81332 Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices 

3700 East-West Highway, Room 6F01, 

Hyattsville, MD 20782. 

Dated: December 14, 2010. 

Laura Carrico, 

Director, Financial Accounting and Services 

Division, Financial Management Service. 

[FR Doc. 2010–32299 Filed 12–23–10; 8:45 am] 

BILLING CODE 4810–35–M 

DEPARTMENT OF VETERANS 

AFFAIRS 

Health Outcomes Not Associated With 

Exposure to Certain Herbicide Agents; 

Veterans and Agent Orange: Update 

2008 

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 of 

the Agent Orange Act of 1991, Public 

Law 102–4 (codified in relevant part at 

38 U.S.C. 1116), has determined that a 

presumption of service connection is 

not warranted based on exposure to 

herbicides used in the Republic of 

Vietnam during the Vietnam Era for any 

of the diseases, illnesses, or health 

effects identified in the July 24, 2009, 

National Academy of Sciences (NAS) 

report entitled ‘‘Veterans and Agent 

Orange: Update 2008’’ (Update 2008), 

except for hairy cell leukemia (HCL) and 

other chronic b-cell leukemias, 

Parkinson’s disease, and ischemic heart 

disease. In this regard, the Secretary of 

Veterans Affairs determined, based 

upon the NAS report, that there is a 

positive association between exposure 

to herbicides and the subsequent 

development of HCL and other chronic 

b-cell leukemias, Parkinson’s disease, 

and ischemic heart disease. The 

Secretary recently published a notice of 

proposed rulemaking to implement this 

decision. See 75 FR 14391 (Mar. 25, 

2010). 

The determination to not establish a 

presumption of service connection, 

based on exposure to herbicides used in 

the Republic of Vietnam during the 

Vietnam era for any other of the 

diseases, illnesses, or health effects 

identified in the July 24, 2009, NAS 

report, does not in any way preclude VA 

from granting service connection for 

these diseases, including those 

specifically discussed in this notice, nor 

does it change any existing rights or 

procedures. 

The Secretary’s determinations 

regarding individual diseases are based 

on all available evidence in the 2008 

report of the NAS and prior NAS 

reports. This notice generally states 

specific information only with respect 

to significant additional studies that 

were first reviewed by NAS in its 2008 

report. Information regarding additional 

relevant studies is stated in VA’s prior 

notices following earlier NAS reports, 

and generally will not be repeated here. 

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 

Section 3 of the Agent Orange Act of 

1991, Public Law 102–4, 105 Stat. 11, 

directed the Secretary to seek to enter 

into an agreement with the NAS to 

review and evaluate the available 

scientific evidence regarding 

associations between exposure to 

herbicides used in support of military 

operations in the Republic of Vietnam 

during the Vietnam era and each disease 

suspected to be associated with such 

exposure. 

Congress mandated that NAS 

determine, to the extent possible: (1) 

Whether there is a statistical association 

between the suspected diseases and 

herbicide exposure, 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 

disease among individuals exposed to 

herbicide agents during service in the 

Republic of Vietnam during the Vietnam 

era; and (3) whether a plausible 

biological mechanism or other evidence 

of a causal relationship exists between 

herbicide exposure and the health 

outcome. Section 3 of Public Law 102– 

4 also requires that NAS submit reports 

on its activities every 2 years (as 

measured from the date of the first 

report) for a 10-year period. The 

Veterans Education and Benefits 

Expansion Act of 2001, Public Law 107– 

103, extended this period until October 

1, 2014. 

Section 2 of Public Law 102–4, 

codified in pertinent part at 38 U.S.C. 

1116(b) and (c), provides that whenever 

the Secretary determines, based on 

sound medical and scientific evidence, 

that a positive association (i.e., the 

credible evidence for the association is 

equal to or outweighs the credible 

evidence against the association) exists 

between exposure of humans to an 

herbicide agent (i.e., a chemical in an 

herbicide used in support of the United 

States and allied military operations in 

the Republic of Vietnam during the 

Vietnam era) and a disease, the 

Secretary will publish regulations 

establishing presumptive service 

connection for that disease. 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. The Secretary’s 

determination must be based on 

consideration of the NAS reports and all 

other sound medical and scientific 

information and analysis available to 

the Secretary. 

Section 2 of the Agent Orange Act of 

1991 provided that the Secretary’s 

authority and duties under that section 

would expire 10 years after the first day 

of the fiscal year in which NAS 

transmitted its first report to VA. The 

first NAS report was transmitted to VA 

in July 1993, during the fiscal year that 

began on October 1, 1992. Accordingly, 

VA’s authority under section 2 of the 

Agent Orange Act of 1991 expired on 

September 30, 2002. In December 2001, 

however, Congress enacted the Veterans 

Education and Benefits Expansion Act 

of 2001, Public Law 107–103. Section 

201(d) of that Act extended VA’s 

authority under 38 U.S.C. 1116(b)–(d) 

through September 30, 2015. 

Although 38 U.S.C. 1116 does not 

define ‘‘credible,’’ it does instruct the 

Secretary to ‘‘take into consideration 

whether the results [of any study] are 

statistically significant, are capable of 

replication, and withstand peer review.’’ 

The Secretary reviews studies that 

report a positive relative risk and 

studies that report a negative relative 

risk of a particular health outcome. He 

then determines whether the weight of 

evidence supports a finding that there is 

or is not a positive association between 

herbicide exposure and the subsequent 

health outcome. The Secretary does this 

by taking into account the statistical 

significance, capability of replication, 

and whether that study will withstand 

peer review. Because of differences in 

statistical significance, confidence 

levels, control for confounding factors, 

bias, and other pertinent characteristics, 

some studies are more credible than 

others. The Secretary gives weight to 

more credible studies in evaluating the 

overall evidence concerning specific 

health outcomes. 

II. Prior NAS Reports 

The Secretary’s determination that 

there is not a positive association 

between herbicide exposure and the 

diseases addressed in this notice is 

based upon the NAS’s 2008 review and 


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Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices 81333 

analysis of the relevant scientific 

evidence as summarized below, the 

additional analyses provided in this 

notice, and NAS’s and VA’s previous 

analyses of the scientific and medical 

literature set forth in earlier Federal 

Register notices at: 59 FR 341 (Jan. 4, 

1994), 61 FR 41442 (Aug. 8, 1996), 64 

FR 59232 (Nov. 2, 1999), 66 FR 2376 

(Jan. 11, 2001), 67 FR 42600 (Jun. 4, 

2002), 68 FR 27630 (May 30, 2003), 72 

FR 32395 (June 12, 2007), and 75 FR 

32540 (Jun. 8, 2010). 

III. Update 2008 

NAS issued Update 2008 on July 24, 

2009. The report is available at http:// 

www.nap.edu/ 

catalog.php?record_id=12662. For 

Update 2008, NAS conducted a search 

of literature published through 

September 30, 2008, and identified 

more than 7,000 potentially relevant 

citations. About 850 were retained for 

closer consideration, and about 300 

contributed information for the NAS’s 

detailed analysis. 

a. Sufficient Evidence of Association 

Consistent with its prior reports, NAS 

in Update 2008 found that there was 

‘‘sufficient evidence of an association’’ 

between herbicide exposure and five 

categories of diseases in veterans. VA 

has previously established or proposed 

presumptions of service connection for 

each of these diseases. See 38 CFR 

3.309(e); 75 FR 14391 (Mar. 25, 2010) 

(proposing to add HCL and other 

chronic b-cell leukemias to the category 

of chronic lymphocytic leukemia (CLL)). 

b. Limited/Suggestive Evidence of 

Association 

NAS, in 2008, categorized certain 

health outcomes to have ‘‘limited or 

suggestive evidence of an association.’’ 

This category is defined to mean that 

evidence suggests an association 

between exposure to herbicides and the 

outcome, but a firm conclusion is 

limited because chance, bias, and 

confounding could not be ruled out 

with confidence. Health outcomes 

placed in the ‘‘limited or suggestive 

evidence of an association’’ category are 

laryngeal cancer; cancer of the lung, 

bronchus, or trachea; prostate cancer; 

multiple myeloma; early-onset transient 

peripheral neuropathy; porphyria 

cutanea tarda; type 2 diabetes (mellitus); 

spina bifida in offspring of exposed 

persons; AL amyloidosis; hypertension; 

Parkinson’s disease; and ischemic heart 

disease. VA has previously established 

presumptions of service connection for 

laryngeal cancer; cancer of the lung, 

bronchus, or trachea; prostate cancer; 

multiple myeloma; early-onset transient 

peripheral neuropathy, porphyria 

cutanea tarda; type 2 diabetes (mellitus); 

and AL amyloidosis. See 38 CFR 

3.309(e). In instances of spina bifida in 

offspring of exposed persons, VA pays 

a monetary allowance under 38 CFR 

3.814. VA recently proposed 

presumptions of service connection for 

Parkinson’s disease and ischemic heart 

disease. See 75 FR 14391 (Mar. 25, 

2010). Hypertension is discussed below. 

NAS identified and reviewed 

information from comprehensive 

databases covering biologic, medical, 

toxicologic, chemical, historical and 

regulatory information to determine 

whether a statistical association with 

herbicide exposure exists, whether there 

is an increased risk of disease among 

those exposed to herbicides during 

service in the Republic of Vietnam 

during the Vietnam era; and whether 

there exists a plausible biological 

mechanism or other evidence of a causal 

relationship between herbicide 

exposure and hypertension. In Update 

2006, the NAS changed the category for 

hypertension from ‘‘insufficient 

evidence’’ to ‘‘limited or suggestive 

evidence,’’ but clearly could not 

distinguish the possibility of a small 

increased risk for hypertension due to 

herbicide exposure from more prevalent 

scientifically established risk factors in 

evaluating the risk to individual 

Veterans. NAS noted the limitations of 

the studies regarding hypertension. In 

the Federal Register of June 8, 2010, VA 

explained why the studies reviewed in 

Update 2006 did not, in VA’s view, 

warrant a presumption of service 

connection for hypertension in veterans 

exposed to herbicides in service. 75 FR 

32540 (Jun. 8, 2010). 

In Update 2008, NAS identified six 

new studies concerning hypertension 

that the committee found to be generally 

consistent with its conclusion in Update 

2006 that there is ‘‘limited/suggestive 

evidence’’ of an association between 

herbicide exposure and hypertension. 

However NAS also found significant 

limitations in each of the studies. It 

noted that a mortality study of a 

population accidentally exposed to 

dioxin in Seveso, Italy, had little ability 

to control for potentially important 

confounders. Three of the new studies 

analyzed data from the National Health 

and Nutrition Examination Survey 

(NHANES), which the committee 

characterized as broadly consistent with 

the Update 2006 conclusion, but also as 

limited by selection bias that may 

distort the evidence of association and 

by the inconsistency of the findings 

among various exposure categories. 

NAS noted that a study of 47 exposed 

people in Florida involved a small 

survey of a problematic sample, making 

the data difficult to interpret. Finally, 

the committee noted that a study of an 

exposed population in Taiwan found no 

association between hypertension and 

being in the exposed population. When 

the analysis was restricted to persons 

having chloracne (a skin condition 

associated with herbicide exposure), the 

study found an increased incidence of 

hypertension in women, but not in men, 

making the findings difficult to 

interpret. 

Relatively few of the positive findings 

were statistically significant and the 

findings overall are limited by the 

inconsistency of the results, the lack of 

controls, and other methodological 

concerns. The inconsistent findings 

within and across the studies limit the 

ability to draw any conclusions 

regarding dose-response relationship. 

Viewing the new studies published 

since 2006 in relation to the previously 

reviewed evidence, VA has determined 

that the evidence overall does not 

establish a positive association between 

herbicide exposure and hypertension. 

Therefore, a presumption of service 

connection is not warranted. 

c. Inadequate or Insufficient Evidence 

To Determine Whether an Association 

Exists 

NAS, in Update 2008, categorized 

certain other health outcomes as having 

inadequate or insufficient evidence to 

determine whether an association with 

herbicide exposure exists. This category 

is defined to mean that the available 

studies are of insufficient quality, 

consistency, or statistical power to 

permit a conclusion regarding the 

presence or absence of an association 

with herbicide exposure. The health 

outcomes that met this category are: 

cancers of the oral cavity (including lips 

and tongue), pharynx (including 

tonsils), nasal cavity (including ears and 

sinuses); cancers of the pleura, 

mediastinum, and other unspecified 

sites within the respiratory system and 

intrathoracic organs; esophageal cancer; 

stomach cancer; colorectal cancer 

(including small intestine and anus); 

hepatobiliary cancers (liver, gallbladder 

and bile ducts); pancreatic cancer; bone 

and joint cancer; melanoma; nonmelanoma skin cancer (basal cell and 

squamous cell); breast cancer; cancers of 

reproductive organs (cervix, uterus, 

ovary, testes, and penis; excluding 

prostate); urinary bladder cancer; renal 

cancer (kidney and renal pelvis); 

cancers of brain and nervous system 

(including eye); endocrine cancer 

(thyroid, thymus, and other endocrine 

organs); leukemia (other than all chronic 

B-cell leukemias including chronic 


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lymphocytic leukemia (CLL) and HCL); 

cancers at other and unspecified sites; 

neurobehavioral disorders (cognitive 

and neuropsychiatric); movement 

disorders (including amyotrophic lateral 

sclerosis (ALS) but excluding 

Parkinson’s disease); chronic peripheral 

nervous system disorders; respiratory 

disorders (wheeze or asthma, chronic 

obstructive pulmonary disorder, and 

farmer’s lung); gastrointestinal, 

metabolic, and digestive disorders 

(changes in liver emzymes, lipid 

abnormalities and ulcers); immune 

system disorders (immune suppression, 

allergy and autoimmunity); circulatory 

disorders (other than hypertension or 

ischemic heart disease); endometriosis; 

effects on thyroid homeostasis and 

certain reproductive effect i.e., 

infertility, spontaneous abortion, 

neonatal or infant death and stillbirth in 

offspring of exposed people, low birth 

weight in offspring of exposed people, 

birth defects (other than spina bifida) in 

offspring of exposed people, and 

childhood cancer (including acute 

myelogenous leukemia) in offspring of 

exposed people. 

After considering the NAS report, the 

Secretary has determined that 

presumptions of service connection are 

not warranted for any of the diseases 

listed above. As noted above, VA has 

previously explained, in a series of 

Federal Register notices, its analysis of 

prior NAS reports concerning these 

diseases. The additional evidence and 

analysis addressed in Update 2008 with 

respect to these conditions is 

summarized below. 

In Update 2008, NAS identified no 

additional studies relevant to the 

possible association between herbicide 

exposure and cancers of the pleura, 

mediastinum, and other unspecified 

sites within the respiratory system and 

intrathoracic organs; esophageal cancer; 

bone and joint cancer; cancers of the 

male reproductive organs (other than 

prostate cancer), endocrine cancer, 

movement disorders (including ALS but 

excluding Parkinson’s disease); 

endometriosis; effects on thyroid 

homeostasis; and certain reproductive 

effects. Accordingly, the NAS’s 

conclusions regarding those conditions 

were unchanged from Update 2006. 

In Update 2008, NAS found that the 

relevant new studies it identified did 

not include any statistically significant 

findings of association between 

herbicide exposure and the following 

diseases: oral, nasal, and pharyngeal 

cancers; colorectal cancer; hepatobiliary 

cancer, melanoma, non-melanoma skin 

cancer; cancers of the female 

reproductive organs; urinary bladder 

cancer; renal cancer; chronic peripheral 

nervous system disorders; 

gastrointestinal, metabolic, and 

digestive disorders (including changes 

in liver enzymes, lipid abnormalities, 

and ulcers); and endometriosis. 

Accordingly, NAS found that the 

additional evidence generally did not 

support an association between 

herbicide exposure and those health 

outcomes. 

With respect to several other health 

outcomes, NAS in Update 2008 found 

that, although the new studies included 

some statistically significant positive 

findings, those findings did not warrant 

a change in the conclusion that the 

evidence overall is inadequate or 

insufficient to determine whether the 

health outcome is associated with 

herbicide exposure, as explained below. 

NAS discussed two new studies 

regarding stomach cancer. One of the 

studies found no increased mortality 

from stomach cancer in the exposed 

population. The other study found a 

statistically significant increased risk of 

stomach cancer among farm workers 

who used pesticides. NAS noted that 

this study was consistent with findings 

of a previously-reviewed occupational 

study finding evidence of an association 

between exposure to phenoxy 

herbicides (but not other types of 

herbicides) and stomach cancer. 

However, NAS noted that several other 

significant studies it had previously 

reviewed—including studies of Vietnam 

veteran cohorts, studies of the 

International Agency for Research on 

Cancer (IARC) cohort, and the U.S. 

Agricultural Health Study—had 

provided no evidence suggestive of an 

association between herbicide exposure 

and stomach cancers. Accordingly, NAS 

in Update 2008 concluded that the 

overall evidence does not support an 

association between exposure to the 

herbicides of interest and stomach 

cancer. 

NAS discussed two new studies 

regarding pancreatic cancer. One of the 

studies found no increased mortality 

from pancreatic cancer in the exposed 

population. The other study found a 

statistically significant increase in 

pancreatic cancer among deployed U.S. 

female Vietnam veterans in comparison 

to their nondeployed counterparts. NAS 

noted that a previously reviewed study 

also found evidence of an increased risk 

of pancreatic cancer in deployed 

Australian Vietnam veterans. NAS 

noted that no increase in risk has been 

detected to date in U.S. male Vietnam 

veterans or in agricultural cohorts or 

IARC follow-up studies. It further noted 

that the Vietnam veteran studies were 

limited due to lack of control for 

smoking and lack of supportive 

evidence from occupational or 

environmental studies. NAS found that 

the overall evidence remained 

insufficient or inadequate to determine 

whether an association exists. 

NAS discussed four new studies 

concerning breast cancer. Three of the 

studies, including a Vietnam veteran 

study, found no increased risk of breast 

cancer in exposed populations. One 

study found an increased risk of breast 

cancer associated with self-reported use 

of household pesticides. NAS 

concluded that the new evidence tended 

to weigh against an association and that 

the one positive study was limited by 

potential recall bias and the lack of 

information regarding specific 

exposures. 

NAS discussed four new studies 

regarding cancers of the brain and 

nervous system (including the eye). It 

found that the new studies were 

consistent in finding no association 

between herbicide exposure and the 

development of gliomas (the most 

common type of brain cancer). NAS 

noted that one of the new studies 

provided evidence of a possible 

relationship between herbicide 

exposure and meningiomas (a type of 

nervous system cancer) in women, but 

that the lack of identification of specific 

chemicals of interest makes 

interpretation of that result uncertain. 

NAS concluded that the overall 

evidence remained inadequate or 

insufficient to determine whether and 

association exists. 

NAS discussed three new studies 

addressing whether all forms of 

leukemia are associated with herbicide 

exposure. One of the studies found no 

evidence of an association between 

herbicide exposure and leukemias, 

while the other two found evidence of 

such an association. However, NAS 

found that one of the positive studies 

was limited by concern over possible 

misclassification of causes of death for 

the few people whose deaths were 

attributed to forms of leukemia other 

than those already considered to be 

associated with herbicide exposure (i.e., 

b-cell leukemias). Viewing the new 

evidence in relation to the previously 

reviewed evidence, NAS found that the 

overall evidence was inadequate or 

insufficient to determine whether an 

association exists. NAS’s finding that 

the evidence does not establish an 

association between herbicide exposure 

and all forms of leukemia does not affect 

its independent finding that there is 

sufficient evidence of a causal 

association between herbicide exposure 

and specific forms of leukemia (i.e., CLL 

and other chronic b-cell leukemias). 


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Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices 81335 

NAS discussed three new studies 

regarding neurobehavioral effects. Two 

of the studies found an increased 

reporting of neurobehavioral symptoms 

with self-reported pesticide exposure, 

but no associations specific to herbicide 

exposure. The third study found an 

increased incidence of abnormalities on 

neurobehavioral testing among persons 

chronically exposed to herbicides, but 

NAS found this study limited by the 

small sample size, the lack of 

information on methodology, and the 

possibility that many other 

environmental and age-related factors 

may have affected the results. Further, 

the data do not clearly relate the 

increased symptoms or abnormal test 

results to specific neurobehavioral 

diseases or diagnoses. NAS concluded 

that the overall evidence remained 

inadequate or insufficient to detect an 

association. 

NAS noted that several previously 

reviewed studies failed to support the 

hypothesis that herbicide exposure is 

associated with respiratory mortality 

from non-cancer diseases. In Update 

2008, NAS identified one new study 

showing increased respiratory mortality, 

but determined that no conclusions 

could be drawn from the study due to 

lack of specificity regarding the health 

outcomes and due to other 

methodological concerns. In Update 

2008, NAS also discussed new and 

previously reviewed studies relating to 

three specific categories of respiratory 

effects: chronic obstructive pulmonary 

disease (COPD), ‘‘wheeze’’ and asthma, 

and farmer’s lung. NAS concluded that 

most prevalence studies found no 

association between herbicide exposure 

and COPD, and the two that did find 

evidence of such association were 

limited by methodological concerns. 

NAS found that the relevant studies did 

not detect an association between 

herbicide exposure and ‘‘wheeze’’ or 

asthma after adjusting for known 

confounders, and that the sole relevant 

study on farmer’s lung was 

inconclusive. 

NAS discussed two new studies 

regarding immune system disorders. 

One study found no evidence of 

immune system disorders in persons 

highly exposed to dioxin. The other 

study found an increase in self-reported 

arthritis (thought to be an autoimmune 

disorder) among exposed women, but 

not men. NAS concluded that the 

positive finding was unsupported by 

experimental evidence and that the 

overall evidence remained inadequate 

or insufficient to determine whether an 

association exists. 

NAS identified one study finding 

evidence of an increased risk of 

mortality from rheumatic heart disease 

in an exposed population, but 

concluded that the basis for the 

observed association was unclear and 

that the data were limited by the lack of 

control for significant confounders and 

other methodological concerns. NAS 

found that the overall evidence was 

inadequate or insufficient to determine 

whether herbicide exposure is 

associated with any circulatory 

disorders other than ischemic heart 

disease or hypertension. 

NAS discussed four new studies 

regarding thyroid homeostasis. It found 

that the new studies were generally 

consistent with previously reviewed 

studies suggesting that herbicides may 

exert some effect on thyroid function. 

However, NAS concluded that the 

significance of the observed effects is 

unclear because the body’s adaptive 

capacity should be sufficient to 

accommodate them. NAS concluded 

that there was inadequate or insufficient 

evidence to determine whether 

herbicide exposure is associated with 

clinical or overt adverse effects on 

thyroid homeostasis. 

NAS noted that previous Veterans and 

Agent Orange (VAO) committee findings 

did not find any significant association 

between the relevant exposure and 

several reproductive outcomes. In 

Update 2008, NAS determined that 

there is inadequate or insufficient 

evidence of an association between 

herbicide exposure and endometriosis; 

semen quality; infertility; spontaneous 

abortion; late fetal, neonatal, or infant 

death; low birth weight or preterm 

delivery; birth defects other than spina 

bifida; and childhood cancers 

(including acute myelogenous leukemia) 

in offspring of exposed people. 

Among three new studies on 

endometriosis, two found no significant 

evidence of association and the third 

found a decreased risk among the most 

highly exposed persons. NAS found that 

several new studies regarding the effects 

of herbicide exposure on semen quality 

and female infertility provided little 

evidence of any adverse impact. NAS 

found that two new studies regarding 

spontaneous abortion provided 

conflicting results and that the overall 

evidence indicates that paternal 

exposure is not associated with 

spontaneous abortion and that there is 

inadequate or insufficient evidence to 

determine whether maternal exposure is 

associated with such outcomes. NAS 

concluded that one new study regarding 

the effect of dioxin-like substances on 

stillbirth, neonatal, death, or 

spontaneous abortion, did not provide 

primary evidence for an association 

between dioxin and such outcomes. 

NAS discussed four new studies 

concerning low birth weight or preterm 

delivery and found that the evidence 

overall suggests no association between 

herbicide exposure and those outcomes. 

NAS concluded that two new studies 

provided no evidence of an association 

between herbicide exposure and birth 

defects other than spina bifida. NAS 

concluded that the four new studies of 

childhood cancer in the offspring of 

exposed individuals contained 

conflicting findings, but that the 

positive findings in two studies were 

limited by broad exposure 

classifications. 

Conclusion: 

After careful review of the findings of 

the NAS Report, Veterans and Agent 

Orange Update 2008, the Secretary has 

determined that the scientific evidence 

presented in the 2008 NAS report and 

other information available to the 

Secretary indicates that no new 

presumption of service connection is 

warranted at this time for any disease 

other than HCL and other chronic b-cell 

leukemias, Parkinson’s disease, and 

ischemic heart disease. 

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 December 20, 2010, for 

publication. 

Dated: December 20, 2010. 

Robert C. McFetridge, 

Director, Regulations Policy and 

Management, Department of Veterans Affairs. 

[FR Doc. 2010–32332 Filed 12–23–10; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

Reasonable Charges for Medical Care 

or Services; 2011 Calendar Year 

Update 

AGENCY: Department of Veterans Affairs. 

ACTION: Notice. 

SUMMARY: This Department of Veterans 

Affairs (VA) notice informs the public of 

updated data for calculating the 

‘‘reasonable charges’’ collected or 

recovered by VA for medical care or 

services provided or furnished by VA to 

a veteran for: (1) A non serviceconnected disability for which the 

veteran is entitled to care or the 


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