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Federal Register / Vol. 71, No.

172 / Wednesday, September 6, 2006 / Rules and Regulations 52457

this certification is that this amendment Disability; and 64.110, Veterans not have obtained when it decided the
would not directly affect any small Dependency and Indemnity claim because the records did not exist
entities. Only VA beneficiaries could be Compensation for Service-Connected when VA decided the claim, or because
directly affected. Therefore, pursuant to Death. the claimant failed to provide sufficient
5 U.S.C. 605(b), this final rule is exempt information for VA to identify and
List of Subjects in 38 CFR Part 3
from the initial and final regulatory obtain the records from the respective
flexibility analysis requirements of Administrative practice and service department, the Joint Services
sections 603 and 604. procedure, Claims, Disability benefits, Records Research Center, or from any
Health care, Pensions, Radioactive other official source.
Executive Order 12866
materials, Veterans, Vietnam. (3) An award made based all or in part
Executive Order 12866 directs on the records identified by paragraph
Approved: May 26, 2006.
agencies to assess all costs and benefits (c)(1) of this section is effective on the
Gordon H. Mansfield,
of available regulatory alternatives and, date entitlement arose or the date VA
when regulation is necessary, to select Deputy Secretary of Veterans Affairs.
received the previously decided claim,
regulatory approaches that maximize ■ For the reasons set out in the whichever is later, or such other date as
net benefits (including potential preamble, 38 CFR part 3 is amended as may be authorized by the provisions of
economic, environmental, public health set forth below: this part applicable to the previously
and safety, and other advantages; decided claim.
distributive impacts; and equity). The PART 3—ADJUDICATION
(4) A retroactive evaluation of
Order classifies a rule as a significant disability resulting from disease or
regulatory action requiring review by Subpart A—Pension, Compensation,
and Dependency and Indemnity injury subsequently service connected
the Office of Management and Budget if on the basis of the new evidence from
it meets any one of a number of Compensation
the service department must be
specified conditions, including: having ■ 1. The authority citation for part 3, supported adequately by medical
an annual effect on the economy of $100 subpart A continues to read as follows: evidence. Where such records clearly
million or more, creating a serious support the assignment of a specific
Authority: 38 U.S.C. 501(a), unless
inconsistency or interfering with an otherwise noted. rating over a part or the entire period of
action of another agency, materially time involved, a retroactive evaluation
altering the budgetary impact of ■ 2. Section 3.156 is amended by: will be assigned accordingly, except as
entitlements or the rights of entitlement ■ a. Adding a paragraph heading to it may be affected by the filing date of
recipients, or raising novel legal or paragraph (a). the original claim.
policy issues. VA has examined the ■ b. Adding a paragraph heading to
economic, legal, and policy implications paragraph (b). (Authority: 38 U.S.C. 501(a))
of this final rule and has concluded that ■ c. Revising paragraph (c). * * * * *
it is a significant regulatory action under The additions and revision read as ■ 3. Section 3.400 is amended by:
Executive Order 12866. follows: ■ a. Revising the heading of paragraph
(q).
Unfunded Mandates § 3.156 New and material evidence.
■ b. Removing paragraph (q)(1) heading.
The Unfunded Mandates Reform Act (a) General. * * * ■ c. Redesignating paragraph (q)(1)(i) as
of 1995 requires, at 2 U.S.C. 1532, that (b) Pending claim. * * * new paragraph (q)(1).
agencies prepare an assessment of (c) Service department records. (1) ■ d. Removing paragraph (q)(2).
anticipated costs and benefits before Notwithstanding any other section in ■ e. Redesignating paragraph (q)(1)(ii) as
issuing any rule that may result in the this part, at any time after VA issues a new paragraph (q)(2).
expenditure by State, local, and tribal decision on a claim, if VA receives or The revision reads as follows:
governments, in the aggregate, or by the associates with the claims file relevant
private sector, of $100 million or more official service department records that § 3.400 General.
(adjusted annually for inflation) in any existed and had not been associated * * * * *
year. This final rule would have no such with the claims file when VA first (q) New and material evidence
effect on State, local, and tribal decided the claim, VA will reconsider (§ 3.156) other than service department
governments, or on the private sector. the claim, notwithstanding paragraph records. * * *
(a) of this section. Such records include, * * * * *
Catalog of Federal Domestic Assistance but are not limited to:
Numbers and Titles [FR Doc. E6–14746 Filed 9–5–06; 8:45 am]
(i) Service records that are related to
BILLING CODE 8320–01–P
The Catalog of Federal Domestic a claimed in-service event, injury, or
Assistance program numbers and titles disease, regardless of whether such
for this proposal are 64.100, records mention the veteran by name, as DEPARTMENT OF VETERANS
Automobiles and Adaptive Equipment long as the other requirements of AFFAIRS
for Certain Disabled Veterans and paragraph (c) of this section are met;
Members of the Armed Forces; 64.101, (ii) Additional service records 38 CFR Part 4
Burial Expenses Allowance for forwarded by the Department of Defense
Veterans; 64.102, Compensation for RIN 2900–AL26
or the service department to VA any
Service-Connected Deaths for Veterans’ time after VA’s original request for Schedule for Rating Disabilities;
Dependents; 64.104, Pension for Non- service records; and Guidelines for Application of
Service-Connected Disability for (iii) Declassified records that could Evaluation Criteria for Certain
Veterans; 64.105, Pension to Veterans not have been obtained because the
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Respiratory and Cardiovascular


Surviving Spouses, and Children; records were classified when VA Conditions; Evaluation of
64.106, Specially Adapted Housing for decided the claim. Hypertension With Heart Disease
Disabled Veterans; 64.109, Veterans (2) Paragraph (c)(1) of this section
Compensation for Service-Connected does not apply to records that VA could AGENCY: Department of Veterans Affairs.

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52458 Federal Register / Vol. 71, No. 172 / Wednesday, September 6, 2006 / Rules and Regulations

ACTION: Final rule. no regulatory effect. Nevertheless, we it would be speculative to say that most
agree with the rationale of this have a low exercise tolerance. The
SUMMARY: This document amends the suggestion. Therefore, we will address regulations do not require that a
Department of Veterans Affairs (VA) the commenter’s suggestion by changing maximum exercise capacity test be
Schedule for Rating Disabilities by the regulatory language in § 4.96(d)(7) to conducted in any case, and it is not
adding guidelines for the evaluation of the following: ‘‘If the FEV–1 and the routinely conducted. If there is already
certain respiratory and cardiovascular FVC are both greater than 100 percent, a maximum exercise capacity test of
conditions and by explaining that do not assign a compensable evaluation record, and the results are 20 ml/kg/min
hypertension will be evaluated based on a decreased FEV–1/FVC ratio.’’ or less, evaluation (at a 60- or 100-
separately from hypertensive and other Chronic bronchitis (diagnostic code percent level, depending on the exact
types of heart diseases. 6600), pulmonary emphysema results) may be based on these results.
DATES: Effective Date: This amendment (diagnostic code 6603), chronic If no maximum exercise capacity test is
is effective October 6, 2006. obstructive pulmonary disease of record, as would be true in most
Applicability Date: The provisions of (diagnostic code 6604), interstitial lung cases, this regulation directs that
this final rule shall apply to all disease (diagnostic codes 6825–6833), evaluation be based on the alternative
applications for benefits received by VA and restrictive lung disease (diagnostic criteria. In any given case, the examiner
on or after the effective date of this final codes 6840–6845) are evaluated may request, based on clinical
rule. primarily on the basis of pulmonary judgment, that a maximum exercise
FOR FURTHER INFORMATION CONTACT: function tests (PFT’s). However, these capacity test be conducted, such as in
Maya Ferrandino, Consultant, conditions may also be evaluated based cases where the PFT’s do not fully
Regulations Staff (211D), Compensation on alternative evaluation criteria, which explain symptomatology. However, the
and Pension Service, Veterans Benefits may include measures of the maximum maximum exercise capacity test is not
Administration, Department of Veterans exercise capacity; the presence of available in some medical facilities, and
Affairs, 810 Vermont Ave., NW., pulmonary hypertension (documented evaluation will properly be based in
Washington, DC 20420, (202) 273–7211. by echocardiogram or cardiac some cases on the clinician’s assessment
catheterization), cor pulmonale, or right of severity based on history, physical
SUPPLEMENTARY INFORMATION: On August
ventricular hypertrophy; episode(s) of findings, and available laboratory tests.
22, 2002, VA published in the Federal respiratory failure; and a requirement We therefore make no change based on
Register (67 FR 54394) a proposal to for outpatient oxygen therapy. For this comment.
amend those portions of the Schedule example, a 100-percent evaluation for The commenter stated that the
for Rating Disabilities that address these conditions may be based on a diagnostic codes in the VA rating
cardiovascular and respiratory maximum exercise capacity test result schedule for the listed conditions in the
conditions by providing guidelines for of less than 15 ml/kg/min oxygen proposed rule were confusing and
the evaluation of these conditions and consumption (with cardiac or suggested that VA use the International
by explaining that hypertension will be respiratory limitation), and a 60-percent Classification of Diseases, Ninth
evaluated separately from hypertensive evaluation may be based on a maximum Revision, Clinical Modification (ICD–9–
and other types of heart diseases. exercise capacity test result of 15 to 20 CM) diagnostic coding system that is
Interested persons were invited to ml/kg/min oxygen consumption (with used throughout the United States in the
submit written comments on or before cardiac or respiratory limitation). We health care delivery system. For several
October 21, 2002. We received a proposed that PFT’s be required to reasons, we believe that using ICD–9–
combined comment from the American evaluate this group of respiratory CM codes is not a reasonable option.
College of Chest Physicians, the conditions except, among other First, ICD–9–CM and the VA rating
American Thoracic Society, and the exceptions, when the results of a schedule serve very different purposes.
National Association for Medical maximum exercise capacity test are of The ICD–9–CM is used by medical
Direction of Respiratory Care. record and are 20 ml/kg/min or less. We professionals in diagnosing medical
VA currently uses the ratio of FEV–1 also proposed that if a maximum conditions. The rating schedule is used
(Forced Expiratory Volume in one exercise capacity test is not of record, by VA personnel in assigning
second) to FVC (Forced Vital Capacity), the veteran’s disability evaluation evaluations to conditions that have been
or FEV–1/FVC ratio, to evaluate certain would be based on alternative criteria. diagnosed by medical professionals for
respiratory conditions. Proposed 38 CFR The commenter stated that since most of VA compensation purposes. The rating
4.96(d)(7) would direct raters to the patients with these respiratory schedule is not simply a listing of
consider a decreased FEV–1/FVC ratio conditions have a low exercise conditions and symptoms. It includes
to be normal if the FEV–1 is greater than tolerance, using the results of only evaluation criteria for each of the more
100 percent. The rationale was that in effort-dependent tests would make it than 700 disabilities listed. VA also
that case the FVC would also be high easy for some marginal patients to rates disabilities not listed in the rating
(better than normal), so a decreased qualify for compensation for their schedule to the most analogous
ratio would not indicate pathology. The respiratory condition. The commenter disability that is listed there. Also,
commenter suggested that we not use stated that exercise tests should be despite its length, the ICD–9–CM does
the ratio but, rather, use 100 percent of considered maximal and should be not include certain conditions that VA
predicted value. Because a decreased performed after PFT results do not fully must commonly evaluate, such as
ratio could indicate pathology, but not explain symptomatology. specific muscle injuries. For example,
disability, the commenter suggested we The vast majority of veterans with the criteria under diagnostic code 5301
delete the statement in the preamble to respiratory diseases are evaluated on the in the rating schedule govern the
the proposed rule that a decreased ratio basis of PFT results. Since the disability evaluation of injuries to muscle group I
is not indicative of pathology. Because due to respiratory disease in veterans (trapezius, levator scapulae, and
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the statement noted by the commenter ranges from minimal to very severe, and serratus magnus). There are 23 muscle
was not part of the proposed regulatory veterans of all ages and all degrees of groups listed in the VA rating schedule
language, but was made in the preamble physical conditioning undergo that govern the evaluation of injuries to
to the proposed rule, it would have had examinations for respiratory disability, those muscle groups, and each of the 23

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Federal Register / Vol. 71, No. 172 / Wednesday, September 6, 2006 / Rules and Regulations 52459

muscle groups has its own set of Executive Order 12866 ■ 2. Section 4.96 is amended by adding
evaluation criteria based on the severity Executive Order 12866 directs paragraph (d) to read as follows:
of the injuries affecting specific muscle agencies to assess all costs and benefits
functions. Six of them refer to various § 4.96 Special provisions regarding
of available regulatory alternatives and, evaluation of respiratory conditions.
muscle injuries of the shoulder and when regulation is necessary, to select
upper arm. In contrast, ICD–9–CM code * * * * *
regulatory approaches that maximize (d) Special provisions for the
959.2 covers injuries to the axilla and net benefits (including potential
scapular region of the ‘‘Shoulder and application of evaluation criteria for
economic, environmental, public health diagnostic codes 6600, 6603, 6604,
upper arm,’’ which is as specific as ICD– and safety, and other advantages;
9–CM gets for these injuries. Over 6825–6833, and 6840–6845.
distributive impacts; and equity). The (1) Pulmonary function tests (PFT’s)
350,000 veterans are currently evaluated
Order classifies a rule as a significant are required to evaluate these conditions
under VA’s muscle injury criteria,
regulatory action requiring review by except:
which are commonly used for
the Office of Management and Budget if
evaluating residuals of combat injuries, (i) When the results of a maximum
it meets any one of a number of
such as gunshot and shell fragment exercise capacity test are of record and
specified conditions, including: Having
wounds. Such VA diagnostic codes are are 20 ml/kg/min or less. If a maximum
an annual effect on the economy of $100
therefore of great importance to VA in exercise capacity test is not of record,
million or more, creating a serious
evaluating veterans with combat evaluate based on alternative criteria.
inconsistency or interfering with an
wounds, and also provide useful (ii) When pulmonary hypertension
action of another agency, materially
information for statistical purposes. (documented by an echocardiogram or
Other problems would arise from altering the budgetary impact of
cardiac catheterization), cor pulmonale,
replacing VA’s diagnostic codes with entitlements or the rights of entitlement
or right ventricular hypertrophy has
the ICD–9–CM codes. ICD–9–CM’s high recipients, or raising novel legal or
been diagnosed.
level of specificity for some conditions policy issues. This document has been
reviewed by the Office of Management (iii) When there have been one or
would make use by raters difficult, since more episodes of acute respiratory
in some cases a specific code would and Budget under Executive Order
12866. failure.
apply, while in others only the general (iv) When outpatient oxygen therapy
code would be required for rating Unfunded Mandates is required.
purposes. Another issue is that VA has (2) If the DLCO (SB) (Diffusion
The Unfunded Mandates Reform Act
special codes for certain combined Capacity of the Lung for Carbon
of 1995 requires, at 2 U.S.C. 1532, that
disabilities—loss or loss of use of an Monoxide by the Single Breath Method)
agencies prepare an assessment of
arm and loss or loss of use of a leg, for test is not of record, evaluate based on
anticipated costs and benefits before
example—which have special alternative criteria as long as the
issuing any rule that may result in the
significance for VA rating purposes, but examiner states why the test would not
expenditure by State, local, and tribal
which have no equivalent in ICD–9–CM. be useful or valid in a particular case.
governments, in the aggregate, or by the
For these reasons, VA does not believe (3) When the PFT’s are not consistent
private sector, of $100 million or more
that using ICD–9–CM codes to indicate with clinical findings, evaluate based on
(adjusted annually for inflation) in any
veterans’ disabilities for purposes of the PFT’s unless the examiner states
year. This final rule would have no such
compensation would be feasible or why they are not a valid indication of
effect on State, local, and tribal
useful. We therefore make no change respiratory functional impairment in a
governments, or on the private sector.
based on this comment. particular case.
VA appreciates the comment Catalog of Federal Domestic Assistance
Numbers
(4) Post-bronchodilator studies are
submitted in response to the proposed
required when PFT’s are done for
rule. Based on the rationale stated in the The Catalog of Federal Domestic disability evaluation purposes except
proposed rule and in this document, the Assistance program numbers and titles for
this proposal are 64.104, Pension for Non-
when the results of pre-bronchodilator
proposed rule is adopted with the
Service-Connected Disability for Veterans, pulmonary function tests are normal or
changes noted.
and 64.109, Veterans Compensation for when the examiner determines that
Paperwork Reduction Act Service-Connected Disability. post-bronchodilator studies should not
This document contains no provisions be done and states why.
List of Subjects in 38 CFR Part 4 (5) When evaluating based on PFT’s,
constituting a collection of information
under the Paperwork Reduction Act of Disability benefits, Pensions, use post-bronchodilator results in
1995 (44 U.S.C. 3501–3521). Veterans. applying the evaluation criteria in the
Approved: May 26, 2006. rating schedule unless the post-
Regulatory Flexibility Act bronchodilator results were poorer than
Gordon H. Mansfield,
The Secretary hereby certifies that the pre-bronchodilator results. In those
Deputy Secretary of Veterans Affairs.
this final rule will not have a significant cases, use the pre-bronchodilator values
economic impact on a substantial ■ For the reasons set out in the for rating purposes.
number of small entities as they are preamble, 38 CFR part 4, subpart B, is (6) When there is a disparity between
defined in the Regulatory Flexibility amended as set forth below: the results of different PFT’s (FEV–1
Act, 5 U.S.C. 601–612. The reason for (Forced Expiratory Volume in one
PART 4—SCHEDULE FOR RATING
this certification is that this amendment second), FVC (Forced Vital Capacity),
DISABILITIES
would not directly affect any small etc.), so that the level of evaluation
entities. Only VA beneficiaries could be Subpart B—Disability Ratings would differ depending on which test
directly affected. Therefore, pursuant to result is used, use the test result that the
jlentini on PROD1PC65 with RULES

5 U.S.C. 605(b), this final rule is exempt ■ 1. The authority citation for part 4 examiner states most accurately reflects
from the initial and final regulatory continues to read as follows: the level of disability.
flexibility analysis requirements of Authority: 38 U.S.C. 1155, unless (7) If the FEV–1 and the FVC are both
sections 603 and 604. otherwise noted. greater than 100 percent, do not assign

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52460 Federal Register / Vol. 71, No. 172 / Wednesday, September 6, 2006 / Rules and Regulations

a compensable evaluation based on a ENVIRONMENTAL PROTECTION www.regulations.gov or in hard copy at


decreased FEV–1/FVC ratio. AGENCY the Regulatory Development Section,
* * * * * Air Planning Branch, Air, Pesticides and
40 CFR Part 52 Toxics Management Division, U.S.
■ 3. Section 4.100 is added to read as Environmental Protection Agency,
[EPA–R04–OAR–2006–0337–200613(f);
follows: FRL–8216–7] Region 4, 61 Forsyth Street, SW.,
Atlanta, Georgia 30303–8960. EPA
§ 4.100 Application of the evaluation
Approval and Promulgation of requests that if at all possible, you
criteria for diagnostic codes 7000–7007,
Implementation Plans for Kentucky: contact the person listed in the FOR
7011, and 7015–7020.
Air Permit Regulations FURTHER INFORMATION CONTACT section to
(a) Whether or not cardiac schedule your inspection. The Regional
AGENCY: Environmental Protection
hypertrophy or dilatation (documented Office’s official hours of business are
Agency (EPA).
by electrocardiogram, echocardiogram, Monday through Friday, 8:30 to 4:30,
ACTION: Final rule.
or X-ray) is present and whether or not excluding Federal holidays.
there is a need for continuous SUMMARY: EPA is now taking final action FOR FURTHER INFORMATION CONTACT:
medication must be ascertained in all to approve two of four requested James Hou, Regulatory Development
cases. revisions to the State Implementation Section, Air Planning Branch, Air,
(b) Even if the requirement for a 10% Plan (SIP) for the Commonwealth of Pesticides and Toxics Management
(based on the need for continuous Kentucky submitted to EPA on March Division, Region 4, U.S. Environmental
medication) or 30% (based on the 15, 2001. The two revisions being Protection Agency, 61 Forsyth Street,
approved today regard two main SW., Atlanta, Georgia 30303–8960. The
presence of cardiac hypertrophy or
changes to Kentucky’s rules. The first telephone number is (404) 562–8965.
dilatation) evaluation is met, METs change involves the removal and Mr. Hou can also be reached via
testing is required in all cases except: separation of rule 401 Kentucky electronic mail at Hou.James@epa.gov.
(1) When there is a medical Administrative Regulations (KAR) SUPPLEMENTARY INFORMATION:
contraindication. 50:035 (‘‘Permits’’) into three separate
rules under a new Chapter 52 (Permits, I. Today’s Action
(2) When the left ventricular ejection II. Background
fraction has been measured and is 50% Registrations, and Prohibitory Rules). III. Comment and Response
or less. Specifically, these rules are 52:001 IV. Final Action
(Definitions for 401 KAR Chapter 52), V. Statutory and Executive Order Reviews
(3) When chronic congestive heart 52:030 (Federally-enforceable permits
failure is present or there has been more for non-major sources), and 52:100 I. Today’s Action
than one episode of congestive heart (‘‘Public, affected state, and U.S. EPA EPA is now taking final action to
failure within the past year. review’’). The second change involves approve two of four requested revisions
(4) When a 100% evaluation can be corrections to grammatical errors in rule to the (SIP) for the Commonwealth of
assigned on another basis. 50:032 (‘‘Prohibitory Rule for Hot Mix Kentucky submitted to EPA on March
Asphalt Plants’’) and the removal of rule 15, 2001, and clarified in a letter dated
(c) If left ventricular ejection fraction 50:032 from Chapter 50 and adding it to
(LVEF) testing is not of record, evaluate July 18, 2001. The SIP submittal and the
Chapter 52, under 52:090 (‘‘Prohibitory letter-clarification were submitted by
based on the alternative criteria unless Rule for Hot Mix Asphalt Plants’’). This the Kentucky Department for
the examiner states that the LVEF test is final action also responds to adverse Environmental Protection, Division of
needed in a particular case because the comments submitted in response to Air Quality. The two revisions being
available medical information does not EPA’s proposed rule published on approved today regard two main
sufficiently reflect the severity of the December 30, 2002. This final action changes to Kentucky’s rules. The first
veteran’s cardiovascular disability. does not address the removal of 401 change involves the removal and
KAR 50:030 (‘‘Registration of Sources’’) separation of rule 401 Kentucky
■ 4. Section 4.104, diagnostic code 7101 or changes made to 401 KAR 52:080 Administrative Regulations (KAR)
is amended by adding a Note (3) to read (‘‘Regulatory limit on potential to 50:035 (‘‘Permits’’) into three separate
as follows: emit’’), that was part of the March 15, rules under a new Chapter 52 (Permits,
2001, submittal, but which will be Registrations, and Prohibitory Rules).
§ 4.104 Schedule of ratings— addressed in a separate action.
cardiovascular system. Specifically, these rules are 52:001
DATES: Effective Date: This rule will be (Definitions for 401 KAR Chapter 52),
* * * * * effective October 6, 2006. 52:030 (‘‘Federally-enforceable permits
7101 * * * ADDRESSES: EPA has established a for non-major sources’’), and 52:100
Note (3): Evaluate hypertension separately docket for this action under Docket (‘‘Public, affected state, and U.S. EPA
from hypertensive heart disease and other Identification No. EPA–R04–OAR– review’’). The second change involves
types of heart disease. 2006–0337. All documents in the docket corrections to grammatical errors in rule
are listed on the www.regulations.gov 50:032 (‘‘Prohibitory Rule for Hot Mix
* * * * * Web site. Although listed in the index, Asphalt Plants’’) and the removal of rule
[FR Doc. E6–14732 Filed 9–5–06; 8:45 am] some information is not publicly 50:032 from Chapter 50 and adding it to
BILLING CODE 8320–01–P available, i.e., CBI or other information Chapter 52, under 52:090 (‘‘Prohibitory
whose disclosure is restricted by statute. Rule for Hot Mix Asphalt Plants’’).
Certain other material, such as Today’s final action also responds to
copyrighted material, is not placed on one set of adverse comments submitted
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the Internet and will be publicly in response to EPA’s proposed rule


available only in hard copy form. published on December 30, 2002 (67 FR
Publicly available docket materials are 79543). Today’s final action does not
available either electronically through address the removal of 401 KAR 50:030

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