Previously, in the July/August Serving You, we discussed the Australian process of decision-making about disease causation, the Repatriation Medical Authority (RMA), an independent statutory authority which determines Statements of Principles (SOPs) for disease related to military service in Australian military forces. The United States, like Australia, has a similar formal process. Through the Office of Regulation Policy and Management, the U.S. Department of Veterans Affairs (VA) publishes proposed rulings and planned amendments to regulations concerning veterans’ benefits. This formal process consists in posting draft rulings with planned effective dates of implementation, seeking public input either online or in person.

A not so recent ruling, in 2008, concerns Amyotrophic Lateral Sclerosis (ALS). A review of the summary of the ruling is quite enlightening. As stated in the Federal Register, Vol. 73, No. 185, Rules and Regulations: “ALS (also called Lou Gehrig’s disease) is a neuromuscular disease that…is often relentlessly progressive and almost always fatal. ALS causes degeneration of nerve cells in the brain and spinal cord…. People suffering from ALS eventually lose the ability to move their arms and legs and to speak and swallow…. Currently there is no effective treatment for ALS.

“There is limited and suggestive evidence of an association between military service and later development of ALS…studies indicate that there exists a statistical correlation between activities in military service and development of ALS…. After careful consideration of these studies and the fact that further research is unlikely to clarify the association between ALS and military service, there is sufficient evidence…that supports a presumption of service connection for ALS for any veteran with that diagnosis.

“The Secretary has determined that proof of active military, naval, or air service and the subsequent development of ALS is sufficient evidence to support a presumption that the resulting disability was incurred in the line of duty…to establish entitlement to service connection…. Several circumstances unique to ALS warrant the establishment of a presumption of service…its incurably debilitating, rapidly progressing, and invariably fatal characteristics…and its statistically high development rate in veterans compared to the general public.”

Furthermore, VA recognizes that if presumption is not assumed, it would be very difficult for claimants to establish service connection by direct evidence, and that by asking for this greater evidential proof, this would have a profound impact on veterans and their families because of the “rapid and devastating course of ALS…in order to benefit veterans currently suffering from ALS as quickly as possible, it is critical that VA establish this presumption immediately.”

While Australia and the U.S. have established proactive tools to rapidly improve access to benefits, resulting in the recognition that veterans who suffer from ALS deserve quick intervention, Veterans Affairs Canada has no such formal review mechanism and continues to turn its back on a very small number of ALS sufferers who deserve rapid intervention.