Federal Register / Vol. 75, No. 45 / Tuesday, March 9, 2010 / Notices 10867 

detailed justification in the Federal 

Register. Finally, section 1605(d) of the 

Recovery Act states that the Buy 

American provision must be applied in 

a manner consistent with the United 

States’ obligations under international 

agreements. 

II. Nonavailability Finding 

The Commission’s Executive Director 

determined—as applied to certain water 

quality treatment and monitoring 

equipment components to be used in a 

hatchery rearing June sucker, an 

endangered species—application of the 

Buy American provision is not possible 

because the components, specifically 

rotating drum filter upgrades and a 

water quality monitoring system 

expansion, are not available from 

American manufacturers in sufficient 

and reasonably available commercial 

quantities of a satisfactory quality. 

Expansion of the recirculation system 

requires adding a second drum filter for 

aquaculture water treatment. The 

existing system uses a drum filter 

manufactured by PRAqua Supplies 

Ltd.—Nanaimo, British Columbia, 

Canada. The Division owns an RFM 

4872 drum filter also manufactured by 

PRAqua Supplies Ltd that will be used 

for the system expansion. This drum 

filter requires modification with new 

drum filter seals, screen panels and a 

new control panel to be suitable for use 

in the aquaculture system. This will 

allow the expanded system to match the 

existing equipment and drum filter. 

The existing recirculation facility is 

equipped with a variety of automated 

sensors that allow system operators to 

monitor water quality, flow and 

temperature in the fish hatchery. The 

existing equipment was provided and 

installed by Point Four Systems Inc. of 

Coquitlam, BC, Canada. 

Recirculation system expansion will 

also require new components to expand 

aquaculture water quality monitoring. 

New components will include 

additional oxygen sensors, flow meters 

and related control panel wiring to 

connect to the existing system. Use of 

components sharing the same 

manufacturer will allow efficient 

operation of equipment that is in place. 

New monitoring system components 

that will function with existing 

components are not available from 

American manufacturers in sufficient 

and reasonably available commercial 

quantities of a satisfactory quality. 

III. Waiver 

On February 17, 2010 based on the 

non-availability finding discussed above 

and pursuant to ARRA section 1605(c), 

the Commission’s Executive Director 

granted a limited waiver of the Recovery 

Act’s Buy American requirements with 

respect to Agreement No. 09FCUT– 

RA04 between the Commission and 

Division for the aforementioned 

components of a hatchery recirculation 

system. 

Dated: February 25, 2010. 

Michael C. Weland, 

Executive Director. 

[FR Doc. 2010–4775 Filed 3–8–10; 8:45 am] 

BILLING CODE 4310–05–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

Determinations Concerning Illnesses 

Discussed in the Institute of Medicine 

Report on Gulf War and Health: 

Updated Literature Review of Depleted 

Uranium 

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 not to establish a 

presumption of service connection at 

this time, based on exposure to depleted 

uranium in the Persian Gulf during the 

Persian Gulf War, for any of the 

diseases, illnesses, or health effects 

discussed in the July 30, 2008, report of 

the Institute of Medicine (IOM) of the 

National Academy of Sciences (NAS), 

titled Gulf War and Health: Updated 

Literature Review of Depleted Uranium. 

This determination does not in any way 

preclude VA from granting service 

connection for any disease, including 

those specifically discussed in this 

notice, nor does it change any existing 

rights or procedures. 

FOR FURTHER INFORMATION CONTACT: 

Nancy Copeland, Regulations Staff 

(211D), Compensation and Pension 

Service, Veterans Benefits 

Administration, Department of Veterans 

Affairs, 810 Vermont Avenue, NW., 

Washington, DC 20420, telephone (202) 

461–9685. (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, previously directed the Secretary 

to seek to enter into an agreement with 

the NAS IOM to review and evaluate the 

scientific literature regarding 

associations between illness and 

exposure to specific 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. 

In 1998, IOM began a program to 

examine the scientific and medical 

literature on the potential health effect 

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 (1) depleted uranium (DU), 

pyridostigmine bromide, sarin, and 

vaccines (Volume 1); (2) insecticides 

and solvents; (3) fuels, combustion 

products, and propellants; (4) health 

effects of serving in the Gulf War 

irrespective of exposure information; 

and (5) infectious diseases. A sixth IOM 

report, Gulf War and Health, Volume 6: 

Deployment Related Stress, examined 

the physiologic, psychologic, and 

psychosocial effects of deploymentrelated stress. 

The present report updates the review 

of DU presented in Volume 1. When 

Volume 1 was published, few studies of 

health outcomes of exposure to DU had 

been conducted. Therefore, the IOM 

studied the health outcomes of exposure 

to natural and processed uranium in 

workers at plants that processed 

uranium ore for use in weapons. After 

evaluating the literature, the IOM 

concluded that there was inadequate or 

insufficient evidence to determine 

whether an association exists between 

uranium exposure and 14 health 

outcomes: lymphatic cancer; bone 

cancer; nervous system disease; 

reproductive or developmental 

dysfunction; non-malignant respiratory 

disease; gastrointestinal disease; 

immune-mediated disease; effects on 

hematologic measures; genotoxic effects; 

cardiovascular effects; hepatic disease; 

dermal effects; ocular effects; and 

musculoskeletal effects. The IOM also 

concluded that there was limited or 

suggestive evidence of no association 

between uranium and clinically 

significant renal dysfunction and 

between uranium and lung cancer at 

specified cumulative internal doses. 

Although previously used, the Gulf 

War marked the first time that DU 

munitions and armor were used 

extensively by the military. DU was 

used by the U.S. military for both 

offensive and defensive purposes in the 


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Gulf War. Heavy-armor tanks have a 

layer of DU armor to increase 

protection. Offensively, DU is used in 

kinetic-energy cartridges and 

ammunition rounds. The U.S. Army 

used an estimated 9,500 DU tank rounds 

during the Gulf War. Ammunition 

containing DU was used in BosniaHerzegovina in 1994–1995 and in 

Kosovo in 1999; about 10,800 DU 

rounds were fired in BosniaHerzegovina, and about 30,000 in 

Kosovo. Weapons containing DU were 

also used in Operation Iraqi Freedom 

(OIF), which began in 2003. 

Military personnel have been exposed 

to DU as a result of friendly-fire 

incidents, cleanup and salvage 

operations, and proximity to burning 

DU containing tanks and ammunition. 

During the Gulf War, an estimated 134– 

164 people experienced ‘‘level I’’ 

exposure (the highest of three exposure 

categories as classified by the U.S. 

Department of Defense) through wounds 

caused by DU fragments, inhalation of 

airborne DU particles, ingestion of DU 

residues, or wound contamination by 

DU residues. Hundreds or thousands 

more may have been exposed to lower 

exposure through inhalation of dust 

containing DU particles and residue or 

ingestion from hand-to-mouth contact or 

contamination of clothing. Ten U.S. 

military personnel who served in OIF 

had confirmed DU detected in their 

urine; all 10 had DU embedded 

fragments or fragment injuries. When 

Volume 1 was published in 2000, few 

studies of health outcomes of exposure 

to natural uranium and DU had been 

conducted. Because DU continues to be 

used by the military, VA asked IOM to 

update its 2000 report and take into 

consideration information published 

since Volume 1. 

II. Authority 

Section 1602 of Public Law 105–277 

provides that whenever the Secretary 

receives a report under section 1603 of 

Public Law 105–277, the Secretary must 

determine whether a presumption of 

service connection is warranted for any 

illness covered by that report. The 

statute provides that a presumption will 

be warranted when the Secretary 

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. When a positive association 

exists, the Secretary will publish 

regulations establishing presumptive 

service connection for that illness. 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. 

Although Section 1118 does not 

define ‘‘credible evidence,’’ it does 

instruct the Secretary to take into 

consideration whether the results (of 

any report, information, or analysis) are 

statistically significant, are capable of 

replication, and withstand peer review. 

See 38 U.S.C. 1118(b)(2)(B). Simply 

comparing the number of studies that 

report a significantly increased relative 

risk to the number of studies that report 

a relative risk that is not significantly 

increased is not a valid method for 

determining whether the weight of 

evidence overall supports a finding that 

there is or is not a positive association 

between exposure to an agent, hazard, 

or medicine or vaccine and the 

subsequent development of the 

particular illness. Because of differences 

in statistical significance, confidence 

levels, control for confounding factors, 

and other pertinent characteristics, 

some studies are clearly more credible 

than others; and the Secretary has given 

the more credible studies more weight 

in evaluating the overall weight of the 

evidence concerning specific illnesses. 

III. Prior NAS Report 

NAS issued its initial report, Gulf War 

and Health, Volume 1: Depleted 

Uranium, Pyridostigmine Bromide, 

Sarin, Vaccines, on January 1, 2000. In 

that report, NAS limited its analysis to 

the health effects of DU, the chemical 

warfare agent sarin, vaccinations against 

botulism toxin and anthrax, and 

pyridostigmine bromide, which was 

used in the Gulf War as a pretreatment 

for possible exposure to nerve agents. 

On July 6, 2001, VA published a notice 

in the Federal Register announcing the 

Secretary’s determination that the 

available evidence did not warrant a 

presumption of service connection for 

any disease discussed in that report. See 

66 FR 35702 (2001). 

IV. Gulf War and Health: Updated 

Literature Review of DU 

On July 30, 2008, the IOM issued an 

updated report, Gulf War and Health: 

Updated Literature Review of Depleted 

Uranium. The report updated the 

review of DU that appeared in Volume 

1. IOM conducted an extensive search of 

the scientific literature from among 

3,500 titles and abstracts from which 

approximately 1,000 relevant articles 

were selected. These articles included 

epidemiologic, toxicologic, and 

exposure-assessment studies with 

additional information obtained from 

invited experts and the public. 

V. Categories of Strength of Association 

The IOM used the evidence in the 

scientific literature to draw conclusions 

about associations between exposure to 

DU and specific adverse health 

outcomes. Those conclusions are 

presented as categories of strength of 

association. The categories have been 

used in many previous IOM studies, and 

they have gained wide acceptance by 

Congress, government agencies, 

researchers, and Veteran groups. In its 

report, IOM classified the evidence of an 

association between exposure to a 

specific agent and a specific health 

outcome in the categories summarized 

as follows: 

• Sufficient Evidence of a Causal 

Relationship: This category means that 

the evidence is sufficient to conclude 

that a causal relationship exists between 

the exposure to uranium and a specific 

health outcome in humans. The 

evidence fulfills the criteria for 

sufficient evidence of an association and 

satisfies several of the criteria used to 

assess causality: strength of association, 

dose-response relationship, consistency 

of association, temporal relationship, 

specificity of association, and biological 

plausibility. 

IOM did not find any health outcomes 

that met the criteria for this category. 

• Sufficient Evidence of an 

Association: This category means that 

the evidence is sufficient to conclude 

that there is an association. That is, a 

consistent association unlikely to be due 

to sampling variability has been 

observed between exposure to uranium 

and a specific health outcome in human 

studies that were free of severe bias and 

that controlled for confounding. 

IOM did not find any health outcomes 

that met the criteria for this category. 

• Limited/Suggestive Evidence of an 

Association: This category means that 

the evidence is suggestive of an 

association between exposure to 

uranium and a specific health outcome, 

but the body of evidence is limited by 


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insufficient avoidance of bias, 

insufficient control for confounding, or 

large sampling variability. 

IOM did not find any health outcomes 

that met the criteria for this category. 

• Limited/Suggestive Evidence of No 

Association: This category means that 

the evidence is consistent in not 

showing an association between 

exposure to uranium of any magnitude 

and a specific health outcome. A 

conclusion of no association is 

inevitably limited to the conditions, 

magnitudes of exposure, and length of 

observation in the available studies. 

IOM did not find any health outcomes 

that met the criteria for this category. 

• Inadequate/Insufficient Evidence to 

Determine Whether an Association 

Exists: This category means that the 

evidence is of insufficient quantity, 

quality, or consistency to permit a 

conclusion regarding the existence of an 

association between exposure to 

uranium and a specific health outcome 

in humans. 

IOM concluded that there is 

inadequate/insufficient evidence to 

determine whether an association exists 

between exposure to uranium and each 

health outcome described in the report 

because well-conducted studies showed 

equivocal results, the magnitude or 

frequency of the health outcome may be 

so low that it cannot be reliably detected 

given the sizes of the study populations, 

and the available studies had limitations 

that prevented the IOM from reaching 

clear conclusions about health 

outcomes. The health outcomes are 

discussed below. 

VI. Uranium and DU 

Uranium is a dense, radioactive 

element that occurs naturally in soil, 

rocks, surface and underground water, 

air, plants, and animals. It also occurs 

in trace amounts in many foods and 

drinking water as a result of its presence 

in the environment. Uranium is the 

heaviest naturally occurring element. Its 

density is 19 times that of water and 

1.65 times that of lead. The primary 

civilian use of uranium is as fuel for 

nuclear power plants. 

DU is a byproduct of the uranium 

enrichment process used to generate 

fuel for nuclear power plants. As a 

byproduct of uranium enrichment, DU 

is abundant and inexpensive. The U.S. 

Army began researching the use of DU 

for military applications in the early 

1970s, and DU is now used both 

offensively and defensively. In the Gulf 

War, heavy-armor tanks had a layer of 

DU armor to increase protection, and 

DU was used in kinetic-energy 

cartridges and ammunition rounds by 

the U.S. Army, Air Force, Marine Corps, 

and Navy. 

After reviewing approximately 1,000 

articles, the IOM focused on a number 

of relevant health outcomes on which to 

draw conclusions. The selected health 

outcomes were ten types of cancer and 

several non-malignant diseases or 

conditions. The types of cancer were 

lung cancer, leukemia, lymphoma, bone 

cancer, renal cancer, bladder cancer, 

brain and other central nervous system 

cancers, stomach cancer, prostatic 

cancer and testicular cancer. The nonmalignant diseases or conditions 

included renal disease, respiratory 

disease, neurologic disease, and 

reproductive and developmental effects. 

With the exception of prostatic and 

testicular cancers, the health outcomes 

were selected by the IOM because there 

are plausible mechanisms of action (for 

example, lung cancer and respiratory 

disease were selected because inhaled 

insoluble uranium oxides lodge in the 

lung). Prostatic cancer is the most 

frequently diagnosed cancer in all men 

in the U.S., and any slight increase in 

risk could result in large numbers of 

cases and deaths. Testicular cancer, the 

most common cancer in young men, is 

of special interest to Gulf War Veterans, 

and some recent studies of Veterans 

suggested a higher but non-significant 

risk in Gulf War Veterans than in their 

nondeployed counterparts. 

VII. Conclusions 

A. Lung Cancer 

Lung cancer is the leading cause of 

cancer deaths in the U.S. and the 

second-most common cancer in both 

American men and women. Tobaccosmoking is the predominant risk factor, 

and it is thought to account for about 87 

percent of lung-cancer deaths. 

Twenty-three studies of uraniumprocessing workers examined the 

association between exposure to 

uranium and lung cancer, as did three 

studies of military populations and 

three studies of residents. In the studies 

reviewed, the IOM found no consistent 

evidence of an effect of exposure to 

natural uranium or DU on lung-cancer 

incidence. Even considering the 

evidence from the studies with the 

strongest designs, the pattern among the 

studies varied: some studies show 

increases in risk of lung cancer, and 

other show decreases. A major 

shortcoming of the studies is the lack of 

individual data on smoking, a primary 

risk factor for lung cancer. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and lung cancer exists. 

B. Leukemia 

Leukemia originates in the bone 

marrow and is a malignant blood 

disease. Leukemia is a relatively 

uncommon malignancy, so large study 

populations are generally needed to 

demonstrate any significant moderate 

effects. The studies reviewed by the 

IOM generally did not have adequate 

sample size. The results of only 1 of 23 

studies reviewed by the IOM achieved 

statistical significance, indicating a 

reduction in mortality from leukemia. 

However, that study was limited by a 

lack of exposure data and information 

on other risk factors. The remaining 22 

studies showed both increases and 

decreases in risk associated with 

exposure to uranium, all of which were 

non-significant. There was no consistent 

evidence of effect, and the pattern 

among studies was highly varied. The 

same pattern was observed after 

restriction of consideration to larger 

studies. On the basis of the evidence to 

date, the IOM would assign a low 

priority to additional study of an 

association between exposure to DU and 

leukemia. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and leukemia exists. 

C. Lymphomas 

1. Hodgkin Lymphoma 

Hodgkin Lymphoma (also known as 

Hodgkin’s disease) is a very rare cancer 

that originates in lymphatic tissue. The 

studies considered by the IOM split 

virtually evenly between showing an 

increase in risk of Hodgkin Lymphoma 

associated with exposure to natural 

uranium or DU and showing no change 

or a decrease in the risk of Hodgkin 

Lymphoma associated with uranium 

exposure. Only one study achieved a 

statistically significant finding, showing 

a significant increase in the risk of 

Hodgkin Lymphoma. Most of the 

smaller studies show a non-significant 

decrease in risk of incidence or death. 

The IOM noted that the pattern among 

the studies was highly varied, as would 

be expected if there truly were no effect 

in the population. 

2. Non-Hodgkin Lymphoma and Other 

Lymphatic Cancers 

Non-Hodgkin Lymphoma (NHL) 

encompasses the types of cancers of the 

lymphatic tissues that remain after 

exclusion of Hodgkin lymphoma. IOM 

evaluated 24 published studies of a 

possible relationship between exposure 

to natural uranium or DU and NHL. 

Most of the studies showed that the 

exposed subjects experienced a risk of 


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NHL equal to or lower than that in 

unexposed subjects. 

On the basis of the available evidence, 

the IOM concludes that there is a lack 

of strong and consistent evidence of an 

association between uranium exposure 

and lymphatic cancers. Although the 

available evidence does not justify 

further consideration of a possible 

association between DU and lymphatic 

cancers, IOM concludes that further 

study of this type of cancer may be 

warranted on biologic grounds, given 

that uranium is known to accumulate in 

the lymph nodes. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and lymphomas exists. This 

conclusion applies to both Hodgkin 

Lymphoma and NHL. 

D. Bone Cancer 

Twelve studies of uranium-processing 

workers, one study of a deployed 

population, and two residential studies 

assessed bone-cancer outcomes. In most 

of the studies, the risk of bone cancer 

was the same or decreased after 

exposure to natural uranium or DU. 

Only one study had a significant 

finding: a statistically significant 

increase in bone-cancer incidence—four 

cases—in a Danish military population 

deployed to the Balkans. However, 

because three of the four cases occurred 

within the first year after deployment, it 

is unlikely that deployment-related 

exposure was a factor, given the latency 

of cancer. The studies generally did not 

have adequate sample size to detect any 

significant moderate effects. Overall, the 

available studies did not provide clear 

and consistent evidence of an 

association between natural uranium or 

DU, and bone cancer. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and bone cancer exists. 

E. Renal Cancer 

The IOM considered 20 studies of an 

association between natural uranium or 

DU and renal cancer. None of the 

published results demonstrated a 

significant increase in risk after uranium 

exposure. One study indicated a 

statistically significant decrease in 

renal-cancer mortality associated with 

uranium exposure. That study did not 

include exposure assessment or 

information on other risk factors. On the 

basis of the available evidence, the IOM 

would assign a low priority to further 

study of an association between 

exposure to DU and renal cancer. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and renal cancer exists. 

F. Bladder Cancer 

The IOM evaluated 20 published 

studies of a potential association 

between exposure to natural uranium or 

DU and bladder cancer: 14 uraniumprocessing studies, two studies of 

military populations, and four 

residential studies. Most of the studies 

reported the same or reduced bladdercancer mortality or incidence in 

exposed subjects. Only one finding 

achieved statistical significance, a 

reduction in bladder-cancer incidence. 

That study is limited by a lack of data 

on internal radiation exposure and other 

risk factors. Overall, the IOM finds little 

evidence that exposure to natural 

uranium or DU increases the risk of 

bladder cancer. The IOM would assign 

a low priority to further study of an 

association between exposure to DU and 

bladder cancer. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and bladder cancer exists. 

G. Brain and Other Central Nervous 

System Cancers 

Of the 20 published studies of an 

association between uranium exposure 

and brain and other central nervous 

system cancers reviewed by the IOM, 

almost all failed to demonstrate 

statistically significant associations. The 

studies are roughly evenly split between 

those showing increases in and those 

showing the same or decreases in 

mortality or incidence. The two studies 

that had statistically significant results 

showed decreases in risk after uranium 

exposure. 

The published studies show 

inconsistent results that do not lead to 

a conclusion of an association between 

natural uranium or DU and cancers of 

the central nervous system. Studies of 

some other cancers (for example, 

bladder cancer) showed an equal or 

reduced risk after exposure, but the 

distribution of studies of brain and other 

central nervous system cancers is more 

balanced. Because of that pattern, the 

IOM believes that further study of an 

association between DU and central 

nervous system cancers may be 

warranted but should not be assigned a 

high priority. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and cancers of the central 

nervous system, including brain cancer, 

exists. 

H. Stomach Cancer 

The IOM considered 21 published 

studies of a possible association 

between natural uranium or DU, and 

stomach cancer, including 16 processing 

studies, one study of military 

populations, and four residential 

studies. All but three had statistically 

non-significant results, and most 

demonstrated the same or decreased 

mortality or incidence. The three 

studies that had statistically significant 

results all showed a decrease in 

mortality or incidence. Overall, the IOM 

finds little evidence to suggest that 

exposure to natural uranium or DU 

increases the risk of stomach cancer. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and stomach cancer exists. 

I. Male Genital Cancers 

1. Prostatic Cancer 

The IOM evaluated 19 published 

studies of a potential association 

between exposure to natural or depleted 

uranium and prostatic cancer, including 

14 processing studies, two studies of 

deployed populations, and three 

residential studies. Only one reported a 

statistically significant finding: a 

significant reduction in prostatic-cancer 

incidence, but not mortality. This study 

is limited by a lack of data on internal 

radiation exposure. Three other studies 

of processing workers reported 

increased prostatic-cancer mortality, but 

none of the standard mortality rates 

were statistically different from the null 

value, indicating no effect (Ritz, 1999; 

Beral et al., 1988; Loomis and Wolf, 

1996). 

Of the 19 studies considered, none 

demonstrated a significant increase in 

the risk of prostatic cancer after 

exposure to uranium, and one showed 

a significant decrease in cancer 

incidence but not mortality. On the 

basis of the available evidence, IOM 

would assign a low priority to further 

study of an association between 

exposure to DU and prostatic cancer. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and prostatic cancer exists. 

2. Testicular Cancer 

IOM considered 15 published studies 

for a possible relationship between 

exposure to natural uranium or DU and 

testicular cancer, including 11 studies of 

uranium-processing workers, three 

studies of military populations, and one 

study of residents living near a nuclear 

facility in Pennsylvania. None of the 

results achieved statistical significance, 


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although all occupational cohorts had 

lower mortality. IOM finds no 

consistent evidence that uranium 

exposure increases the risk of testicular 

cancer. Testicular cancer, although very 

rare in the general population, is 

common in young adult males and 

therefore prevalent in deployed 

Veterans. Despite the inconsistent 

evidence, testicular cancer is of special 

interest to Gulf War Veterans. The IOM 

believes that further study of an 

association between DU and testicular 

cancer may be warranted, but should 

not be assigned a high priority. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and testicular cancer exists. 

VIII. Non-Cancer Outcomes 

A. Non-malignant Renal Disease 

1. Mortality 

Fourteen studies assessed the 

association between occupational 

exposure and renal-disease mortality. In 

many of the 14 studies, the computed 

death rates included all genitourinary 

conditions instead of focusing on renal 

diseases. In several of the plants, 

uranium exposure coexisted with other 

relevant heavy-metal or chemical 

exposure. Generally, most researchers 

were unable to isolate the effects of 

uranium exposure alone. Four studies 

found an excess mortality that was not 

statistically significant. One study 

reported a statistically significant 

decrease in mortality. Other studies also 

reported a decrease or no difference in 

mortality after uranium exposure. 

2. Morbidity 

IOM concludes that there is 

inadequate/insufficient evidence to 

determine whether an association 

between exposure to uranium and nonmalignant renal disease exists. 

B. Non-maligant Respiratory Disease 

IOM evaluated 16 studies of exposure 

to uranium and non-malignant 

respiratory disease. The results of 

several of the studies support an effect 

of employment in uranium-processing 

facilities on nonmalignant respiratory 

disease, but their applicability to 

military DU exposure is limited by the 

extent of concomitant coexposure of 

such workers to other respiratory 

toxicants. Several other studies found 

decreases in lung-disease mortality in 

exposed populations. On the basis of the 

evidence, IOM would assign a high 

priority to further study of an 

association between exposure to DU and 

nonmalignant respiratory disease. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and nonmalignant respiratory 

disease exists. 

C. Neurologic Effects 

Overall, the published studies of 

neurologic outcomes are either negative 

studies that do not find any evidence of 

health effects of exposure to DU or 

relatively small studies that find 

inconstant associations. On the basis of 

the available evidence, IOM would 

assign a high priority to further study of 

an association between exposure to DU 

and neurologic effects. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and nonmalignant respiratory 

disease exists. 

D. Reproductive and Developmental 

Effects 

A few studies examined the effects of 

natural uranium or DU on human 

reproduction and development. 

Relatively large populations are 

generally necessary to demonstrate 

significant but subtle reproductive or 

developmental effects. The studies 

reviewed generally had too few subjects 

or relied on insufficiently precise 

exposure assessment to support 

definitive conclusions. On the basis of 

the available evidence, IOM would 

assign a high priority to further study of 

an association between exposure to DU 

and reproductive and developmental 

effects. 

IOM found inadequate/insufficient 

evidence to determine whether an 

association between exposure to 

uranium and reproductive and 

developmental effects exist. 

IX. Other Health Outcomes 

For other health outcomes, IOM found 

that the effects of exposure to natural 

uranium or DU have not been studied in 

detail in humans, and that the evidence 

from which to draw conclusions is 

sparse. Consequently, IOM found 

inadequate/insufficient evidence to 

determine whether an association exists 

between exposure to uranium and 

cardiovascular effects, genotoxic effects, 

hematologic effects, immunologic 

effects and skeletal effects. 

Summary 

The likelihood of detecting an 

association between exposure and a 

health outcome depends on several 

factors. For the health outcomes 

discussed, IOM concluded that 

exposure to uranium is not associated 

with a large or frequent effect. 

Nevertheless, it is possible that DUexposed Veterans will have a small 

increase in the likelihood of developing 

the disease. Typically, extremely large 

study populations are necessary to 

demonstrate that a specific exposure is 

not associated with a health outcome. 

IOM’s evaluation of the literature 

supports the conclusion that a large or 

frequent effect is unlikely, but it is not 

possible to state conclusively that a 

particular health outcome cannot occur. 

IOM concluded that there is 

inadequate/insufficient evidence to 

determine whether an association exists 

between exposure to uranium and the 

following health outcomes: lung cancer; 

leukemias; lymphomas; bone cancer; 

renal cancer; bladder cancer; brain and 

other central nervous system cancers; 

stomach cancer; male genital cancers 

(prostatic and testicular cancers); nonmalignant renal disease; non-malignant 

respiratory disease; neurologic effects; 

reproductive effects; and other health 

outcomes (cardiovascular effects, 

genotoxicity, hematologic effects, 

immunologic effects, and skeletal 

effects). 

Conclusion 

After careful review of the findings of 

the IOM Report, Gulf War and Health: 

Updated Literature Review of Depleted 

Uranium, the Secretary has determined 

that the scientific evidence presented in 

the 2008 IOM report and other 

information available to the Secretary 

indicates that no new presumption of 

service connection is warranted at this 

time for any of the illnesses described 

in the 2008 IOM report. 

Approved: March 1, 2010. 

John R. Gingrich, 

Chief of Staff, Department of Veterans Affairs. 

[FR Doc. 2010–4882 Filed 3–8–10; 8:45 am] 

BILLING CODE 8320–01–P 


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