[Federal Register Volume 75, Number 45 (Tuesday, March 9, 2010)]
[Notices]
[Pages 10867-10871]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-4882]
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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.
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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 deployment-related 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
[[Page 10868]]
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 Bosnia-
Herzegovina in 1994-1995 and in Kosovo in 1999; about 10,800 DU rounds
were fired in Bosnia-Herzegovina, 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
[[Page 10869]]
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 non-malignant 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. Tobacco-
smoking is the predominant risk factor, and it is thought to account
for about 87 percent of lung-cancer deaths.
Twenty-three studies of uranium-processing 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
[[Page 10870]]
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
uranium-processing studies, two studies of military populations, and
four residential studies. Most of the studies reported the same or
reduced bladder-cancer 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,
[[Page 10871]]
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 non-
malignant 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 DU-
exposed 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); non-malignant 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