Medical Malpractice Claims by Members of the Uniformed Services

Published date10 May 2024
Record Number2024-10130
Citation89 FR 40378
CourtDefense Department
SectionRules and Regulations
Federal Register, Volume 89 Issue 92 (Friday, May 10, 2024)
[Federal Register Volume 89, Number 92 (Friday, May 10, 2024)]
                [Rules and Regulations]
                [Pages 40378-40382]
                From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
                [FR Doc No: 2024-10130]
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                DEPARTMENT OF DEFENSE
                Office of the Secretary
                32 CFR Part 45
                [Docket ID: DoD-2023-OS-0065]
                RIN 0790-AL70
                Medical Malpractice Claims by Members of the Uniformed Services
                AGENCY: Department of Defense (DoD) Office of General Counsel, DoD.
                ACTION: Final rule.
                -----------------------------------------------------------------------
                SUMMARY: The DoD is finalizing amendments to apply offsets for payments
                made by the U.S. Government for medical malpractice claims to potential
                economic damages only and not to total potential damages. Under this
                rule total potential damages will no longer be reduced by offsetting
                most of the compensation otherwise provided or expected to be provided
                by DoD or the Department of Veterans Affairs (VA) for the same harm
                that is the subject of the medical malpractice claim. Instead, only
                economic damages will be reduced by offsetting most of the compensation
                otherwise provided or expected to be provided by DoD or the VA for the
                same harm that is the subject of the medical malpractice claim. This
                rule also clarifies future lost earnings may be awarded until the time
                DoD determines that the claimant is, or is expected to be, medically
                rehabilitated and able to resume employment; in cases of permanent
                incapacitation, until expiration of the claimant's work-life
                expectancy; or, in cases of death, until the expiration of the
                claimant's work-life expectancy, after deducting for the claimant's
                personal consumption.
                DATES: This final rule is effective May 10, 2024.
                FOR FURTHER INFORMATION CONTACT: Melissa D. Walters, (703) 681-6027.
                SUPPLEMENTARY INFORMATION:
                I. Background
                 Section 2733a of title 10, United States Code, allows members of
                the uniformed services or their authorized representatives to file
                claims, and the Secretary of Defense to pay such claims, for personal
                injury or death caused by a DoD health care provider in a covered
                [[Page 40379]]
                military medical treatment facility, as defined in that section. DoD
                published an interim final rule to establish uniform standards and
                procedures for adjudicating these claims on June 17, 2021 (86 FR 32194)
                and a final rule on August 26, 2022 (87 FR 52446). Proposed amendments
                to this regulation were published in the Federal Register on October
                20, 2023 (88 FR 72412), that proposed to apply offsets for payments
                made by the U.S. Government to economic damages only and clarify when
                future lost earnings may be awarded. Comments were accepted for 60 days
                until December 19, 2023. DoD is making no changes to the regulatory
                text based on the comments received.
                II. Discussion of Comments and Changes
                 A total of 24 comments were posted on the regulatory docket.
                Summaries of the comments and the Department's responses are as
                follows.
                General
                 Two comments from individual members of the public reflected
                general support for the proposed changes. One of these commenters
                stated that the proposed changes would benefit Service members and
                reduce the financial burdens on them and their families following
                injury or death.
                 One comment was too general to be actionable. The commenter
                generally sought to have a fair, efficient, and consistent system
                without making any suggestions for changes to the proposed rule.
                 The Department received a number of comments that were outside of
                the scope of the proposed rule and therefore did not result in changes
                to the proposed rule. Several comments expressed concerns about the
                quality of care provided by DoD or the VA and included personal
                narratives from Service members, their family members, or others on
                Service members' behalf about specific medical care the Service members
                received from DoD and VA medical providers. One comment sought to have
                32 CFR part 45 extended to all patients of DoD's military health system
                and not just members of the uniformed services. Another commenter
                sought to have the doctrine in Feres v. United States, a 1950 Supreme
                Court decision, overturned to allow Service members to bring lawsuits
                in Federal court. An individual submitted comments seeking a change
                related to the definition of ``DoD health care provider'' in 32 CFR
                part 45. An additional comment beyond the scope of the regulation
                recommended that Service members receive copies of their DD Form 2807-
                1, ``Report of Medical History,'' and their DD Form 2807-2,
                ``Accessions Medical History Report,'' in addition to their DD Form
                214, ``Certificate of Uniformed Service.'' One comment suggested that
                Service members be educated about the claims process. Finally, one
                individual generally expressed concerns about the claims process,
                including a belief that settlements under the process were unfair and
                lacked transparency.
                Section 45.9 Calculation of Damages: Economic Damages
                 Comment: A State legislator supported the portions of the proposed
                rule clarifying when future lost wages may be awarded.
                 Response: This comment did not recommend any changes to Sec. 45.9
                and no changes were made to this section.
                Section 45.10 Calculation of Damages: Non-Economic Damages
                 Comment: One individual commented that the rule change may provide
                additional compensation for non-economic harms, although noted that
                compensation could never make a malpractice victim or survivor whole. A
                number of comments, including comments from Members of Congress, a
                local elected official, a State legislator, and individuals sought
                elimination of the cap on non-economic damages.
                 Response: DoD did not make any changes as a result of these
                comments. Section 2733a(g)(2)(B) of title 10, U.S.C., requires DoD to
                adjudicate claims, including calculating damages, based on uniform
                national standards consistent with generally accepted standards used in
                a majority of States in adjudicating claims under the Federal Tort
                Claims Act (FTCA), 28 U.S.C. 2671 et seq., without regard to the place
                where the Service member received medical care. This standard in 10
                U.S.C. 2733a(g)(2)(B) is a different standard from the FTCA. Under the
                FTCA, 28 U.S.C. 2672 and 1346(b)(1), the law applied is the law of the
                place where the medical care was provided. A majority of States, 28,
                have caps on non-economic damages applicable in medical malpractice
                claims and therefore DoD has retained the cap on non-economic damages.
                 DoD administratively removed a description of ``physical
                disfigurement'' that used outdated terminology and is unnecessary for
                purposes of claims adjudication.
                Section 45.11 Calculation of Damages: Offsets for DoD and VA
                Compensation
                 Comment: One commenter, a city elected official, was supportive of
                eliminating offsets from non-economic damages. A State legislator
                indicated support for the changes that would allow more Service members
                to receive compensation for non-economic damages than under the current
                regulation. A number of comments, including from Members of Congress, a
                State legislator, and individuals, sought to eliminate offsets from the
                portion of potential malpractice damage awards for economic damages in
                addition to the portion for non-economic damages. Some comments
                incorrectly seemed to suggest that ``offsets'' meant that the Service
                member's DoD and VA compensation would be reduced. Some comments also
                seemed to suggest, inaccurately, that the Department is offsetting an
                amount equal to all VA compensation for all line of duty injuries, not
                just offsetting the amount of compensation received for those
                additional injuries caused by malpractice.
                 Response: Federal law provides a comprehensive system of
                compensation for military members and their families in cases of death
                or disability incurred in military service. This system applies to all
                causes of death or disability incurred in service, whether due to
                combat injuries, training mishaps, motor vehicle accidents, naturally
                occurring illnesses, household events, with limited exceptions (e.g.,
                when the member is absent without leave or the injury is due to the
                member's intentional misconduct or willful negligence). This
                compensation system also applies to injuries incurred in service caused
                by medical malpractice.
                 Offsets from economic damages account for the fact that
                compensation has already been paid or will be paid by the Government
                for economic injuries caused by the malpractice. In other words, the
                claimant has already received, is receiving, or will be receiving
                compensation from the U.S. Government on account of his or her economic
                losses. For example, VA disability ratings ``represent as far as can
                practically be determined the average impairment in earning capacity''
                resulting from service-related injuries. (See 38 CFR 4.1) DoD is
                required by 10 U.S.C. 2733a(g)(2)(B) to apply the law in the majority
                of states when adjudicating Service member medical malpractice claims.
                Offsetting economic damages for compensation already paid by the United
                States is consistent with general tort law principles that states would
                apply.
                 The fact that offsets are made from potential medical malpractice
                damages awards does not change a Service member's entitlement to the
                DoD or VA
                [[Page 40380]]
                compensation. The same amount of DoD or VA compensation is still paid
                to a claimant even if the claimant receives an award of medical
                malpractice damages. What happens with offsets is that the applicable
                amount of DoD or VA compensation is subtracted from the medical
                malpractice damages award that otherwise would be payable.
                 Additionally, offsets are made only for the amount of compensation
                received from the DoD or VA that is related to the medical conditions
                caused by the malpractice. The amount of compensation for medical
                conditions unrelated to the malpractice is not offset. For example, if
                a Service member receives VA disability compensation both for a combat
                injury to her hand and for an injury to her knee caused by malpractice,
                only the amount of compensation for the knee injury would be used as an
                offset from the proposed damages award.
                 DoD did not make changes to this section.
                III. Effective Date
                 Pursuant to 5 U.S.C. 553(d), DoD has decided not to delay the
                effective date of this rule and to make it effective immediately. The
                final rule relieves a restriction on the amount of non-economic damages
                claimants may receive. Moreover, there is good cause not to delay the
                effectiveness of this rule. The amendments apply to claims received by
                DoD on or after the date this final rule is published in the Federal
                Register and to claims pending before DoD on that date. An immediate
                effective date allows more timely adjudication of those claims
                currently pending which would be impacted by the final rule and more
                timely payments to those claimants. Further, delaying the effective
                date would result in no benefit to claimants because the final rule
                imposes no burdens on them and therefore they do not need time to
                prepare for compliance with the final rule.
                IV. Regulatory Analysis
                Executive Order 12866, ``Regulatory Planning and Review,'' as Amended
                by Executive Order 14094, ``Modernizing Regulatory Review'' and
                Executive Order 13563, ``Improving Regulation and Regulatory Review''
                 Executive Orders 12866 (as amended by Executive Order 14094) and
                13563 direct agencies to assess all costs and benefits of available
                regulatory alternatives and, if regulation is necessary, to select
                regulatory approaches that maximize net benefits (including potential
                economic, environmental, public health, and safety effects;
                distribution of impacts; and equity). Executive Order 13563 emphasizes
                the importance of quantifying both costs and benefits, of reducing
                costs, of harmonizing rules, and of promoting flexibility. This final
                rule has been determined to be a significant regulatory action under
                paragraph 3(f) of the amended Executive Order 12866. Accordingly, it
                has been reviewed by the Office of Management and Budget as required by
                these Executive orders.
                Congressional Review Act (5 U.S.C. 804(2))
                 This final rule is not a ``major rule'' as defined by 5 U.S.C.
                804(2).
                Public Law 96-354, ``Regulatory Flexibility Act'' (5 U.S.C. 601 et seq)
                 The General Counsel of the Department of Defense certified that
                this final rule is not subject to the Regulatory Flexibility Act (5
                U.S.C. 601) because it would not, if promulgated, have a significant
                economic impact on a substantial number of small entities. Therefore,
                the Regulatory Flexibility Act, as amended, does not require a
                regulatory flexibility analysis.
                Section 202, Public Law 104-4, ``Unfunded Mandates Reform Act''
                 Section 202 of the Unfunded Mandates Reform Act of 1995 (2 U.S.C.
                1532) requires agencies to assess anticipated costs and benefits before
                issuing any rule whose mandates require non-Federal spending in any one
                year of $100 million in 1995 dollars, updated annually for inflation.
                This final rule does not mandate any requirements for State, local, or
                tribal governments, nor affect private sector costs.
                Public Law 96-511, ``Paperwork Reduction Act'' (44 U.S.C. Chapter 35)
                 It has been determined that this final rule does not impose new
                reporting or recordkeeping requirements under the Paperwork Reduction
                Act of 1995.
                Executive Order 13132, ``Federalism''
                 Executive Order 13132 establishes certain requirements that an
                agency must meet when it promulgates a final rule that imposes
                substantial direct requirement costs on State and local governments,
                preempts State law, or otherwise has federalism implications. This
                final rule does not have a substantial effect on State and local
                governments.
                Executive Order 13175, ``Consultation and Coordination With Indian
                Tribal Governments''
                 Executive Order 13175 establishes certain requirements that an
                agency must meet when it promulgates a final rule that imposes
                substantial direct compliance costs on one or more Indian tribes,
                preempts tribal law, or affects the distribution of power and
                responsibilities between the Federal Government and Indian tribes. This
                final rule will not have a substantial effect on Indian tribal
                governments.
                V. Impact of this Regulation
                a. Summary
                 The amendments adjust and update certain portions of the regulation
                related to calculation of damages. Currently, DoD offsets from both
                economic and noneconomic damages compensation made by DoD and VA on
                account of the injuries from malpractice. The amendments apply offsets
                to economic damages only. Under the current rule, a claimant who has
                little or no economic damages would be unable to recover any damages if
                the compensation that the claimant already receives or will receive
                from DoD and VA for the injuries from malpractice exceeds the total
                amount of potential economic and non-economic damages. Under the
                amendment, these claimants will be able to recover non-economic damages
                because the amount of the DoD and VA compensation will no longer be
                used to offset the non-economic damages.
                 The amendments also include two changes that were made to better
                describe the applicable principles used when adjudicating claims to
                make the rule clearer for claimants. First, language was added to
                address medical rehabilitation as it relates to future lost earnings by
                explicitly stating the principle that future lost earnings do not
                continue beyond the point when DoD determines that the claimant is, or
                is expected to be, medically rehabilitated and able to resume
                employment. Second, because 10 U.S.C. 2733a(b)(5) prevents recovery for
                claims that are allowed to be settled and paid under any other
                provision of law, language was added to explicitly state that an injury
                or condition does not result in lost earnings for purposes of this
                regulation if the lost earnings stem from disability discrimination,
                since disability discrimination is compensable under other provisions
                of law. These principles, if applicable to the facts of a claim,
                already would have been applied in adjudicating those claims.
                Therefore, these changes will have no meaningful economic impact.
                [[Page 40381]]
                b. Affected Population
                 At the end of Fiscal Year 2022, there were approximately 1,410,000
                Active Duty Service members, and 440,000 Reserve and National Guard
                members eligible for DoD healthcare benefits. These uniformed Service
                members will be able to file claims with DoD alleging malpractice from
                care at DoD military medical treatment facilities as defined in 10
                U.S.C. 2733a.
                c. Costs
                 DoD does not estimate that any additional claims will be filed as a
                result of the amendments to the regulation. Since the enactment of 10
                U.S.C. 2733a, individuals who believe they have been subjected to
                malpractice have filed claims involving injuries ranging from minor
                injuries to death, regardless of the potential application of offsets.
                d. Transfers
                 Regardless of the number of claims in which malpractice occurred,
                the only claims in which damages will be awarded are those which exceed
                the offsets for any payment to be made. The amendments solely impact
                non-economic damages. No amendments are being made that impact offsets
                from economic damages.
                 Similar to malpractice claims under the FTCA, claims payable under
                this regulation could include a wide range of non-economic damages
                depending on their facts. A claim involving minor pain and temporary
                injuries would result in a lower non-economic damages award than a
                claim involving significant, continuing pain and/or debilitating
                injury. Initially, non-economic damages were capped at $500,000. This
                cap was raised to $600,000 in August 2022 and again to $750,000 in
                October 2023.
                 Based on claims adjudicated under this part in 2021 and 2022, four
                claims were adjudicated in which offsets were applied. In two of these
                claims, the economic damages alone were larger than the offsets so the
                payouts would not have been impacted had the amendments been in effect.
                Only for the remaining two claims would the outcome have been different
                had the amendments been in effect. In one claim, an additional $200,000
                would have been paid to the claimant if offsets had not been made from
                non-economic damages. In the other claim, an additional $100,000 would
                have been paid to the claimant if offsets had not been made from non-
                economic damages.
                 Claims in 2021 and 2022 may not necessarily be representative of
                claims in future years. Claims were accepted beginning January 1, 2020,
                but could only begin to be adjudicated beginning on July 17, 2021, when
                the interim final rule at 86 FR 32194 became effective. The first
                claims adjudicated under this new process were claims that did not
                require a decision on the merits of whether malpractice occurred, such
                as claims that were denied because the alleged malpractice fell outside
                the statute of limitations in 10 U.S.C. 2733a(b)(4). Just as with claim
                resolution processes involving non-Service member claims, more complex
                claims, which tend to involve higher amounts of damages, require time
                for review. Since Service members' claims have only been able to be
                adjudicated since July 17, 2021, more complex claims may still be under
                adjudication, and the two claims that would have had a different
                outcome in 2021 and 2022 may not be representative of the number of
                claims that would be impacted going forward.
                 Taking the limited information DoD has into account, DoD estimates
                that the amendments to the regulation will affect two claims per year.
                The average of the additional non-economic damages at issue in the two
                claims which would have been impacted if this regulation had been in
                effect was $150,000. Assuming $150,000 additional would be paid in two
                claims, the estimated total additional transfers from the Government to
                claimants therefore would be $300,000. Of this, the first $100,000 of
                each of the two claims would be paid by DoD, with the remainder to be
                paid by the Treasury.
                 There could be significant variation in the number of claims that
                would be impacted by the amendments to the regulation from year to
                year. In some years, there could be no claims affected by the
                amendments, so there would be zero additional transfers from the
                Government to claimants. In other years, there could be more claims
                impacted by the amendments and/or claims involving different amounts of
                non-economic damages than the $150,000 estimate. For example, assuming
                that in another year there were four claims in which non-economic
                damages would be paid and assuming the non-economic damages in these
                four claims would be paid at the cap of $750,000, this would lead to
                transfers of $3 million from the Government to claimants.
                e. Benefits
                 The amendments to the regulation will allow some Service members to
                receive compensation for non-economic damages that they would not have
                been able to receive under the current regulation. The amendments
                afford some Service members additional compensation in light of the
                non-economic harms they have experienced as a result of malpractice.
                List of Subjects in 32 CFR Part 45
                 Claims, Malpractice, Medical, Uniformed services.
                 Accordingly, the Department of Defense amends 32 CFR part 45 to
                read as follows:
                PART 45--MEDICAL MALPRACTICE CLAIMS BY MEMBERS OF THE UNIFORMED
                SERVICES
                0
                1. The authority for part 45 continues to read as follows:
                 Authority: 10 U.S.C. 2733a.
                0
                2. Amend Sec. 45.1 by revising paragraph (b) to read as follows:
                Sec. 45.1 Purpose of this part.
                * * * * *
                 (b) Relationship to military and veterans' compensation programs.
                Federal law provides a comprehensive system of compensation for
                military members and their families in cases of death or disability
                incurred in military service. This system applies to all causes of
                death or disability incurred in service, whether due to combat
                injuries, training mishaps, motor vehicle accidents, naturally
                occurring illnesses, or household events, with limited exceptions
                (e.g., when the member is absent without leave or the injury is due to
                the member's intentional misconduct or willful negligence). This
                comprehensive compensation system applies to cases of personal injury
                or death caused by medical malpractice incurred in service as it does
                to all other causes. This part provides for the possibility of separate
                compensation in certain cases of medical malpractice but in no other
                type of case. A medical malpractice claim under this part will have no
                effect on any other compensation the member or the member's family is
                entitled to under the comprehensive compensation system applicable to
                all members. However, if the U.S. Government makes a payment for harm
                caused by malpractice, this payment reduces the potential damages under
                this part as provided in Sec. 45.11.
                * * * * *
                0
                3. Amend Sec. 45.9 by revising paragraph (b)(4) and adding paragraph
                (d) to read as follows:
                Sec. 45.9 Calculation of damages: economic damages.
                * * * * *
                 (b) * * *
                 (4) For future lost earnings:
                [[Page 40382]]
                 (i) Until DoD determines that the claimant is, or is expected to
                be, medically rehabilitated and able to resume employment;
                 (ii) In cases of permanent incapacitation, until expiration of the
                claimant's work-life expectancy; or
                 (iii) In cases of death, until the expiration of the claimant's
                work-life expectancy, after deducting for the claimant's personal
                consumption.
                 (iv) Future lost earnings must be substantiated by appropriate
                documentation and claimants have an obligation to mitigate damages.
                 (v) In addition, loss of retirement benefits is compensable and
                similarly discounted after appropriate deductions. Estimates for future
                lost earnings and retirement benefits must be discounted to present
                value.
                * * * * *
                 (d) Disability discrimination. An injury or condition does not
                result in lost earnings for purposes of, and is not compensable under,
                this part if the lost earnings stem from disability discrimination,
                which may be settled and paid under other provisions of law.
                0
                4. Amend Sec. 45.10 by revising paragraphs (a) through (c) to read as
                follows:
                Sec. 45.10 Calculation of damages: non-economic damages.
                 (a) In general. Non-economic damages are one component of a
                potential damages award. The claimant has the burden of proof on the
                amount of non-economic damages by a preponderance of evidence. DoD may
                request an interview of or statement from the claimant or other person
                with primary knowledge of the claimant. DoD may also require medical
                statements documenting the claimant's condition and, in cases of
                disfigurement, photographs documenting the claimant's condition.
                 (b) Elements of non-economic damages. Non-economic damages include
                pain and suffering; physical discomfort; mental and emotional trauma or
                distress; loss of enjoyment of life; physical disfigurement; and the
                inability to perform daily activities that one performed prior to
                injury, such as recreational activities. Such damages are compensable
                as part of non-economic damages.
                 (c) Cap on non-economic damages. In any claim under this part,
                total non-economic damages may not exceed a cap amount published by DoD
                via a Federal Register notice. DoD will periodically publish updates to
                this cap amount via Federal Register notices, consistent with changes
                in prevailing amounts in the majority of the States with non-economic
                damages caps.
                * * * * *
                0
                5. Amend Sec. 45.11 by:
                0
                a. Revising paragraph (a);
                0
                b. Redesignating paragraphs (c) and (d) as paragraphs (d) and (c),
                respectively;
                0
                c. Revising the first sentence in the newly redesignated paragraph (c);
                0
                d. Adding a sentence to the end of the newly redesignated paragraph
                (d);
                0
                e. Revising paragraph (e); and
                0
                f. Removing paragraphs (f) and (g).
                 The revisions and addition read as follows:
                Sec. 45.11 Calculation of damages: offsets for DoD and VA Government
                compensation.
                 (a) In general. Total potential economic damages calculated under
                this part are reduced by offsetting most of the compensation otherwise
                provided or expected to be provided by DoD or VA for the same harm that
                is the subject of the medical malpractice claim. DoD has the burden to
                establish the applicability and amount of any offsets.
                * * * * *
                 (c) * * * In determining offsets under this section from economic
                damages, DoD will use the present value of future payments and
                benefits. * * *
                 (d) * * * Claimants must provide information not available to DoD,
                but requested by DoD, for the purpose of determining offsets.
                 (e) Benefits and payments that may be considered as potential
                offsets. The general rule is that potential damages calculated under
                this part may be offset only by DoD or VA payments and benefits that
                are primarily funded by Government appropriations. Potential damages
                calculated under this part are not offset by U.S. Government payments
                and benefits that are substantially funded by the military member. The
                following examples are provided for illustrative purposes only, are not
                all-inclusive, and are subject to adjustment as appropriate.
                 (1) The following DoD and VA payments and benefits are primarily
                funded from Government appropriations and will be offset:
                 (i) Disability retired pay in the case of retirement due to the
                disability caused by the alleged medical malpractice;
                 (ii) Disability severance pay in the case of non-retirement
                disability separation caused by the alleged medical malpractice.
                 (iii) Incapacitation pay.
                 (iv) Involuntary and voluntary separation pays and incentives.
                 (v) Death gratuity.
                 (vi) Housing allowance continuation.
                 (vii) Survivor Benefit Plan.
                 (viii) VA disability compensation, to include Special Monthly
                Compensation, attributable to the disability resulting from the
                malpractice.
                 (ix) VA Dependency and Indemnity Compensation, attributable to the
                disability resulting from the malpractice.
                 (x) Special Survivor Indemnity Allowance.
                 (xi) Special Compensation for Assistance with Activities of Daily
                Living.
                 (xii) Program of Comprehensive Assistance for Family Caregivers.
                 (xiii) Fry Scholarship.
                 (xiv) TRICARE coverage, including TRICARE-for-Life, for a
                disability retiree, family, or survivors. Future TRICARE coverage is
                part of the Government's compensation package for a disability retiree
                or survivor.
                 (2) The following U.S. Government payments and benefits are
                substantially funded by the military members or are otherwise generally
                not eligible for consideration as potential offsets:
                 (i) Servicemembers Group Life Insurance.
                 (ii) Traumatic Servicemembers Group Life Insurance.
                 (iii) Social Security disability benefits.
                 (iv) Social Security survivor benefits.
                 (v) Prior Government contributions to a Thrift Savings Plan.
                 (vi) Commissary, exchange, and morale, welfare, and recreation
                facility access.
                 (vii) Value of legal assistance and other services provided by DoD.
                 (viii) Medical care provided while in active service or in an
                active status prior to death, retirement, or separation.
                 Dated: May 6, 2024.
                Aaron T. Siegel,
                Alternate OSD Federal Register Liaison Officer, Department of Defense.
                [FR Doc. 2024-10130 Filed 5-9-24; 8:45 am]
                BILLING CODE 6001-FR-P
                

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