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 


erowe on DSK5CLS3C1PROD with NOTICES
81336 Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices 

payment of expenses for care under a 

health plan contract; (2) a non serviceconnected disability incurred incident 

to the veteran’s employment and 

covered under a worker’s compensation 

law or plan that provides 

reimbursement or indemnification for 

such care and services; or (3) a non 

service-connected disability incurred as 

a result of a motor vehicle accident in 

a state that requires automobile accident 

reparations insurance. The charge tables 

and supplemental tables that are 

applicable to this notice can be viewed 

on the Veterans Health Administration 

Chief Business Office’s Intranet and 

Internet Web sites. These changes are 

effective January 1, 2011. 

FOR FURTHER INFORMATION CONTACT: 

Romona Greene, Chief Business Office 

(168), Veterans Health Administration, 

Department of Veterans Affairs, 810 

Vermont Avenue, NW., Washington, DC 

20420, (202) 461–1595. This is not a toll 

free number. 

SUPPLEMENTARY INFORMATION: Section 

17.101 of title 38, United States Code of 

Federal Regulations (CFR), sets forth the 

Department of Veterans Affairs (VA) 

medical regulations concerning 

‘‘reasonable charges’’ 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 

payment of expenses for care) under a 

health plan contract; (2) a non serviceconnected disability incurred incident 

to the veteran’s employment and 

covered under a worker’s compensation 

law or plan that provides 

reimbursement or indemnification for 

such care and services; or (3) a non 

service-connected disability incurred as 

a result of a motor vehicle accident in 

a state that requires automobile accident 

reparations insurance. 

The regulation also provides that data 

for calculating actual charge amounts at 

individual VA facilities based on these 

methodologies will either be published 

as a notice in the Federal Register or 

will be posted on the Internet site of the 

Veterans Health Administration Chief 

Business Office, currently at http:// 

www.va.gov/cbo, under ‘‘Charge Data.’’ 

The charge tables and supplemental 

tables that are applicable to this Federal 

Register notice can be viewed on the 

Veterans Health Administration Chief 

Business Office’s Intranet and Internet 

Web sites. Certain charges are hereby 

updated as described below. These 

changes are effective January 1, 2011. 

We note that in cases where charges 

for medical care or services provided or 

furnished at VA expense (by either VA 

or non-VA providers) have not been 

established under other provisions or 

regulations, the method for determining 

VA’s charges is set forth at 38 CFR 

17.101(a)(8). 

The regulation includes 

methodologies for establishing billed 

amounts for the following types of 

charges: Acute inpatient facility charges; 

skilled nursing facility and sub-acute 

inpatient facility charges; partial 

hospitalization facility charges; 

outpatient facility charges; physician 

and other professional charges, 

including professional charges for 

anesthesia services and dental services; 

pathology and laboratory charges; 

observation care facility charges; 

ambulance and other emergency 

transportation charges; and charges for 

durable medical equipment, drugs, 

injectables, and other medical services, 

items, and supplies identified by 

Healthcare Common Procedure Coding 

System (HCPCS) Level II codes. Each 

type of charge is addressed below. 

Acute inpatient facility charges 

remain the same as set forth in the 

notice published in the Federal Register 

on September 27, 2010 (75 FR 59329). 

VA’s current inpatient charge structure 

utilizes the methodology set forth in 38 

CFR 17.101 and does not itemize 

inpatient bills. 

Skilled nursing facility/sub-acute 

inpatient facility charges also remain 

the same as set forth in a notice 

published in the Federal Register on 

September 27, 2010 (75 FR 59329). 

Based on the methodologies set forth 

in 38 CFR 17.101, this document 

provides an update to charges for 2011 

HCPCS Level II and Current Procedural 

Technology (CPT) codes. Charges are 

also being updated based on more 

recent versions of data sources for the 

following charge types: Partial 

hospitalization facility charges; 

outpatient facility charges; physician 

and other professional charges, 

including professional charges for 

anesthesia services and dental services; 

pathology and laboratory charges; 

observation care facility charges; 

ambulance and other emergency 

transportation charges; and charges for 

durable medical equipment, drugs, 

injectables, and other medical services, 

items, and supplies identified by 

HCPCS Level II codes. These updated 

charges are effective January 1, 2011. 

In this update, we are retaining the 

table designations used for HCPCS Level 

II and CPT Codes in the notice posted 

on the Internet site of the Veterans 

Health Administration Chief Business 

Office currently at http://www.va.gov/ 

cbo , under ‘‘Charge Data.’’ The effective 

date of this change was January 1, 2010, 

and the notice can be found in the 

Federal Register. 74 FR 68660 (Dec. 28, 

2009). Accordingly, the tables identified 

as being updated by this notice 

correspond to the applicable tables 

posted on the Internet with the notice, 

beginning with Table C. 

The list of VA medical facility 

locations has also been updated. As a 

reminder, in Supplementary Table 3 we 

set forth the list of VA medical facility 

locations, which includes the first threedigits of their zip codes and provider 

based/non-provider based designations. 

Consistent with VA’s regulations, the 

updated data tables and supplementary 

tables containing the changes described 

in this notice will be posted on the 

Internet site of the Veterans Health 

Administration Chief Business Office, 

currently at http://www.va.gov/cbo, 

under ‘‘Charge Data.’’ The updated data 

tables and supplementary tables 

containing the changes described will 

be effective until changed by a 

subsequent Federal Register notice. 

Approved: December 20, 2010. 

John R. Gingrich, 

Chief of Staff, Department of Veterans Affairs. 

[FR Doc. 2010–32426 Filed 12–23–10; 8:45 am] 

BILLING CODE 8320–01–P 


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