Comment on AN16-Proposed Rule-James Edward LaPointe

Addition of osteoporosis at 3.309 does not eliminate the requirements of 3.307. As seen with the Secretary's recent decision on hypertension due to herbicide exposure, treatise evidence is not determinative. The proposed addition is a paper tiger as the Secretary may still deny service connection under 3.307(d) through affirmative evidence of rebuttal. While the Secretary recognizes the impact of nutrition on the development of osteoporosis, the National Institute of Health also recognizes corticosteroid induced bone loss (Calcium and Vitamin D therapy in corticosteroid-induced bone loss: What is the Evidence - www.ncbi.nlm.nih.gov). A treatise supporting the Secretary's position may also rebut presumptive service connection. "Corticosteroids are widely used and effective agents for the control of many inflammatory diseases. Corticosteroid osteoporosis is a common problem associated with the long term high dose use of these medications." (see Corticosteroid Induced Osteoporosis in Austrailian Family Physician, Vol. 30, No. 8 August 2001). It would seem as least as likely as not that corticosteroid treatment would result in osteoporosis as vitamin deficiency (see Corticosteroids, Osteoporosis, Asthma, Vitamin D, Calcium and Magnesium at Canadian Asthma Prevention Institute's www.asthmaworld.org). The Secretary argued semantics and etiology with traumatic arthritis until Greyzck v West in March 1999. This seems to be another example of the Secretary offering to grant service connection knowing he will never have to actualy do so as with peripheral neuropathy at 3.309(e). Stated simply, will the VA grant service connection for osteoporosis in a veteran with a history of treatment with corticosteroids?