Veterans with amyotrophic lateral sclerosis can now receive services and equipment from the Department of Veterans Affairs without having to prove that their condition is connected to their military service.
The VA established a presumption of service connection for amyotrophic lateral sclerosis (ALS) for any veteran who develops the disease at any time after their separation from service. Veterans must have 90 days or more of continuous active service in the military to qualify for the benefits, according to an interim final regulation issued on Sept. 23.
Researchers have been studying the link between military service and ALS for years, and the evidence has been suggestive of an association but a definitive link has not been made. In 2001, the VA issued a policy giving “special consideration” to ALS claims made by veterans of the 1991 Gulf War, regardless of when the disease manifested itself.
VA Secretary James B. Peake said he based the decision to presumptively connect ALS to military service primarily on a November 2006 report from the Institute of Medicine that concluded that “there is limited and suggestive evidence of an association between military service and later development of ALS.” The IOM conclusion was based on a review of available evidence. The IOM committee that issued the study recommended further research to establish a definitive association, but Dr. Peake said he thought it was unlikely that further research would show the link given the rarity of the disease.
“There simply isn't time to develop the evidence needed to support compensation claims before many veterans become seriously ill,” Dr. Peake said in a statement. “My decision will make those claims much easier to process, and for them and their families to receive the compensation they have earned through their service to our nation.”
The new regulation will apply to all applications for benefits received by VA on or after Sept. 23, as well as those currently pending before the VA, the U.S. Court of Appeals for Veterans Claims, and the U.S. Court of Appeals for the Federal Circuit. VA officials are also planning to contact veterans with ALS whose claims were previously denied.
For neurologists working outside of the VA who are seeing veterans with ALS, its critical to get patients connected with a VA physician, said Dr. Carlayne E. Jackson, professor of neurology and otolaryngology at the University of Texas at San Antonio, and director of the South Texas ALS Clinic at the University Health Science Center. Once patients are connected to the VA system, a physician there will be able to help them get coverage for necessary equipment and services, she said.
“It's an opportunity to dramatically improve the services and equipment that our patients have access to,” Dr. Jackson said.
For example, veterans will have greater access to wheelchairs, speech devices, specialized mattresses, and home health care services that may not have been covered or were only partially covered through Medicare disability benefits, she said.
The new designation by the VA will also ease the burden on veterans who previously had to prove that their disease was connected to their military service, said Pat Wildman, director of public policy for the ALS Association. Because of the progressive nature of the disease, some veterans were dying before they had the chance to prove their service connection, he said.
At press time, the ALS Association was developing frequently asked questions and answers about the VA benefits that will be posted on the organization's Web site (www.alsa.org
It is estimated that ALS affects about 20,000–30,000 individuals in the United States. Though the number of veterans with the condition is unknown, recent studies indicate that the disease strikes military veterans at about double the rate of the general population, according to the ALS Association.
But researchers and patients may get more information about the disease prevalence thanks to the passage of the ALS Registry Act (S. 1382). The legislation passed Congress in late September and was signed into law by President Bush.
The bill will establish the first national patient registry of individuals with ALS. The registry, which will be run by the Centers for Disease Control and Prevention, could yield clues about the cause, treatment, and cure for the disease, including why vets appear to be at greater risk.