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Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Rules and Regulations discretion weighs more strongly here than it would if the science related to the composition and duration of actual particulate matter and airborne hazard exposures of service members were more robust.
a. Gulf War Service Based on the weight of the evidence considered as described above, VA
presumes exposure to PM2.5 for Gulf War veterans deployed in the Southwest Asia theater of operations, as defined in 38 CFR 3.317e2 including Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, and the Red Sea during the Persian Gulf War.
Based on presumed PM2.5 exposures, VA is granting a presumption of service connection for the chronic respiratory conditions of asthma, sinusitis, and rhinitis, to include rhinosinusitis, for the service periods and manifestation timelines that follow.
b. Service in Afghanistan, Syria, and Djibouti on or After September 19, 2001

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The presumption of PM2.5 exposure will also include those deployed to Afghanistan, Syria, and Djibouti on or after September 19, 2001, the earliest date when service members were deployed in these locations. The literature and studies overwhelmingly show the prevalence of particulate matter due to the nature of the arid climate in these locations as well.13 VA
determined that the Southwest Asia theater of operations, Afghanistan, Syria, and Djibouti had similar arid or semi-arid climates with periods of high winds to suspend geologic dusts and regional pollutants, adhered to or a part of these dusts, though the composition of the PM varies in different regions.
Therefore, VA is including Afghanistan, Syria, and Djibouti as qualifying locations for presumption of service connection based on presumed exposure to PM2.5.
VAs Airborne Hazards and Open Burn Pit Registry, which encourages veteran participation to help VA gather discretionary authority to grant a presumption of service connection.
13 See Lindsay T. McDonald, Steven J.
Christopher, Steve L. Morton & Amanda C. LaRue 2020 Physical and elemental analysis of Middle East sands from recent combat zones, Inhalational Toxicology, 32:5, 189199, available at https
doi.org/10.1080/08958378.2020.1766602. See UNEP, WMO, UNCCD 2016 Global Assessment of Sand and Dust Storms, United Nations Environment Programme, Nairobi, 115, 2124, available at https uneplive.unep.org/redesign/
media/docs/assessments/global_assessment_of_
sand_and_dust_storms.pdf.

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data and better understand the potential health effects of exposure to airborne hazards during military service, currently covers the Southwest Asia theater of operations, including Afghanistan, and will also expand the locations to include Syria and Uzbekistan. Expansion will be encouraged through periodic communications through the MyPay pay notifications with both active duty service members and veterans, and through press releases as well as through VAs Health Outcomes Military Exposures website https www.public health.va.gov/exposures/burnpits/
index.asp.
As the literature and studies overwhelmingly demonstrate the prevalence of particulate matter in these locations, VA is including Afghanistan, Syria and Djibouti in addition to the Southwest Asia theater of operations, as qualifying locations for the presumption of service connection and exposure to fine, particulate matter.
c. Service in Uzbekistan on or After September 19, 2001
Furthermore, the VA workgroup recommended that the presumption of PM2.5 exposure include those service members who were deployed to Uzbekistan in support of Operation Enduring Freedom. In March 2020, the Army Public Health Center issued, Environmental Conditions at Karshi Khanabad K2 Air Base, Uzbekistan, to provide information to service members and veterans on environmental exposures at the K2 Air Base and the risk of potential long-term adverse health effects related to such deployment.14 It noted that service members, mostly Army, Air Force and some Marines, were stationed at the air base Camp Stronghold Freedom from October 2001 to November 2005. This fact sheet referenced the results of three declassified assessments conducted by DoD, namely the Environmental Site Characterization and an Operational Health Risk Assessment completed in 2001 and follow-up Post-Deployment Occupational and Environmental Health Site Assessments completed in 2002
and 2004. The collective findings of these assessments found the K2 Air Base often had high levels of dust and other particulate matter in the air, depending upon the season and weather conditions, but also noted significantly 14 Army Public Health Center, Environmental Conditions at Karshi Khanabad K2 Air Base, Uzbekistan, Fact Sheet 640380617, https
phc.amedd.army.mil/
PHC%20Resource%20Library/Environmental ConditionsatK-2AirBaseUzbekistan_FS_64-0380617.pdf. accessed July 30, 2021.

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high levels of dust during dust storms.
The fact sheet concluded that there was inconclusive evidence that there is an increased risk of chronic respiratory conditions associated with military deployment to K2 Air Base. It was noted that DoD was collaborating with VA and independent researchers to further evaluate the potential long-term health risks related to deployment exposures.
Based on these findings regarding particulate matter exposure at the K2
Air Base, VA will presume PM2.5
exposure for those service members who were deployed to Uzbekistan on or after September 19, 2001. VA acknowledges that this will cover a greater geographic area and time frame than the other studies annotated in this document.
However, VA believes this is a veterancentric approach that will enhance its operational efficiencies by simplifying the work necessary for claims adjudication.
VA will continue to collaborate with DoD as directed by E.O. 13982, Care of Veterans with Service in Uzbekistan, executed on January 19, 2021, and published on January 25, 2021. This Executive Order requires that DoD
conduct a study to assess the conditions at the K2 Air Base, to identify any toxic substances that may have contaminated the Air Base, and to conduct an epidemiological study on potential health consequences for those deployed to K2 Air Base. Once the studies have been completed, VA will consider the results and findings from these studies in making determinations regarding diseases subject to presumptive service connection.15
d. Manifestation Period for Chronic Respiratory Conditions of Asthma, Rhinitis, and Sinusitis The VA workgroup also considered the onset of asthma, rhinitis, and sinusitis after service members separated from military service in the Southwest Asia theater of operations as well as Afghanistan, Syria, Djibouti, and Uzbekistan. The consensus of the VA
workgroup was that the manifestation period for these three chronic respiratory conditions was generally five to 10 years after separation from service, supported by a review of claims data, and the human and epidemiological studies showed that manifestation of these respiratory conditions did not exceed 10 years. The VA Secretary will apply the liberal 15 E.O. 13982, Care of Veterans With Service in Uzbekistan, January 19, 2021, https
www.federalregister.gov/documents/2021/01/25/
2021-01712/care-of-veterans-with-service-inuzbekistan.

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