Federal Register / Vol. 62, No. 36 / Monday, February 24, 1997 / Proposed Rules 8201

in PW ASB No. A6272, dated September 24,

1996.

(b) Report the number of completed

inspections on a monthly basis and report

findings of cracked fan hubs in accordance

with Accomplishment Instructions,

Paragraph F, of Attachment 1 to PW ASB No.

A6272, dated September 24, 1996, within 48

hours after inspection to Robert Guyotte,

Manager, Engine Certification Branch, Engine

Certification Office, FAA, Engine and

Propeller Directorate, 12 New England

Executive Park, Burlington, MA 01803–5299;

telephone (617) 238–7142, fax (617) 238–

7199; Internet: Robert.Guyotte@faa.dot.gov.

Reporting requirements have been approved

by the Office of Management and Budget and

assigned OMB control number 2120–0056.

(c) An alternative method of compliance or

adjustment of the compliance time that

provides an acceptable level of safety may be

used if approved by the Manager, Engine

Certification Office. The request should be

forwarded through an appropriate FAA

Principal Maintenance Inspector, who may

add comments and then send it to the

Manager, Engine Certification Office.

Note 2: Information concerning the

existence of approved alternative methods of

compliance with this airworthiness directive,

if any, may be obtained from the Engine

Certification Office.

(d) Special flight permits may be issued in

accordance with sections 21.197 and 21.199

of the Federal Aviation Regulations (14 CFR

21.197 and 21.199) to operate the aircraft to

a location where the inspection requirements

of this AD can be accomplished.

Issued in Burlington, Massachusetts, on

February 14, 1997.

James C. Jones,

Acting Manager, Engine and Propeller

Directorate, Aircraft Certification Service.

[FR Doc. 97–4370 Filed 2–21–97; 8:45 am]

BILLING CODE 4910–13–P

DEPARTMENT OF LABOR

Employment Standards Administration

20 CFR Parts 718, 722, 725, 726 and

727

RIN 1215–AA99

Regulations Implementing the Federal

Coal Mine Health and Safety Act of

1969, as Amended; Extension of

Comment Period

AGENCY: Employment Standards

Administration, Labor.

ACTION: Proposed rule; extension of

comment period.

SUMMARY: This document extends the

period for filing comments regarding the

proposed rule to amend and revise the

regulations implementing the Black

Lung Benefits Act. This action is taken

to permit additional comment from

interested persons.

DATE: Comments must be received on or

before May 23, 1997.

ADDRESSES: Send written comments on

the proposed rule to James L. DeMarce,

Director, Division of Coal Mine

Workers’ Compensation, Room C–3520,

Frances Perkins Building, 200

Constitution Ave., NW, Washington, DC

20210.

FOR FURTHER INFORMATION CONTACT:

James L. DeMarce, (202) 219–6692.

SUPPLEMENTARY INFORMATION: In the

Federal Register of the January 22, 1997

(62 FR 3338–3435), the Department of

Labor published a proposed rule

intended to amend and revise the

regulations implementing the Black

Lung Benefits Act, subchapter IV of the

Federal Coal Mine Health and Safety

Act of 1969, as amended. Interested

persons were requested to submit

comments on or before March 24, 1997.

The Department has received requests

for an extension of the comment period

from groups representing coal mine

operators, coal mine construction

companies, the insurance industry,

organized labor, and black lung

claimants. Because of the interest in this

proposal, the Department believes that it

is desirable to extend the comment

period for all interested persons.

Therefore, the comment period for the

proposed rule, amending and revising

20 CFR parts 718, 722, 725, 726 and

727, is extended through May 23, 1997.

Signed at Washington, DC, this 18 day of

February, 1997.

Bernard E. Anderson,

Assistant Secretary for Employment

Standards.

[FR Doc. 97–4467 Filed 2–21–97; 8:45 am]

BILLING CODE 4510–27–M

DEPARTMENT OF VETERANS

AFFAIRS

38 CFR Parts 3 and 4

RIN 2900–AH41

Service Connection of Dental

Conditions for Treatment Purposes

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

SUMMARY: The Department of Veterans

Affairs is proposing to amend its

adjudication regulations for determining

service connection of dental conditions

for purposes of eligibility for outpatient

dental treatment. Current regulations

contain overlapping provisions which

do not clearly state requirements for

service connection, and provide that

service connection will be granted for

certain dental conditions shown after a

‘‘reasonable period of service’’ without

defining what constitutes such a period.

We intend to consolidate the

information, and replace the term

‘‘reasonable period of service’’ with a

precise period of 180 days. We also

propose to eliminate redundant

material, and to clearly state

requirements for service connection for

purposes of eligibility for outpatient

dental treatment.

DATES: Comments must be received on

or before April 25, 1997.

ADDRESSES: Mail or hand deliver written

comments to: Director, Office of

Regulations Management (02D),

Department of Veterans Affairs, 810

Vermont Ave., NW, Room 1154,

Washington, DC 20420. Comments

should indicate that they are submitted

in response to ‘‘RIN 2900–AH41.’’ All

written comments will be made

available for public inspection at the

above address in the Office of

Regulations Management, Room 1158,

between the hours of 8 a.m. and 4:30

p.m., Monday through Friday (except

holidays).

FOR FURTHER INFORMATION CONTACT:

Lorna Fox, Consultant, Regulations

Staff, Compensation and Pension

Service (213), Veterans Benefits

Administration, Department of Veterans

Affairs, 810 Vermont Ave., NW,

Washington, DC 20420, (202) 273–7223.

SUPPLEMENTARY INFORMATION: The

provisions of 38 U.S.C. 1712 (restated in

38 CFR 17.123) set forth eligibility

requirements for VA outpatient

treatment of dental conditions and

disabilities. This section provides that

veterans with non-compensable serviceconnected dental conditions are entitled

to a one-time correction of the dental

condition provided that certain

requirements are met, including

application for dental treatment made

within 90 days of service discharge.

Following completion of this initial

care, subsequent additional treatment

may be provided in certain other cases,

i.e., if the veteran was a prisoner of war,

if the dental condition or disability is

due to combat or other in-service

trauma, or if the veteran has serviceconnected disabilities rated at 100

percent.

38 CFR part 4, the Schedule for Rating

Disabilities, provides evaluations for

dental conditions considered disabling

in nature. (See § 4.150, Schedule of

ratings—dental and oral conditions.)

There are other dental conditions,

however, which are not considered

disabling and thus do not generally fall

under the purview of § 4.150. The issue

of service connection arises for these

conditions only for the purpose of
8202 Federal Register / Vol. 62, No. 36 / Monday, February 24, 1997 / Proposed Rules

determining eligibility for outpatient

dental treatment. These conditions are

listed at 38 CFR 4.149, ‘‘Rating diseases

of the teeth and gums’’, and include

treatable carious teeth, replaceable

missing teeth, dental or alveolar

abscesses, periodontal disease, and

Vincent’s stomatitis (also referred to as

Vincent’s infection, Vincent’s disease,

or acute necrotizing gingivitis).

The Schedule for Rating Disabilities is

a guide for evaluating disabilities for

compensation purposes. Because the

dental conditions listed in § 4.149 are

not evaluated for compensation, but

only to determine eligibility for

treatment, it is more appropriate to list

them in 38 CFR part 3, which contains

general rules for determining service

connection. We therefore propose to list

these non-compensable dental

conditions in § 3.381(a) and to delete

section § 4.149.

The current regulations at 38 CFR

3.381 and 3.382 set forth the principles

for determining whether a dental

condition was incurred or aggravated

during service for purposes of treatment.

Provisions for determining which

conditions are service connected for

outpatient treatment purposes, and

which are not, are scattered throughout

both sections. Section 3.381 establishes

the conditions under which dental

conditions that were present at entry

into service will be service connected;

§ 3.382 (a) and (b) list the evidence

requirements for establishing service

connection; and § 3.382(c) states that

certain dental conditions will not be

service connected. We propose to

rewrite the regulations to consolidate

the information, make requirements for

service connection for treatment

purposes clear, list specific conditions

that will not be service connected, and

eliminate redundant material.

The regulations at §§ 3.381 and 3.382

currently state that service connection

for certain non-compensable dental

conditions is warranted only if the

conditions are shown after a

‘‘reasonable period of service.’’ The

condition of ‘‘reasonable period of

service’’ was intended to provide a basis

for determining those dental conditions

which would be considered as incurred

or aggravated during active duty. (See

38 U.S.C. 1110, 1131.) In the absence of

a definition for the term ‘‘reasonable

period of service,’’ the Court of Veterans

Appeals held in Manio v. Derwinski, 1

Vet. App. 140 (1991), that four months

‘‘is sufficient to satisfy the ‘reasonable

period of service’ requirement’’ under

the facts of that case.

We propose to revise § 3.381 to

replace the subjective term ‘‘reasonable

period of service’’ with the objective

requirement of 180 days or more of

active service. Dental caries and other

dental pathology take time to develop,

often a year or two in permanent teeth.

Thus it is more likely than not that

caries or pathology that became

apparent within the first 180 days of a

person’s active service pre-existed that

service. Periodontal disease, which

results from the long term effects of

plaque on the periodontium, also

develops over time, and we believe the

same period is appropriate for effects of

this condition.

In § 3.381, paragraph (c) currently

states that effective principles relating to

the establishment of service connection

for dental diseases and injuries by

reason of their association with other

service-connected diseases and injuries

will be observed. The provisions

governing such secondary service

connection are contained in § 3.310.

Therefore, inclusion of this statement

here is unnecessary and we propose to

delete it.

In § 3.381, paragraph (d) currently

states that the presumption of

soundness does not apply to noncompensable dental conditions.

However, 38 CFR 3.304(b) provides that

a veteran shall be considered to have

been in sound condition when entering

service ‘‘except as to defects, infirmities,

or disorders noted at entrance into

service.’’ In order to maintain

consistency between the provisions of

38 CFR part 3, we propose to eliminate

the statement in § 3.381, paragraph (d)

that the presumption of soundness does

not apply to non-compensable dental

conditions.

In § 3.381, paragraph (b) currently

states that treatment during service is

not considered per se as aggravation of

a condition noted as present at entry

because such treatment is considered

ameliorative. We propose to retain that

principle in proposed § 3.381, paragraph

(c) but will replace the phrase ‘‘per se’’

with a statement that treatment in

service is not evidence that a condition

noted at entry has been aggravated,

unless additional pathology developed

after 180 days or more of service. The

use of the 180-day time period has

already been explained.

We propose to place in § 3.381,

paragraph (d), specific rules for

determining whether dental conditions

that are noted at entry into service and

treated during active duty are service

connected for treatment purposes. This

paragraph will incorporate provisions

now listed at § 3.381(b) for teeth that are

noted as carious but restorable, filled,

and defective but not restorable. We

propose to include new provisions for

teeth normal at entry but which are

filled or extracted during service and

teeth missing at entry because these

situations frequently require decision

but are not addressed in the current

regulation.

In § 3.381, paragraph (d)(1), we

propose to state that teeth noted as

normal at the time of entry into service

will be service connected only if filled

or extracted after 180 days or more of

active service. Setting a precise period

of 180 days for development of dental

pathology as a requirement for service

connection is consistent with our

statement that conditions that

manifested before expiration of 180 days

of active service more likely than not

pre-existed that service.

In § 3.381, paragraph (d)(2), we

propose to state that teeth noted as filled

at entry into service will be service

connected if they were extracted, or if

the existing filling was replaced, after

180 days or more of service. This is not

a change from the current provision, but

substitutes a precise period of 180 days

for the ‘‘reasonable time’’ provision of

the current rule.

In § 3.381, paragraph (d)(3), we

propose to state that teeth that are

carious but restorable at entry will not

be service connected if they are filled

during service, but that if new caries

develop in the same tooth 180 days or

more after a filling has been placed,

service connection will be granted. This

substitutes a precise period for the

current language granting service

connection if such new caries develop

‘‘a reasonable time’’ after the original

cavity has been filled.

In § 3.381, paragraph (d)(4), we

propose to state that teeth noted as

carious but restorable at entry will be

service connected, regardless of whether

or not they are filled, if extraction is

required after 180 days or more of active

service. This is not a change from the

current provision, but substitutes the

precise period of 180 days for the

‘‘reasonable time’’ provision of the

current rule.

In § 3.381, paragraph (d)(5), we

propose to state that teeth noted to be

defective and non-restorable at entry

will not be service connected, regardless

of treatment during service. This is not

a change from the current provision.

In § 3.381, paragraph (d)(6), we

propose to state that teeth noted at entry

as missing will not warrant service

connection for treatment purposes,

notwithstanding treatment which may

have been administered during active

duty. This provision is consistent with

proposed § 3.381(c) which states that

treatment in service for a pre-existing

condition does not represent

aggravation of that condition.
Federal Register / Vol. 62, No. 36 / Monday, February 24, 1997 / Proposed Rules 8203

In § 3.381, paragraph (e), we propose

to list conditions that will not be service

connected for treatment purposes.

Conditions now listed at § 3.382(c) for

which service connection will not be

granted include: salivary deposits;

gingivitis; acute Vincent’s disease;

pyorrhea; impacted or malposed teeth

and third molars (wisdom teeth).

Impacted and malposed teeth are

considered developmental defects, as is

the presence of third molars. As noted

above, these conditions are not service

connected under current provisions,

unless separate pathology develops

‘‘after a reasonable time.’’ In the revised

§ 3.381 (e)(3) and (e)(4), we propose to

replace this term with the precise period

of 180 days or more of active service.

We have already explained our use of

the 180-day time period.

We have incorporated current medical

terminology in the regulation, and;

therefore, have substituted the term

‘‘calculus’’ for ‘‘salivary deposits’’ and

‘‘periodontal disease’’ for the terms

‘‘gingivitis,’’ ‘‘Vincent’s disease,’’ and

‘‘pyorrhea.’’

The current regulation states that

gingivitis is not a disease entity and

thus is not ratable. Gingivitis is an

inflammatory condition which is

usually an acute condition, but can be

a precursor of more serious

inflammatory processes. Vincent’s

disease is a form of gingival

inflammation also called ‘‘trench

mouth’’ or ‘‘necrotizing ulcerative

gingivitis’’ which the current regulation

does not service connect in its acute

state. Periodontitis is a more current

term for pyorrhea. All of these

conditions are encompassed by the

broader, more general term periodontal

disease. Periodontal disease is related to

dental hygiene and can be affected by

such other factors as diet, abnormal

stress, other disease processes, and

reaction to certain drugs or chemicals.

With proper treatment, most periodontal

disease resolves with no residuals. For

this reason, service connection for acute

periodontal disease is not warranted.

However, under the current regulation,

chronic periodontal disease (pyorrhea),

which may result in tooth extraction,

warrants service connection for the lost

teeth. We propose to retain this

provision, with the clarification that

such tooth loss will be service

connected only if extraction is required

after at least 180 days of service.

We propose to eliminate as

unnecessary paragraphs (a) and (b) of

§ 3.382, ‘‘Evidence to establish service

connection for dental disabilities.’’

These paragraphs contain information

about kinds of evidence needed to

establish service connection and

alternate sources of evidence when

service medical records are unavailable.

Evidence requirements are adequately

covered elsewhere in the regulations

and stating them here is unnecessary.

(See regulations at 38 CFR 3.303,

‘‘Principles relating to service

connection’’ and § 3.304 ‘‘Direct service

connection; wartime and peacetime.’.)

Regulatory Flexibility Act

The Secretary hereby certifies that

this proposed amendment will not have

a significant economic impact on a

substantial number of small entities as

they are defined in the Regulatory

Flexibility Act (RFA), 5 U.S.C. 601–612.

The proposed amendment would not

directly affect any small entities. Only

VA beneficiaries could be directly

affected. Therefore, pursuant to 5 U.S.C.

605(b), the proposed amendment is

exempt from the initial and final

regulatory flexibility analysis

requirements of sections 603 and 604.

The Catalog of Federal Domestic

Assistance program numbers are 64.104,

64.105, 64.109 and 64.110.

List of Subjects

38 CFR Part 3

Administrative practice and

procedure, Claims, Disability benefits,

Health care, Pensions, Pesticides and

pests, Radioactive materials, Veterans,

Vietnam.

38 CFR Part 4

Disability benefits, Pensions,

Individuals with disabilities, Veterans.

Approved: November 6, 1996.

Jesse Brown,

Secretary of Veterans Affairs.

For the reasons set forth in the

preamble, 38 CFR parts 3 and 4 are

proposed to be amended as follows:

PART 3—ADJUDICATION

Subpart A—Pension, Compensation,

and Dependency and Indemnity

Compensation

1. The authority citation for part 3,

subpart A continues to read as follows:

Authority: 38 U.S.C. 501(a), unless

otherwise noted.

2. Section 3.381 is revised to read as

follows:

§ 3.381 Service connection of dental

conditions for treatment purposes.

(a) Treatable carious teeth, replaceable

missing teeth, dental or alveolar

abscesses, and periodontal disease will

be considered service connected solely

for the purpose of establishing eligibility

for outpatient dental treatment as

provided in section 17.123 of this

chapter.

(b) The rating activity will consider

each defective or missing tooth and each

disease of the teeth and periodontal

tissues separately to determine whether

the condition was incurred or

aggravated in line of duty during active

service. When applicable, the rating

activity will determine whether the

condition is due to combat or other inservice trauma, or whether the veteran

was interned as a prisoner of war.

(c) In determining service connection,

the condition of teeth and periodontal

tissues at the time of entry into active

duty will be considered. Treatment

during service, including filling or

extraction of a tooth, or placement of a

prosthesis, will not be considered

evidence of aggravation of a condition

that was noted at entry, unless

additional pathology developed after

180 days or more of active service.

(d) The following principles apply to

dental conditions noted at entry and

treated during service:

(1) Teeth noted as normal at entry will

be service connected if they were filled

or extracted after 180 days or more of

active service.

(2) Teeth noted as filled at entry will

be service connected if they were

extracted, or if the existing filling was

replaced, after 180 days or more of

active service.

(3) Teeth noted as carious but

restorable at entry will not be service

connected on the basis that they were

filled during service. However, new

caries that developed 180 days or more

after such a tooth was filled will be

service connected.

(4) Teeth noted as carious but

restorable at entry, whether or not filled,

will be service connected if extraction

was required after 180 days or more of

active service.

(5) Teeth noted at entry as nonrestorable will not be service connected,

regardless of treatment during service.

(6) Teeth noted as missing at entry

will not be service connected, regardless

of treatment during service.

(e) The following will not be

considered service connected for

treatment purposes:

(1) Calculus;

(2) Acute periodontal disease;

(3) Third molars, unless disease or

pathology of the tooth developed after

180 days or more of active service, or

was due to combat or in-service trauma;

and

(4) Impacted or malposed teeth, and

other developmental defects, unless

disease or pathology of these teeth

developed after 180 days or more of

active service.
8204 Federal Register / Vol. 62, No. 36 / Monday, February 24, 1997 / Proposed Rules

(f) Chronic periodontal disease. Teeth

extracted because of chronic periodontal

disease will be service connected only

if they were extracted after 180 days or

more of active service.

(Authority: 38 U.S.C. 1712)

§ 3.382 [Removed]

3. Section 3.382 is removed.

PART 4—SCHEDULE FOR RATING

DISABILITIES

Subpart B—Disability Ratings

4. The authority citation for part 4

continues to read as follows:

Authority: 38 U.S.C. 1155.

§ 4.149 [Removed]

5. Section 4.149 is removed.

[FR Doc. 97–4419 Filed 2–21–97; 8:45 am]

BILLING CODE 8320–01–P

38 CFR Part 4

RIN 2900–AI22

Intervertebral Disc Syndrome

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

SUMMARY: This document proposes to

amend the Department of Veterans

Affairs (VA) Schedule for Rating

Disabilities by revising the evaluation

criteria for diagnostic code 5293,

intervertebral disc syndrome. The

intended effect of this amendment is to

clarify the criteria to ensure that

veterans diagnosed with this condition

meet uniform criteria and receive

consistent evaluations.

DATES: Comments must be received by

VA on or before April 25, 1997.

ADDRESSES: Mail or hand deliver written

comments to: Director, Office of

Regulations Management (02D),

Department of Veterans Affairs, 810

Vermont Ave., NW, Room 1154,

Washington DC 20420. Comments

should indicate that they are in

response to ‘‘RIN 2900–AI22.’’ All

written comments will be available for

public inspection at the above address

in the Office of Regulations

Management, Room 1158, between the

hours of 8:00 a.m. and 4:30 p.m.,

Monday through Friday (except

holidays).

FOR FURTHER INFORMATION CONTACT:

Caroll McBrine, M.D., Consultant,

Regulations Staff (213A), Compensation

and Pension Service, Veterans Benefits

Administration, Department of Veterans

Affairs, 810 Vermont Ave., NW,

Washington, DC 20420, (202) 273–7230.

SUPPLEMENTARY INFORMATION: The

central portion of one or more

intervertebral discs, cartilages that

separate the spinal vertebrae, may

protrude or rupture through the outer

fibrous part of the disc and compress or

irritate the adjacent nerve root.

Intervertebral disc syndrome is a group

of signs and symptoms due to nerve root

irritation that commonly includes back

pain and sciatica (pain along the course

of the sciatic nerve) in the case of

lumbar disc disease, and neck and arm

or hand pain in the case of cervical disc

disease. It may also include scoliosis,

paravertebral muscle spasm, limitation

of motion of the spine, tenderness over

the spine, limitation of straight leg

raising, and neurologic findings

corresponding to the level of the disc. If

the disc compresses the cauda equina

(the collection of nerve roots extending

from the lower end of the spinal cord),

bowel or bladder sphincter functions or

sexual function may also be affected.

Intervertebral disc syndrome has a

variable course and variable

manifestations. Many people have a

series of relapses and remissions of back

pain and sciatica over a long period of

time with no symptoms during

remission; other patients experience

chronic signs and symptoms.

The current evaluation criteria for

intervertebral disc syndrome (DC 5293)

include: a 60-percent evaluation for

persistent sciatic neuropathy or other

neurologic findings, with little

intermittent relief; a 40-percent

evaluation for severe recurring attacks; a

20-percent evaluation for moderate

recurring attacks; a 10-percent

evaluation if the condition is mild; and

a zero-percent evaluation if the

condition is postoperative, cured. These

criteria require rating agencies to make

a subjective determination as to whether

the condition is ‘‘mild,’’ ‘‘moderate,’’ or

‘‘severe.’’ In addition, they raise

questions as to whether any neurologic

manifestation, regardless of severity,

warrants a 60-percent evaluation, or

whether intervertebral disc syndrome

with neurologic manifestations may be

evaluated higher or lower than 60

percent.

In order to clarify the evaluation

criteria, and thereby assure more

consistent evaluations, we propose to

eliminate subjective terms such as mild,

moderate, and severe in favor of more

objective criteria, and to provide

specific instructions for evaluating both

the orthopedic and neurologic

manifestations of intervertebral disc

syndrome. We also propose that these

criteria apply both pre-operatively and

post-operatively.

We propose to evaluate intervertebral

disc syndromes that are primarily

disabling because of periods of acute

symptoms that require bed rest

according to the cumulative amount of

time over the course of a year that the

patient is incapacitated, i.e., requires

bed rest and treatment by a physician.

Incapacitating episodes of at least six

weeks total duration per year would be

evaluated at 60 percent; incapacitating

episodes of at least four but less than six

weeks total duration per year at 40

percent; incapacitating episodes of at

least two but less than four weeks total

duration per year at 20 percent; and

incapacitating episodes of at least one

but less than two weeks total duration

per year at 10 percent. Evaluating the

condition in this manner will assure

more consistent evaluations when the

disc disease is episodic because

percentage evaluations will be assigned

based on an objective standard—yearly

cumulative duration of incapacitating

episodes—rather than a subjective

assessment of whether the condition is

mild, moderate, or severe.

We propose to evaluate intervertebral

disc syndromes that are disabling

primarily because of chronic orthopedic

manifestations (e.g., painful muscle

spasm or limitation of motion), chronic

neurologic manifestations (e.g.,

footdrop, muscle atrophy, or sensory

loss), or a combination of both, by

assigning separate evaluations for the

orthopedic and neurologic

manifestations, using DC 5293

hyphenated with the appropriate

orthopedic or neurologic code.

Assigning separate evaluations for the

orthopedic and neurologic

manifestations will assure that

evaluations accurately reflect the actual

disabling effects of the condition, and

that neurologic manifestations in

particular will not be over-or underevaluated by being considered

categorically rather than individually.

When an intervertebral disc syndrome

is disabling both because of

incapacitating episodes and persistent

orthopedic or neurologic manifestations,

we propose that the rating agency use

whichever alternative method of

evaluation results in a higher

evaluation.

The Secretary hereby certifies that

this regulatory amendment will not

have a significant economic impact on

a substantial number of small entities as

they are defined in the Regulatory

Flexibility Act (RFA), 5 U.S.C. 601–612.

The reason for this certification is that

this amendment would not directly

affect any small entities. Only VA

beneficiaries could be directly affected.

Therefore, pursuant to 5 U.S.C. 605(b),