§ 1.18 Guidelines for establishing presumptions of service connection for former prisoners of war. ( a ) *Purpose.* The Secretary of Veterans Affairs will establish presumptions of service connection for former prisoners of war when necessary to prevent denials of benefits in significant numbers of meritorious claims.
( b ) *Standard.* The Secretary may establish a presumption of service connection for a disease when the Secretary finds that there is at least limited/suggestive evidence that an increased risk of such disease is associated with service involving detention or internment as a prisoner of war and an association between such detention or internment and the disease is biologically plausible. ( 1 ) *Definition.* The phrase “limited/suggestive evidence” refers to evidence of a sound scientific or medical nature that is reasonably suggestive of an association between prisoner-of-war experience and the disease, even though the evidence may be limited because matters such as chance, bias, and confounding could not be ruled out with confidence or because the relatively small size of the affected population restricts the data available for study.
( 2 ) *Examples.* “Limited/suggestive evidence” may be found where one high-quality study detects a statistically significant association between the prisoner-of-war experience and disease, even though other studies may be inconclusive. It also may be satisfied where several smaller studies detect an association that is consistent in magnitude and direction. These examples are not exhaustive.
( c ) *Duration of detention or internment.* In establishing a presumption of service connection under paragraph (b) of this section, the Secretary may, based on sound scientific or medical evidence, specify a minimum duration of detention or internment necessary for application of the presumption.
( d ) *Association.* The requirement in paragraph (b) of this section that an increased risk of disease be “associated” with prisoner-of-war service may be satisfied by evidence that demonstrates either a statistical association or a causal association.
( e ) *Evidence.* In making determinations under paragraph (b) of this section, the Secretary will consider, to the extent feasible: ( 1 ) Evidence regarding the increased incidence of disease in former prisoners of war;
( 2 ) Evidence regarding the health effects of circumstances or hardships similar to those experienced by prisoners of war (such as malnutrition, torture, physical abuse, or psychological stress);
( 3 ) Evidence regarding the duration of exposure to circumstances or hardships experienced by prisoners of war that is associated with particular health effects; and
( 4 ) Any other sound scientific or medical evidence the Secretary considers relevant.
( f ) *Evaluation of studies.* In evaluating any study for the purposes of this section, the Secretary will consider: ( 1 ) The degree to which the study's findings are statistically significant;
( 2 ) The degree to which any conclusions drawn from the study data have withstood peer review;
( 3 ) Whether the methodology used to obtain the data can be replicated;
( 4 ) The degree to which the data may be affected by chance, bias, or confounding factors; and
( 5 ) The degree to which the data may be relevant to the experience of prisoners of war in view of similarities or differences in the circumstances of the study population.
( g ) *Contracts for Scientific Review and Analysis.* To assist in making determinations under this section, the Secretary may contract with an appropriate expert body to review and summarize the scientific evidence, and assess the strength thereof, concerning the association between detention or internment as a prisoner of war and the occurrence of any disease, or for any other purpose relevant to the Secretary's determinations.
(Authority: 38 U.S.C. 501(a), 1110)
[69 FR 60089, Oct. 7, 2004]