the report 

explains, ‘‘The US military has 

participated in numerous wars on both 

US and foreign soil and, regardless of 

the conflict, many of the deploymentrelated stressors to which military 

personnel can be exposed are the same: 

possible death or injury to oneself, 

killing or injuring others, poor living 

conditions, and harsh physical 

environment.’’ Similarly, the report 


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noted the universality of symptombased illnesses among war zone 

veterans from essentially all eras: ‘‘Male 

and female veterans who have been 

deployed to a war zone, regardless of 

the war in which they served, report 

more symptoms and poorer health than 

do their nondeployed counterparts. 

Symptoms range from severe, such as 

chest pain and numbing in the 

extremities, to minor, such as loss of 

appetite.’’ Gulf War and Health, Volume 

6, Physiologic, Psychologic, and 

Psychosocial Effects of DeploymentRelated Stress, at p. 31. The report 

specifically notes that this was not a 

unique issue for Gulf War veterans: 

‘‘Some researchers have attempted to 

cluster the symptoms into new diseases 

but in general the symptoms are too 

broad and nonspecific to suggest the 

presence of a new illness specific to the 

Gulf War.’’ We do not believe that 

Congress intended VA to establish 

presumptions for the known health 

effects of military deployments common 

to all military populations. Rather, the 

requirement that the agent, hazard, 

medicine, or vaccine be ‘‘associated 

with’’ Gulf War service makes clear that 

VA’s task is to focus on the unique 

exposure environment in the Persian 

Gulf during the Persian Gulf War. Id. at 

257 

This reading of the statutory language 

comports with the clear purpose of both 

Public Law 105–277 and Public Law 

105–368. Id. Both statutes reflect the 

Government’s commitment to 

addressing the unique health issues 

presented by Gulf War veterans, by 

establishing a process for identifying 

diseases and illnesses that may be 

associated with Gulf War service. It is 

by now well known that many Gulf War 

veterans have reported a variety of 

similar symptoms that cannot presently 

be identified with a known diagnosis or 

cause and that were not considered 

‘‘diseases’’ for the purposes of the 

statutes generally authorizing VA to pay 

compensation for service-connected 

disability or death due to disease or 

injury. Congress responded initially to 

that situation by authorizing VA to pay 

compensation for ‘‘undiagnosed illness’’ 

in such veterans. The process 

established by Public Law 105–277 and 

Public Law 105–368 reflects a further 

effort to bridge the existing gaps in 

medical and scientific knowledge and to 

ensure that Gulf War veterans may 

obtain compensation for diagnosed or 

undiagnosed illnesses that may have 

been caused by the unique exposures or 

hazards of service during the Gulf War. 

Establishing presumptions of service 

connection for illnesses associated with 

exposures or hazards specifically related 

to Gulf War service obviously would 

further that objective. In contrast, 

establishing presumptions of service 

connection for the exclusive benefit of 

Gulf War veterans based solely on the 

well-known health effects of exposures 

shared in common with all veterans of 

other wartime deployments would not 

significantly further the purposes of 

those statutes. Moreover, establishing 

such presumptions would create 

significant inequities in the veterans’ 

benefits system that Congress could not 

have intended. 

Public Law 105–277 requires VA to 

establish presumptions of service 

connection, when the statutory 

requirements are met, exclusively for 

veterans who served in the Southwest 

Asia theater of operations during the 

Persian Gulf War. If the statute were 

construed to require presumptions 

based on exposure in the Persian Gulf 

War to stressors to which other veterans 

serving at other times and places are 

commonly exposed at similar levels, it 

would raise significant concerns of 

fairness and reasonableness. For 

example, veterans exposed or 

presumably exposed to stressors such as 

separation from family or fear of injury 

during the Gulf War might be entitled to 

presumptive service connection for 

certain psychiatric illnesses associated 

with such experiences, while veterans 

who served in other conflicts like 

Vietnam and had equal or greater 

exposure to deployment-related 

traumatic experiences would not be 

entitled to presumptive service 

connection. The fact that most service 

members deployed to a war zone incur 

some degree of exposure to the stressors 

NAS considered further underscores the 

arbitrariness that would attach to 

establishing presumptions for a limited 

class of veterans based on such common 

exposures. As discussed below in 

subsection B of this notice, current VA 

regulations and policies address the 

effects of such combat-related exposures 

and are not limited to veterans of Gulf 

War service. Providing by statute and 

regulation for the disparate treatment of 

similarly situated veterans would 

substantially undermine confidence in 

the objectivity and fairness of the 

veterans benefits system. Additionally, 

establishing different adjudicative rules 

for the claims of similarly situated 

veterans without any reasoned basis for 

the distinction would undoubtedly 

cause confusion to the VA personnel 

responsible for deciding claims, as well 

as to veterans and their representatives 

in presenting and supporting their 

claims. 

We do not believe that Congress 

intended VA to establish presumptions 

unique to Gulf War veterans based on 

the well-known health effects of 

exposures common to deployments 

outside the Gulf War theater. As 

explained above, the language and 

purpose of Public Law 105–277 and 

Public Law 105–368 indicate that 

Congress did not intend such a result, 

and we believe it is reasonable to 

presume that Congress did not intend 

arbitrary or unfair distinctions. We note 

that statutes generally must be 

construed to avoid serious 

constitutional concerns. See Edward J. 

DeBartolo Corp. v. Florida Gulf Coast 

Building & Construction Trades 

Council, 485 U.S. 568, 575 (1988). We 

cannot say it is beyond Congress’ power 

to establish presumptions exclusively 

for Gulf War veterans based on 

exposures not known to differ 

significantly from service outside the 

Gulf War. However, the apparent 

unfairness, in our view, of that result 

supports the conclusion that Congress 

did not intend such a result. 

We recognize that some diseases and 

illnesses may be unique to the Gulf War 

theater. For example, nine diseases are 

currently entitled to a presumption of 

service connection based upon service 

in the Gulf War. 75 FR 59968 

(September 29, 2010). As explained 

above, however, there is presently 

insufficient evidence to indicate that the 

stressors and health effects considered 

by NAS related to the Gulf War differed 

significantly from stressors present in 

other war zones and their attendant 

health effects. 

Although the Secretary has 

determined that presumptions of service 

connection are not warranted for the 

health effects of deployment stressors as 

discussed in the NAS report, we want 

to make clear that this determination 

will not preclude the granting of service 

connection for those health effects that 

are diseases, injuries, or illnesses (as 

discussed in greater detail below, some 

of the health effects (e.g. suicide and 

marital conflict) are not themselves 

diseases, injuries, or illnesses and 

therefore VA has no authority to grant 

service connection on the basis of those 

health effects alone). The health effects 

that NAS found to be supported by 

limited/suggestive evidence are 

generally well-known health effects of 

exposure to war zone-related stressors. 

The established associations between 

war zone stressors and certain health 

effects like PTSD provide a sufficient 

basis for examining physicians and VA 

adjudicators to determine whether a 

veteran’s disease is associated with 

exposure to stressors experienced in 


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service. We note further that our 

conclusion that the war zone-related 

stressors cannot be determined to be 

‘‘associated with’’ Gulf War service is 

not intended to suggest that they are 

irrelevant to further investigations of 

Gulf War veterans’ health. 

Finally, establishment of any new 

presumptions based on the report is also 

unwarranted because the report does 

not identify health effects associated 

with a ‘‘biological, chemical, or other 

toxic agent, environmental or wartime 

hazard, or preventive medicine or 

vaccine.’’ Rather, the report examined 

health effects associated with 

deployment-related ‘‘stressors.’’ The 

statutory reference to agents, hazards, 

medicines, or vaccines is most 

reasonably construed to refer to 

exposure to specific substances capable 

of causing illness and not to the general 

effects of service in a war zone as an 

‘‘exposure’’ in itself. This interpretation 

is consistent with the list of agents, 

hazards, medicines, and vaccines 

Congress provided in § 1603(d) of Public 

Law 105–277. 

B. New Presumptions Under the 

Secretary’s General Rulemaking 

Authority (38 U.S.C. 501) Are Not 

Warranted 

Under 38 U.S.C. 501, the Secretary 

has discretion to issue any regulations 

necessary or appropriate to the 

administration of Veterans benefits. VA 

evaluated the findings in the NAS report 

to determine whether any presumptions 

or other regulatory changes are 

warranted under that discretionary 

authority. As explained below, VA has 

decided not to propose to issue any 

regulatory changes under that general 

authority based on the findings in the 

NAS report. This decision is based on 

one or more of the following with 

respect to the health effects evaluated in 

the report: (1) The report did not find 

an association between the health 

effects studied and service in a war 

zone, (2) the health effects studied were 

not a disease, injury, or illness for 

which service connection can be 

granted (e.g. suicide or marital conflict), 

or (3) existing VA regulations are 

sufficient to ensure that benefits will be 

provided to veterans who incur the 

health effect as a result of service. The 

sections below explain in more detail 

the bases for this decision. 

i. Inadequate/Insufficient Evidence to 

Determine Whether an Association 

Exists 

For some health effects, the report 

found that evidence from available 

studies is of insufficient quantity, 

quality, or consistency to permit a 

conclusion regarding the existence of an 

association between deployment to a 

war zone and a specific health effect in 

humans. Therefore, the evidence for 

these conditions does not provide 

sufficient evidence of association 

between the health effect and service to 

warrant any regulatory changes. The 

health effects under this category of 

association include: 

Cancer 

Diabetes mellitus 

Thyroid disease 

Neurocognitive and neurobehavioral effects 

Sleep disorders or objective measures of 

sleep disturbance 

Hypertension 

Coronary heart disease 

Chronic respiratory health effects 

Structural gastrointestinal diseases 

Reproductive effects 

Homelessness 

Adverse employment outcomes 

ii. Sufficient Evidence of Association or 

Limited But Suggestive Evidence of an 

Association 

For some health effects, the report 

found that evidence from available 

studies is sufficient to conclude that 

there is a positive association, i.e. a 

consistent positive association has been 

observed between deployment to a war 

zone and a specific health effect in 

human studies in which chance and 

bias, including confounding, could be 

ruled out with reasonable confidence. 

The health effects under this category of 

association include: 

Psychiatric disorders, including PTSD, other 

anxiety disorders, and depressive disorders 

Alcohol abuse 

Accidental death in the early years after 

deployment 

Suicide in the early years after deployment 

Marital and family conflict 

For some health effects, the report 

found that evidence from available 

studies is suggestive of an association 

between deployment to a war zone, but 

the body of evidence is limited by 

inability to rule our chance of bias, 

including confounding, with 

confidence. The health effects under 

this category of association include: 

Drug abuse 

Chronic fatigue syndrome 

Gastrointestinal symptoms consistent with 

functional gastrointestinal disorders, such 

as irritable bowel syndrome or functional 

dyspepsia 

Skin disorders 

Fibromyalgia and chronic widespread pain 

Increased symptom reporting, unexplained 

illness, and chronic pain 

Incarceration 

VA has decided not to propose new 

presumptions of service connection for 

any of these health effects for the 

reasons discussed in the sections that 

follow. 

iii. Health Effects that Are Not Injuries, 

Diseases, or Illnesses 

Some health effects evaluated by the 

report are not injuries, diseases, or 

illnesses and therefore cannot form the 

basis of a grant of service connection. 

See 38 CFR 3.1(m); 38 U.S.C. 105. 

Unless these phenomena, such as 

accidental death, can be linked to a 

disease or injury incurred or aggravated 

in service, VA would have no authority 

to compensate veterans or their 

survivors, through new presumptions or 

otherwise, absent new legislative 

authority. These health effects include: 

Accidental death in the early years after 

deployment 

Marital and family conflict 

Incarceration 

Suicide in the early years after deployment 

With respect to suicide, although 

suicide itself is not a disease or injury 

for which service connection can be 

granted, VA regulations at 38 CFR 3.302 

provide that, if a veteran had a service 

connected disability involving mental 

unsoundness, VA will presume that the 

suicide resulted from that condition. 

Accordingly, no change in the current 

regulation is needed with respect to 

suicide for this reason as well. 

iv. Health Effects Statutorily Barred 

From Service Connection 

Alcohol abuse and drug abuse are 

health effects evaluated by the report 

which are statutorily barred from 

service connection under 38 U.S.C. 

1110. See also 38 CFR 3.301(d). A 

veteran may only establish service 

connection for alcohol abuse or drug 

abuse on a secondary basis if the alcohol 

abuse or drug abuse is proximately due 

to another service-connected condition. 

See Allen v. Principi, 237 F.3d 1368 

(Fed. Cir. 2001); 38 CFR 3.310(a). 

Therefore, establishment of a 

presumption of service connection for 

alcohol abuse or drug abuse is 

prohibited. 

v. Psychiatric Disorders 

The report evaluated a number of 

psychological health effects from the 

deployment-related stressors. A 

presumption of service connection is 

not warranted for any of these 

psychiatric health effects, which 

include the following: 

PTSD 

Anxiety 

Depression 

The NAS report notes that these 

psychiatric conditions may be triggered 

by the experience of wartime 


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deployment. However, it is also well 

established that these conditions, 

particularly anxiety and depression, are 

widespread and may be triggered by 

multiple life events, including those 

occurring before and after service. When 

a veteran seeks service-connected 

benefits for a psychiatric disease, VA 

routinely provides a psychiatric 

examination to assist in establishing 

that the condition is related to the 

veteran’s service. This process works 

efficiently to ensure that veterans are 

properly compensated for psychiatric 

disabilities that are associated with 

service. Accordingly, VA has 

determined that a broad presumption of 

service connection for such psychiatric 

conditions is not needed. 

With respect to PTSD, we also believe 

that existing VA regulations provide an 

effective means of ensuring that serviceconnected benefits are properly 

provided for PTSD related to 

deployment to a combat zone and that 

a presumption of service connection is 

thus unnecessary. The diagnosis of 

PTSD and a determination that PTSD is 

related to service both require the 

identification of a specific stressor 

sufficient to cause PTSD. Because the 

identification of a stressor is essential to 

a proper diagnosis of PTSD, a 

presumption of service connection for a 

veteran’s diagnosed PTSD would not 

eliminate that requirement. Further, 

existing VA regulations provide liberal 

evidentiary standards for establishing 

the existence of stressors associated 

with combat or deployment to a combat 

zone. Under 38 CFR 3.304(f)(2), if a 

veteran engaged in combat with the 

enemy, the veteran’s lay statements 

regarding the occurrence of an inservice stressor are sufficient to 

establish that fact, absent clear and 

convincing evidence to the contrary and 

provided the veteran’s statements are 

consistent with the circumstances, 

conditions, or hardships of the veteran’s 

service. 

Further, recent amendments to 38 

CFR 3.304(f) have liberalized the 

evidentiary standard for establishing the 

required in-service stressor in certain 

circumstances. 75 FR 39843 (July 13, 

2010). This amendment eliminates the 

requirement for corroborating that the 

claimed in-service stressor occurred if a 

stressor claimed by a veteran is related 

to the veteran’s fear of hostile military 

or terrorist activity and a VA 

psychiatrist or psychologist, or a 

psychiatrist or psychologist with whom 

VA has contracted, confirms that the 

claimed stressor is adequate to support 

a diagnosis of PTSD and that the 

veteran’s symptoms are related to the 

claimed stressor, provided that the 

claimed stressor is consistent with the 

places, types, and circumstances of the 

veteran’s service. This rule provides a 

low evidentiary standard for 

establishing the existence of stressors 

associated with certain aspects of 

deployment to a combat zone such as 

fear of hostile military or terrorist 

activity related to such deployments. 

vi. Skin Disorders 

With respect to skin disorders, as 

mentioned above the report placed skin 

disorders under the association category 

Limited but Suggestive Evidence of an 

Association. This association category 

indicates that the report found that 

evidence from available studies is 

suggestive of an association between 

deployment to a war zone and skin 

disorders, but the body of evidence is 

limited by inability to rule our chance 

of bias, including confounding, with 

confidence. Specifically, the report 

found a number of studies showing 

increased prevalence of skin disorders 

in deployed veterans, but that the 

studies varied widely as to which 

specific types of skin disorders were 

more prevalent, and NAS noted that 

some of the observed increases could be 

attributable to chance or to 

undetermined environmental exposures, 

while others may be secondary to PTSD 

or other stress disorders. In view of the 

varied nature of the findings, the 

evidence does not indicate a basis for 

presuming specific skin diagnoses to be 

associated with Gulf War service or 

other wartime deployments. To the 

extent the evidence shows increased 

reporting of signs or symptoms relating 

to the skin, 38 U.S.C. 1117 and 38 CFR 

3.317 already provide for presumptive 

service connection of undiagnosed or 

unexplained illnesses involving such 

signs or symptoms. 

vii. Health Effects Already Covered by 

Existing Regulatory or Statutory 

Presumptions 

The remainder of the health effects 

evaluated by the report are already 

considered in the presumptions of 

service connection for undiagnosed 

illnesses and medically unexplained 

chronic multisymptom illnesses under 

38 U.S.C. 1117 and 38 CFR 3.317. 

Chronic fatigue syndrome and 

fibromyalgia are presumptively serviceconnected as medically unexplained 

chronic multisymptom illnesses. 38 CFR 

3.317(a)(2)(B). VA has also recently 

proposed to clarify that functional 

gastrointestinal disorders are medically 

unexplained chronic multisymptom 

illnesses. 75 FR 70162 (November 17, 

2010). Additionally, chronic pain and 

increased symptom reporting can be 

considered as signs and symptoms that 

may be manifestations of undiagnosed 

illness or medically unexplained 

chronic multisymptom illness under 

§ 3.317(a)(2)(i). Therefore, establishment 

of a presumption for these health effects 

is not necessary. 

V. Conclusion 

For the reasons stated above, the 

Secretary has determined that a 

presumption of service connection is 

not warranted at this time for any of the 

diseases, illnesses, or health effects 

discussed in the NAS report issued on 

November 15, 2007, titled, ‘‘Gulf War 

and Health, Volume 6: Physiologic, 

Psychologic, and Psychosocial Effects of 

Deployment-Related Stress.’’ 

Signing Authority 

The Secretary of Veterans Affairs, or 

designee, approved this document 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. John 

R. Gingrich, Chief of Staff, Department 

of Veterans Affairs, approved this 

document on January 6, 2011, for 

publication. 

Dated: January 7, 2011. 

Robert C. McFetridge, 

Director, Regulations Policy and 

Management, Department of Veterans Affairs. 

[FR Doc. 2011–552 Filed 1–12–11; 8:45 am] 

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