[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4540 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 4540

To provide a program of compensation and health research for illnesses 
 arising from service in the Armed Forces during the Persian Gulf War.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 8, 1994

 Mr. Evans (for himself, Mr. Browder, Mr. Dellums, Mr. Gutierrez, Mr. 
 McCloskey, Mr. Oberstar, Mr. Gonzalez, Mr. Brown of California, Mrs. 
   Schroeder, Mr. Filner, Ms. Waters, Mr. Kennedy, Mr. Boucher, Mr. 
    Faleomavaega, Mr. Holden, Mr. Ackerman, Mr. Hochbrueckner, Mr. 
Washington, Mr. Carr of Michigan, Mr. Farr of California, Mr. Frank of 
 Massachusetts, Mr. Cooper, Mr. Gejdenson, Mr. Sanders, Ms. Slaughter, 
 Mr. Serrano, Mr. Kreidler, Mr. Barlow, Mr. Traficant, Mrs. Lowey, Mr. 
   Barrett of Wisconsin, Mr. Hall of Ohio, Mr. Andrews of Maine, Mr. 
Kopetski, Mr. Orton, Mr. Olver, Mr. Underwood, Mr. Kleczka, Mr. Edwards 
of California, Mr. Markey, Mr. Johnston of Florida, Mr. Jefferson, Mr. 
 Fingerhut, Mr. Manton, Mr. Strickland, Mr. Lancaster, Mr. Mineta, Mr. 
Swett, Mr. Deutsch, Mr. Bonior, Mr. Bilbray, Mrs. Unsoeld, Mr. Peterson 
 of Florida, and Mr. Richardson) introduced the following bill; which 
           was referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To provide a program of compensation and health research for illnesses 
 arising from service in the Armed Forces during the Persian Gulf War.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Persian Gulf War Veterans' 
Compensation Act of 1994''.

SEC. 2. CONGRESSIONAL FINDINGS.

    The Congress makes the following findings:
            (1) The United States bears responsibility for the care and 
        treatment of illnesses and disabilities connected with service 
        in the Armed Forces. When the etiology of a specific condition 
        occurring in veterans is unknown, it is the Government's 
        responsibility to give veterans the benefit of the doubt and to 
        provide appropriate treatment and compensation until the 
        scientific evidence warrants otherwise.
            (2) During the Persian Gulf War, members of the Armed 
        Forces (A) were exposed to numerous potentially toxic 
        substances (including fumes and smoke from petrochemicals and 
        depleted uranium), to infectious agents, to chemoprophylactic 
        agents, and to indigenous diseases, (B) received multiple 
        immunizations and (C) may have been exposed to various chemical 
        and biological warfare agents. Threats of enemy use of chemical 
        and biological weapons heightened the psychological stress 
        otherwise associated with the military operation.
            (3) Significant numbers of veterans of the Persian Gulf War 
        are suffering from illnesses, or are exhibiting symptoms of 
        illnesses, that cannot (as of the enactment of this Act) be 
        diagnosed or clearly defined. As a result, many of these 
        conditions or illnesses are not considered to be service 
        connected for purposes of benefits administered by the 
        Secretary of Veterans Affairs.
            (4) The Technology Assessment Workshop on the Persian Gulf 
        Experience and Health conducted by the National Institutes of 
        Health found that the complex biological, chemical, physical, 
        and psychological environment of the Southwest Asia theater of 
        operations produced complex adverse health effects in Persian 
        Gulf War veterans and that it appears as if there is no single 
        condition or illness among affected Persian Gulf War veterans, 
        but rather multiple illnesses with overlapping symptoms and 
        causes.
            (5) That workshop concluded that the data concerning the 
        range and intensity of exposure to toxic substances by military 
        personnel in the Southwest Asia theater of operations are very 
        limited and that such data were collected only after a 
        considerable delay.
            (6) In response to concerns regarding the health care needs 
        of Persian Gulf War veterans, particularly those who suffer 
        from undiagnosable conditions or illnesses, the Congress, in 
        Public Law 102-585, directed the establishment of the Persian 
        Gulf War Veterans Health Registry, authorized health 
        examinations for Persian Gulf War veterans, and provided for 
        the National Academy of Sciences to conduct a comprehensive 
        review and assessment of information regarding the health 
        consequences of military service in the theater of operations 
        during the Persian Gulf War and to develop recommendations for 
        research on such health consequences. In Public Law 103-210, 
        Congress authorized the Department of Veterans Affairs to 
        provide health care services on a priority basis to Persian 
        Gulf War veterans. In Public Law 103-160, Congress provided 
        funding for the establishment of a specialized environmental 
        medical facility for the conduct of research into the potential 
        health effects of low-level chemical exposure and for research 
        on the potential health effects of battlefield exposure to 
        depleted uranium.
            (7) The workshop referred to in paragraph (4) noted that 
        well-designed epidemiological studies have not been conducted 
        to link the conditions or illnesses of the military personnel 
        with exposures in the theater of operations during the Persian 
        Gulf War and found that the absence of such studies has 
        hampered efforts to provide treatment and compensation to 
        veterans of the Persian Gulf War. Accordingly, further research 
        and studies should be undertaken to determine the underlying 
        causes of the illnesses suffered by Persian Gulf War veterans 
        and, pending the outcome of such research, veterans who are 
        seriously ill and whose illness may be related to their 
        military service should receive compensation benefits to offset 
        the impairment in earnings capacities they may be experiencing.

SEC. 3. PURPOSES.

    The purposes of this Act are--
            (1) to require the Secretary of Veterans Affairs to provide 
        compensation to Persian Gulf War veterans who have disabilities 
        resulting from an illness or illnesses that cannot (as of the 
        enactment of this Act) be diagnosed or defined and for which 
        other causes cannot (as of the enactment of this Act) be 
        identified until such time as scientific evidence demonstrates 
        that the illnesses are unrelated to military service during the 
        Persian Gulf War;
            (2) to require the Secretary of Veterans Affairs to develop 
        case assessment protocols and case definitions for such 
        illnesses;
            (3) to establish an outreach program to Persian Gulf War 
        veterans and their families to inform them of ongoing research 
        activities as well as the services and benefits for which they 
        are eligible; and
            (4) to authorize further research activities, including an 
        epidemiological study, on the health risks and effects of 
        military service in the Southwest theater of operations during 
        the Persian Gulf War.

SEC. 4. DEVELOPMENT OF CASE ASSESSMENT PROTOCOLS AND CASE DEFINITIONS.

    (a) Uniform Case Assessment Protocol.--(1) The Secretary of 
Veterans Affairs shall develop and implement a uniform case assessment 
protocol that will ensure thorough assessment, diagnosis, and treatment 
of all Persian Gulf War veterans suffering from illnesses the origins 
of which are (as of the enactment of this Act) unknown and that may be 
attributable to service in the Southwest Asia theater of operations 
during the Persian Gulf War.
    (2) If such a uniform case assessment protocol is not implemented 
before the end of the 120-day period beginning on the date of the 
enactment of this Act, the Secretary shall, before the end of such 
period, submit to the Committees on Veterans' Affairs of the Senate and 
House of Representatives a report as to why such a protocol has not yet 
been developed.
    (b) Case Definitions.--(1) The Secretary shall develop case 
definitions or diagnoses for illnesses, the origins of which are (as of 
the enactment of this Act) unknown and that may be associated with 
service in the Persian Gulf War.
    (2) If such case definitions and diagnoses are not developed before 
the end of the 120-day period beginning on the date of the enactment of 
this Act, the Secretary shall, before the end of such period, submit to 
the Committees on Veterans' Affairs of the Senate and House of 
Representatives a report as to why such case definitions and diagnoses 
have not yet been developed.
    (c) Consultation.--Subsections (a) and (b) shall be carried out in 
consultation with the Secretary of Defense and the Secretary of Health 
and Human Services.

SEC. 5. OUTREACH TO PERSIAN GULF VETERANS.

    (a) In General.--The Secretary of Veterans Affairs shall implement 
a comprehensive outreach program to inform Persian Gulf War veterans 
and their families of the medical care and other benefits that may be 
provided by the Department of Veterans Affairs and the Department of 
Defense arising from service in the Persian Gulf War.
    (b) Newsletter.--The outreach program shall include a newsletter 
which shall be updated and distributed at least annually and shall be 
distributed to the veterans listed on the Persian Gulf War Veterans 
Health Registry. The newsletter shall include summaries of the status 
and findings of Government sponsored research on illnesses of Persian 
Gulf War veterans and their families as well as on benefits available 
to such individuals through the Department of Veterans Affairs. The 
newsletter shall be prepared in consultation with veterans service 
organizations.
    (c) Toll-Free Number.--The outreach program shall include 
establishment of a toll-free telephone number to provide Persian Gulf 
War veterans and their families information on the Persian Gulf War 
Veterans Health Registry, health care and other benefits provided by 
the Department of Veterans Affairs, and such other information as the 
Secretary considers appropriate. Such toll-free telephone number shall 
be established not later than 90 days after the date of the enactment 
of this Act.

SEC. 6. COMPENSATION FOR DISABILITIES RESULTING FROM ILLNESSES 
              ASSOCIATED WITH SERVICE DURING THE PERSIAN GULF WAR.

    (a) In General.--
            (1) Chapter 11 of title 38, United States Code, is amended 
        by adding at the end of subchapter I the following new section:
``Sec. 1117. Compensation for conditions or illnesses of unknown origin 
              associated with service during the Persian Gulf War
    ``(a) The Secretary shall pay compensation under this subchapter to 
a Persian Gulf War veteran suffering from a disability resulting from 
an undiagnosed illness, or combination of illness, that becomes 
manifest to a degree of 10 percent or more within three years of 
separation from active military, naval, or air service.
    ``(b)(1) The Secretary shall issue, within 90 days of the date of 
the enactment of this section, preliminary regulations governing the 
award of such compensation.
    ``(2) The percentage of disability that equals 10 percent shall be 
described as `mild impairment of social and industrial adaptability'.
    ``(3) The percentage of disability that equals a total or 100 
percent rating shall be described as `demonstratively unable to obtain 
or retain substantial gainful employment'.
    ``(4) In determining the rating schedule for such disability, the 
Secretary should examine analogous ratings.
    ``(5) In determining eligibility for compensation under this 
section, the Secretary shall give due consideration to `lay evidence', 
including testimony provided by the claimant, supporting witnesses, and 
independent medical experts.
    ``(c) Not later than 60 days after the date on which the Secretary 
issues any proposed regulations pursuant to this section, the Secretary 
shall issue final regulations under this section. Such regulations 
shall be effective on the date of issuance.
    ``(d) A disability for which compensation under this section is 
awarded shall be considered to be service connected for purposes of all 
other laws of the United States.
    ``(e) Compensation may not be paid under this section for a 
disability occurring in a veteran--
            ``(1) where there is a preponderance of evidence that the 
        disability was not incurred by the veteran in the Southwest 
        Asia theater of operations during the Persian Gulf War; or
            ``(2) where there is a preponderance of evidence to 
        establish that an intercurrent injury or illness which is a 
        recognized cause of the disability was suffered by the veteran 
        between the date of the veteran's most recent departure from 
        the Southwest Asia theater of operations while on active duty 
        and the onset of the disability.
    ``(f) For purposes of this section, the term `Persian Gulf veteran' 
means a veteran who served on active duty in the Armed Forces in the 
Southwest Asia theater of operations during the Persian Gulf War.
    ``(g) Payments shall be made under this section to a veteran until 
such time as the scientific evidence demonstrates that the illnesses 
for which compensation is awarded under this section are not connected 
to service in the Southwest Asia theater of operations during the 
Persian Gulf War. The Secretary may cease payments under this section 
only after providing a report describing the Secretary's intentions, as 
well as the scientific basis for ceasing such payments, at least 90 
days before implementation of such action to the Committees on Veterans 
Affairs of the Senate and House of Representatives.
    ``(h) Compensation awarded under this section shall not preclude a 
veteran from receiving retroactive compensation for a benefit claim 
that was filed before the date of the enactment of this section if the 
veteran's illness or illnesses are later found to be service connected.
    ``(i) The Secretary shall consider having all claims for 
compensation under this section adjudicated on a priority basis at a 
single Department facility in order to better ensure the consistency of 
rating decisions.
    ``(j) The Secretary shall have all claims for service-connected 
benefits connected to an undiagnosable illness or illnesses in veterans 
of the Persian Gulf War that were denied before the date of the 
enactment of this section reopened and adjudicated as original claims. 
In such a case, the date of claim shall be considered to be the date on 
which the original claim was filed.''.
            (2) The table of sections at the beginning of such chapter 
        is amended by inserting after the item relating to section 1116 
        the following new item:

``1117. Presumption of service connection for illnesses associated with 
                            the Persian Gulf War.''.
    (b) Effective Date.--Section 1117 of title 38, United States Code, 
as added by subsection (a), shall take effect on October 1, 1994.

SEC. 7. RESULTS OF EXAMINATIONS AND TREATMENT OF PERSIAN GULF WAR 
              VETERANS WITH UNDIAGNOSABLE ILLNESSES.

    (a) Access to Data.--The Secretary of Veterans Affairs shall enter 
into an agreement with the Secretary of Defense to have access to all 
clinical data of the Department of Defense on veterans of the Persian 
Gulf War who remain on active duty.
    (b) Ongoing Compilation of Data.--The Secretary of Veterans Affairs 
shall compile and analyze, on a continuing basis, all clinical data 
obtained on veterans of the Persian Gulf War in connection with 
examinations and treatment furnished by the Department of Veterans 
Affairs and the Department of Defense that are likely (1) to be 
scientifically useful in determining the association between the 
undiagnosable illnesses of veterans and their service in the Southwest 
Asia theater of operations during the Persian Gulf War, and (2) to be 
useful in the development of case assessment protocols or case 
definitions.
    (c) Annual Report.--The Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives an annual 
report containing--
            (1) the information compiled in accordance with subsection 
        (b);
            (2) the Secretary's analysis of such information;
            (3) a discussion of the incidence of illnesses identified 
        or treated by the Department of Veterans Affairs in the case of 
        veterans referred to in subsection (b); and
            (4) the Secretary's explanation for the incidence of such 
        illnesses and disabilities.

SEC. 8. EPIDEMIOLOGICAL RESEARCH.

    (a) Contract.--The Secretary of Veterans Affairs shall enter into a 
contract for the conduct of an epidemiological study designed to assess 
both the short- and long-term health consequences of service in the 
Southwest Asia theater of operations during the Persian Gulf War on 
veterans of the Persian Gulf War and their immediate family members.
    (b) Oversight.--(1) The Secretary shall seek to enter into an 
agreement with the National Academy of Sciences for the Medical Follow-
Up Agency (MFUA) of the Institute of Medicine of the Academy for (A) 
the review of proposals to conduct the research specified in subsection 
(a), (B) oversight of such research, and (C) review of the research 
findings.
    (2) If the Secretary is unable to enter into an agreement under 
paragraph (1) with the entity specified in that paragraph, the 
Secretary shall enter into an agreement described in that paragraph 
with another appropriate scientific organization which does not have a 
connection to the Department of Veterans Affairs. In such a case, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives, at least 90 days before the date 
on which the agreement is entered into, notice in writing identifying 
the organization with which the Secretary intends to enter into the 
agreement.
    (c) Access to Data.--The Secretary shall enter into agreements with 
the Secretary of Defense and the Secretary of Health and Human Services 
to access and make available to the contractor under subsection (a) all 
data that the Secretary, in consultation with the National Academy of 
Sciences and the contractor, considers relevant to the study.
    (d) Status Report.--Within 180 days after the date of the enactment 
of this Act, the Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives a report on the 
status of the contract specified in subsection (a).
    (e) Authorization.--There is authorized to be appropriated to the 
Department $7,500,000 for each of fiscal years 1995 through 2000 for 
the conduct of the research specified in subsection (a). In addition to 
amounts for such research appropriated pursuant to the preceding 
sentence, the Secretary may provide funds for such research from any 
funds appropriated for any fiscal year after fiscal year 1994 for the 
purpose of research sponsored by the Department.
    (f) Annual Report.--For each year of the study, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report accompanying the budget for that year 
containing--
            (1) the methodology and status of the study specified in 
        subsection (a); and
            (2) any preliminary analyses of the information compiled in 
        accordance with subsection (a), including that provided by the 
        National Academy of Sciences.
    (g) Final Report.--At the conclusion of the study, the Secretary 
shall submit to the Committees on Veterans' Affairs of the Senate and 
House of Representatives a report accompanying the budget containing--
            (1) the methodology of the study specified in subsection 
        (a);
            (2) the analysis of the information compiled in accordance 
        with subsection (a), including that provided by the National 
        Academy of Sciences;
            (3) a discussion of incidence of illnesses observed in 
        veterans of the Persian Gulf War and their families;
            (4) the National Academy of Sciences conclusions concerning 
        the health consequences of service in the Southwest Asia 
        theater of operations during the Persian Gulf War on veterans 
        and their immediate family members; and
            (5) the Secretary's explanation for the incidence of such 
        illnesses and disabilities and recommendations for future 
        action.

SEC. 9. AUTHORIZATION FOR OTHER RESEARCH.

    There is authorized to be appropriated to the Department of 
Veterans Affairs $5,000,000 for each of fiscal years 1995 through 1998 
for the conduct of research which the Secretary, in consultation with 
the Secretary of Defense and the Secretary of Health and Human 
Services, determines could advance understanding of health risks and 
effects of service during the Persian Gulf War and the means of 
treating those health effects.

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