[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 2330 Reported in Senate (RS)]

                                                       Calendar No. 691

103d CONGRESS

  2d Session

                                S. 2330

                          [Report No. 103-386]

_______________________________________________________________________

                                 A BILL

  To amend title 38, United States Code, to provide that undiagnosed 
 illnesses constitute diseases for purposes of entitlement of veterans 
  to disability compensation for service-connected diseases, and for 
                            other purposes.

_______________________________________________________________________

           September 28 (legislative day, September 12), 1994

        Reported with an amendment and an amendment to the title





                                                       Calendar No. 691
103d CONGRESS
  2d Session
                                S. 2330

                          [Report No. 103-386]

  To amend title 38, United States Code, to provide that undiagnosed 
 illnesses constitute diseases for purposes of entitlement of veterans 
  to disability compensation for service-connected diseases, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                July 27 (legislative day, July 20), 1994

    Mr. Rockefeller (for himself, Mr. Murkowski, Mr. DeConcini, Mr. 
    Mitchell, Mr. Graham, Mr. Akaka, Mr. Daschle, Mr. Campbell, Mr. 
  Thurmond, Mr. Simpson, Mr. Specter, Mr. Jeffords, Mr. Sarbanes, Mr. 
   Smith, Mr. Wofford, Mr. Hollings, Mr. Cochran, Mr. Bingaman, Mr. 
  Durenberger, Mr. Dodd, Mr. Moynihan, Mr. Kennedy, Mrs. Murray, Mr. 
   Dole, Mr. Biden, Mr. Pell, Mr. Gregg, Mr. Stevens, Mr. Lott, Mr. 
    Inouye, Mrs. Kassebaum, Mr. Cohen, Mr. Robb, Mr. Wellstone, Mr. 
Lautenberg, Mr. Bond, Mr. Simon, and Mr. Kohl) introduced the following 
 bill; which was read twice and referred to the Committee on Veterans' 
                                Affairs

           September 28 (legislative day, September 12), 1994

Reported by Mr. Rockefeller, with an amendment and an amendment to the 
                                 title
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
  To amend title 38, United States Code, to provide that undiagnosed 
 illnesses constitute diseases for purposes of entitlement of veterans 
  to disability compensation for service-connected diseases, and for 
                            other purposes.

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

-S-E-C-T-I-O-N -1-. -C-L-A-R-I-F-I-C-A-T-I-O-N -O-F 
              -R-E-L-A-T-I-O-N-S-H-I-P -B-E-T-W-E-E-N 
              -U-N-D-I-A-G-N-O-S-E-D -I-L-L-N-E-S-S -A-N-D 
              -D-I-S-E-A-S-E -F-O-R -P-U-R-P-O-S-E-S -O-F 
              -E-N-T-I-T-L-E-M-E-N-T -T-O -D-I-S-A-B-I-L-I-T-Y 
              -C-O-M-P-E-N-S-A-T-I-O-N-.

    -(-a-) -W-a-r-t-i-m-e -D-i-s-a-b-i-l-i-t-y 
-C-o-m-p-e-n-s-a-t-i-o-n-.----S-e-c-t-i-o-n -1-1-1-0 -o-f -t-i-t-l-e 
-3-8-, -U-n-i-t-e-d -S-t-a-t-e-s -C-o-d-e-, -i-s -a-m-e-n-d-e-d---
            -(-1-) -b-y -i-n-s-e-r-t-i-n-g -`-`-(-a-)-'-' -b-e-f-o-r-e 
        -`-`-F-o-r -d-i-s-a-b-i-l-i-t-y-'-'-; -a-n-d
            -(-2-) -b-y -a-d-d-i-n-g -a-t -t-h-e -e-n-d -t-h-e 
        -f-o-l-l-o-w-i-n-g-:
    -`-`-(-b-) -F-o-r -t-h-e -p-u-r-p-o-s-e-s -o-f -t-h-i-s 
-s-e-c-t-i-o-n-, -t-h-e -t-e-r-m -`-d-i-s-e-a-s-e-'-, -i-n -t-h-e 
-c-a-s-e -o-f -a-n -i-n-d-i-v-i-d-u-a-l-, -m-e-a-n-s -a-n-y 
-d-e-v-i-a-t-i-o-n -f-r-o-m -o-r -i-n-t-e-r-r-u-p-t-i-o-n -o-f -t-h-e 
-n-o-r-m-a-l -s-t-r-u-c-t-u-r-e -o-r -f-u-n-c-t-i-o-n -o-f -a-n-y 
-p-a-r-t-, -o-r-g-a-n-, -o-r -s-y-s-t-e-m -o-f -t-h-e -b-o-d-y -o-f 
-t-h-e -i-n-d-i-v-i-d-u-a-l -t-h-a-t -i-s -m-a-n-i-f-e-s-t-e-d -b-y -a 
-s-y-m-p-t-o-m -o-r -s-i-g-n -(-o-r -s-y-m-p-t-o-m-s -o-r -s-i-g-n-s-) 
-t-h-e -e-t-i-o-l-o-g-y-, -p-a-t-h-o-l-o-g-y-, -a-n-d 
-p-r-o-g-n-o-s-i-s -f-o-r -w-h-i-c-h -i-s -k-n-o-w-n -o-r 
-u-n-k-n-o-w-n-.-'-'-.
    -(-b-) -P-e-a-c-e-t-i-m-e -D-i-s-a-b-i-l-i-t-y 
-C-o-m-p-e-n-s-a-t-i-o-n-.----S-e-c-t-i-o-n -1-1-3-1 -o-f -s-u-c-h 
-t-i-t-l-e -i-s -a-m-e-n-d-e-d---
            -(-1-) -b-y -i-n-s-e-r-t-i-n-g -`-`-(-a-)-'-' -b-e-f-o-r-e 
        -`-`-F-o-r -d-i-s-a-b-i-l-i-t-y-'-'-; -a-n-d
            -(-2-) -b-y -a-d-d-i-n-g -a-t -t-h-e -e-n-d -t-h-e 
        -f-o-l-l-o-w-i-n-g-:
    -`-`-(-b-) -F-o-r -t-h-e -p-u-r-p-o-s-e-s -o-f -t-h-i-s 
-s-e-c-t-i-o-n-, -t-h-e -t-e-r-m -`-d-i-s-e-a-s-e-'-, -i-n -t-h-e 
-c-a-s-e -o-f -a-n -i-n-d-i-v-i-d-u-a-l-, -m-e-a-n-s -a-n-y 
-d-e-v-i-a-t-i-o-n -f-r-o-m -o-r -i-n-t-e-r-r-u-p-t-i-o-n -o-f -t-h-e 
-n-o-r-m-a-l -s-t-r-u-c-t-u-r-e -o-r -f-u-n-c-t-i-o-n -o-f -a-n-y 
-p-a-r-t-, -o-r-g-a-n-, -o-r -s-y-s-t-e-m -o-f -t-h-e -b-o-d-y -o-f 
-t-h-e -i-n-d-i-v-i-d-u-a-l -t-h-a-t -i-s -m-a-n-i-f-e-s-t-e-d -b-y -a 
-s-y-m-p-t-o-m -o-r -s-i-g-n -(-o-r -s-y-m-p-t-o-m-s -o-r -s-i-g-n-s-) 
-t-h-e -e-t-i-o-l-o-g-y-, -p-a-t-h-o-l-o-g-y-, -a-n-d 
-p-r-o-g-n-o-s-i-s -f-o-r -w-h-i-c-h -i-s -k-n-o-w-n -o-r 
-u-n-k-n-o-w-n-.-'-'-.
    -(-c-) -C-o-n-s-i-d-e-r-a-t-i-o-n -o-f -C-i-r-c-u-m-s-t-a-n-c-e-s 
-o-f -S-e-r-v-i-c-e-.----S-u-b-s-e-c-t-i-o-n -(-a-) -o-f -s-e-c-t-i-o-n 
-1-1-5-4 -o-f -s-u-c-h -t-i-t-l-e -i-s -a-m-e-n-d-e-d -t-o -r-e-a-d 
-a-s -f-o-l-l-o-w-s-:
    -`-`-(-a-) -T-h-e -S-e-c-r-e-t-a-r-y -s-h-a-l-l -i-n-c-l-u-d-e -i-n 
-t-h-e -r-e-g-u-l-a-t-i-o-n-s -p-e-r-t-a-i-n-i-n-g -t-o 
-s-e-r-v-i-c-e---c-o-n-n-e-c-t-i-o-n -o-f -d-i-s-a-b-i-l-i-t-i-e-s 
-t-h-e -f-o-l-l-o-w-i-n-g -p-r-o-v-i-s-i-o-n-s-:
            -`-`-(-1-) -A-d-d-i-t-i-o-n-a-l -p-r-o-v-i-s-i-o-n-s 
        -r-e-q-u-i-r-i-n-g -t-h-a-t -d-u-e -c-o-n-s-i-d-e-r-a-t-i-o-n 
        -b-e -g-i-v-e-n -i-n -e-a-c-h -c-a-s-e -w-h-e-r-e -a 
        -v-e-t-e-r-a-n -i-s -s-e-e-k-i-n-g -s-e-r-v-i-c-e--
        -c-o-n-n-e-c-t-i-o-n -f-o-r -a -d-i-s-a-b-i-l-i-t-y -a-n-d 
        -w-h-e-r-e -s-u-c-h -c-o-n-s-i-d-e-r-a-t-i-o-n -m-i-g-h-t 
        -m-a-t-e-r-i-a-l-l-y -a-s-s-i-s-t -t-h-e -v-e-t-e-r-a-n -i-n 
        -e-s-t-a-b-l-i-s-h-i-n-g -s-u-c-h -s-e-r-v-i-c-e--
        -c-o-n-n-e-c-t-i-o-n -t-o---
                    -`-`-(-A-) -t-h-e -p-l-a-c-e-s-, -t-y-p-e-s-, 
                -a-n-d -c-i-r-c-u-m-s-t-a-n-c-e-s -o-f -s-u-c-h 
                -v-e-t-e-r-a-n-'-s -s-e-r-v-i-c-e -a-s -s-h-o-w-n -b-y 
                -s-u-c-h -v-e-t-e-r-a-n-'-s -s-e-r-v-i-c-e 
                -r-e-c-o-r-d-, -t-h-e -o-f-f-i-c-i-a-l -h-i-s-t-o-r-y 
                -o-f -e-a-c-h -o-r-g-a-n-i-z-a-t-i-o-n -i-n -w-h-i-c-h 
                -t-h-e -v-e-t-e-r-a-n -s-e-r-v-e-d-, -s-u-c-h 
                -v-e-t-e-r-a-n-'-s -m-e-d-i-c-a-l -r-e-c-o-r-d-s-, 
                -a-n-d -a-l-l -p-e-r-t-i-n-e-n-t -m-e-d-i-c-a-l -a-n-d 
                -l-a-y -e-v-i-d-e-n-c-e-; -a-n-d
                    -`-`-(-B-) -t-h-e -c-o-m-m-o-n -o-r -s-h-a-r-e-d 
                -e-x-p-e-r-i-e-n-c-e-s-, -m-e-d-i-c-a-l 
                -s-y-m-p-t-o-m-s -o-r -s-i-g-n-s-, -o-r -b-o-t-h-, -o-f 
                -o-t-h-e-r -v-e-t-e-r-a-n-s -(-i-n-c-l-u-d-i-n-g 
                -g-r-o-u-p-s -o-f -v-e-t-e-r-a-n-s-) -w-h-o---
                            -`-`-(-i-) -w-e-r-e -e-n-g-a-g-e-d -i-n 
                        -s-e-r-v-i-c-e -s-i-m-i-l-a-r -t-o -t-h-e 
                        -s-e-r-v-i-c-e -o-f -s-u-c-h -v-e-t-e-r-a-n-; 
                        -a-n-d
                            -`-`-(-i-i-) -e-x-h-i-b-i-t-, -o-r -h-a-v-e 
                        -e-x-h-i-b-i-t-e-d -s-i-n-c-e -s-u-c-h 
                        -s-e-r-v-i-c-e-, -m-e-d-i-c-a-l 
                        -s-y-m-p-t-o-m-s -o-r -s-i-g-n-s -s-i-m-i-l-a-r 
                        -t-o -t-h-e -m-e-d-i-c-a-l -s-y-m-p-t-o-m-s 
                        -o-r -s-i-g-n-s -o-f -s-u-c-h -v-e-t-e-r-a-n-.
            -`-`-(-2-) -T-h-e -p-r-o-v-i-s-i-o-n-s -r-e-q-u-i-r-e-d 
        -b-y -s-e-c-t-i-o-n -5 -o-f -t-h-e -V-e-t-e-r-a-n-s-' 
        -D-i-o-x-i-n -a-n-d -R-a-d-i-a-t-i-o-n -E-x-p-o-s-u-r-e 
        -C-o-m-p-e-n-s-a-t-i-o-n -S-t-a-n-d-a-r-d-s -A-c-t -(-3-8 
        -U-.-S-.-C-. -1-1-5-4 -n-o-t-e-)-.-'-'-.

SECTION 1. CLARIFICATION OF DEFINITION OF DISEASE FOR PURPOSES OF 
              ENTITLEMENT TO DISABILITY COMPENSATION.

    (a) Wartime Disability Compensation.--Section 1110 of title 38, 
United States Code, is amended--
            (1) by inserting ``(a)'' before ``For disability''; and
            (2) by adding at the end the following:
    ``(b) For the purposes of this section, the term `disease' means 
any deviation from or interruption of the normal structure or function 
of any part, organ, or system (or combination thereof) of the body that 
is manifested by a characteristic set of symptoms and signs and whose 
etiology, pathology, and prognosis may be known or unknown.''.
    (b) Peacetime Disability Compensation.--Section 1131 of such title 
is amended--
            (1) by inserting ``(a)'' before ``For disability''; and
            (2) by adding at the end the following:
    ``(b) For the purposes of this section, the term `disease' means 
any deviation from or interruption of the normal structure or function 
of any part, organ, or system (or combination thereof) of the body that 
is manifested by a characteristic set of symptoms and signs and whose 
etiology, pathology, and prognosis may be known or unknown.''.
    (c) Consideration of Circumstances of Service.--Subsection (a) of 
section 1154 of such title is amended to read as follows:
    ``(a) The Secretary shall include in the regulations pertaining to 
service-connection of disabilities the following provisions:
            ``(1) Additional provisions requiring that due 
        consideration be given in each case where a veteran is seeking 
        service-connection for a disability and where such 
        consideration might materially assist the veteran in 
        establishing such service-connection to--
                    ``(A) the places, types, and circumstances of such 
                veteran's service as shown by such veteran's service 
                record, the official history of each organization in 
                which the veteran served, such veteran's medical 
                records, and all pertinent medical and lay evidence; 
                and
                    ``(B) the common or shared experiences, medical 
                symptoms or signs, or both, of other veterans 
                (including groups of veterans) who--
                            ``(i) were engaged in service similar to 
                        the service of such veteran; and
                            ``(ii) exhibit, or have exhibited since 
                        such service, medical symptoms or signs similar 
                        to the medical symptoms or signs of such 
                        veteran.
            ``(2) The provisions required by section 5 of the Veterans' 
        Dioxin and Radiation Exposure Compensation Standards Act (38 
        U.S.C. 1154 note).''.

SEC. 2. AUTHORITY TO INVESTIGATE AND RECOMMEND ESTABLISHMENT OF 
              PRESUMPTIONS OF SERVICE CONNECTION.

    (a) In General.--(1) Chapter 11 of title 38, United States Code, is 
amended by inserting after section 1112 the following new section:
``Sec. 1112A. Proposals for presumptions of service connection
    ``(a) If the Secretary becomes aware of assertions that a group of 
veterans who had the same or similar military service suffer from or 
exhibit the same or similar health conditions (including diseases whose 
etiology, pathology, and prognosis is known or unknown, illnesses, or 
medical symptoms or signs) and that such health conditions are related 
to such service, the Secretary may carry out an inquiry in order to--
            ``(1) confirm that veterans who had such service suffer 
        from or exhibit such health conditions;
            ``(2) identify all veterans who had such service for 
        purposes of determining which of such veterans suffer from or 
        exhibit such health conditions; and
            ``(3) determine whether or not a presumption of a service 
        connection should be established between such service and such 
        health conditions.
    ``(b)(1) If the Secretary determines under subsection (a)(3) that a 
presumption of a service connection should be established between 
military service and a health condition, the Secretary shall prepare a 
proposal relating to the establishment of that presumption.
    ``(2) A proposal relating to the establishment of a presumption of 
a service connection under paragraph (1) shall contain the following:
            ``(A) A description of the nature, period, and geographical 
        area or areas of the military service for which the presumption 
        should be established.
            ``(B) A description of the health condition for which the 
        presumption should be established.
            ``(C) A description of any relevant medical characteristic 
        (such as a latency period) associated with the health 
        condition.
            ``(D) A statement of the limitations, if any, on the period 
        for which the Secretary would pay compensation under this 
        chapter for disabilities resulting from the health condition.
    ``(c) Upon completion of a proposal under subsection (b), the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
Senate and the House of Representatives a report containing the 
proposal, together with the recommendations of the Secretary for any 
legislation relating thereto and the reasons for such 
recommendations.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1112 the 
following new item:

``1112A. Proposals for presumptions of service connection.''.
    (b) Conforming Amendment.--Section 1137 of such title is amended by 
inserting ``1112A,'' after ``1112,''.
    (c) Report on Establishment of Presumption for Veterans of Persian 
Gulf War.--(1) Not later than 30 days after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report on whether or not a presumption of a service 
connection should be established between military service in the 
Southwest Asia theater of operations during the Persian Gulf War and 
any health condition of veterans who engaged in such service.
    (2) For purposes of this subsection, the term ``Persian Gulf War'' 
has the meaning given such term in section 101(33) of title 38, United 
States Code.
    (d) Requirements Based on Determination for Establishment.--(1) If 
the Secretary reports under subsection (c) that a presumption of a 
service connection referred to in that subsection should be 
established, the Secretary shall--
            (A) include in the report under that subsection the matters 
        referred to in section 1112A(b)(2) of title 38, United States 
        Code, as added by subsection (a), with respect to the service 
        connection; and
            (B) publish proposed regulations relating to the 
        establishment of a presumption of the service connection and 
        the payment of disability compensation as a result of the 
        service connection.
    (2) The Secretary shall provide for public notice and comment on 
the proposed regulations published under paragraph (1)(B). The period 
of such notice and comment shall be 30 days.
    (3) The Secretary shall publish final regulations relating to the 
matters referred to in paragraph (1)(B) not later than 30 days after 
the end of the period for public notice and comment under paragraph 
(2).
    (e) Treatment of Claims and Compensation.--(1) An award of 
compensation to a veteran under the regulations prescribed under 
subsection (d) shall not preclude the veteran from receiving 
retroactive compensation for a benefit claim that was filed before the 
date of the enactment of this Act if the veteran's health condition is 
later found to be service connected.
    (2) The Secretary shall consider having all claims for compensation 
under such regulations adjudicated on a priority basis at a single 
Department facility in order to better ensure the consistency of rating 
decisions.
    (3) The Secretary shall have all claims for service-connected 
benefits connected to a health condition covered by such regulations 
that were denied before the date of the enactment of this Act 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.

SEC. 3. DEVELOPMENT OF CLINICAL EVALUATION PROTOCOLS.

    (a) Uniform Clinical Evaluation Protocol.--(1) The Secretary of 
Veterans Affairs shall develop and implement a uniform and 
comprehensive clinical evaluation protocol to provide extensive medical 
examinations to Persian Gulf War veterans who are suffering from 
illnesses the origins of which are (as of the date 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. The 
protocol shall include an evaluation of complaints relating to 
illnesses involving the reproductive system.
    (2) If such a clinical 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 
the House of Representatives a report as to why such a protocol has not 
yet been developed.
    (3)(A) The Secretary shall ensure that the evaluation under the 
protocol developed under this section is available at all Department 
medical centers that have the capability of providing the medical 
assessment, diagnosis, and treatment required under the protocol.
    (B) The Secretary may enter into contracts with non-Department 
medical facilities for the provision of the evaluation under the 
protocol.
    (C) In the case of a veteran whose residence is distant from a 
medical center described in subparagraph (A), the Secretary may provide 
the evaluation through a Department medical center described in that 
subparagraph and pay or reimburse the veteran for the cost incurred by 
the veteran in travel to the Department medical center.
    (4)(A) If the Secretary is unable to diagnosis the symptoms or 
illness of a veteran provided an evaluation, or if the symptoms or 
illness of a veteran do not respond to treatment provided by the 
Secretary, the Secretary may provide for the veteran to receive the 
diagnosis or treatment, as the case may be, at a non-Department medical 
facility that may have the capability of diagnosing or treating the 
symptoms or illness of the veteran. The Secretary may pay the veteran 
or reimburse the veteran for the costs incurred by the veteran in 
travel to the non-Department medical facility for the diagnosis or 
treatment.
    (B) The Secretary shall request from each non-Department medical 
facility that provides diagnosis of or treatment to a veteran under 
this paragraph such information relating to the diagnosis or treatment 
as the Secretary considers appropriate. The release of such information 
to the Secretary may be subject to such requirements for 
confidentiality as the facility may impose.
    (5) In each year after the implementation of the protocol, the 
Secretary shall enter into an agreement with the National Academy of 
Sciences under which agreement appropriate members of the Academy shall 
review the adequacy of the protocol and its implementation by the 
Department of Veterans Affairs.
    (b) Relationship to Other Comprehensive Clinical Evaluation 
Protocols.--The Secretary, in consultation with the Secretary of 
Defense, shall ensure that the information collected through the 
protocol described in this section is collected and maintained in a 
manner that permits the effective and efficient cross-reference of that 
information with information collected and maintained through the 
comprehensive clinical protocols of the Department of Defense for 
Persian Gulf War veterans.

SEC. 4. 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. 5. EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN OF PERSIAN 
              GULF WAR VETERANS.

    The Persian Gulf War Veterans' Health Status Act (title VII of 
Public Law 102-585; 38 U.S.C. 527 note) is amended by inserting after 
section 703 the following new section:

``SEC. 703A. REGISTRATION AND HEALTH EXAMINATIONS FOR CERTAIN SPOUSES 
              AND CHILDREN OF PERSIAN GULF WAR VETERANS.

    ``(a) Inclusion of Information on Spouses and Children of Veterans 
in Registry.--(1) Subject to paragraphs (2) and (3), the Persian Gulf 
War Veterans Health Registry established under section 702 shall also 
include the following information:
            ``(A) In the case of any veteran listed in the Registry, 
        the name, address, and taxpayer identification number (if any) 
        of any individual--
                    ``(i) who is the spouse or child of the veteran;
                    ``(ii) who is suffering from an illness or 
                disorder; and
                    ``(iii) who asserts that the illness or disorder is 
                directly related to an illness suffered by the veteran 
                as a result of the service of the veteran in the 
                Persian Gulf theater of operations during the Persian 
                Gulf War.
            ``(B) Such medical data with respect to each such 
        individual as the Secretary determines appropriate in order to 
        determine the nature and extent of the connection, if any, 
        between the illness or disorder of the individual and the 
        illness of the veteran.
    ``(2) An individual referred to in paragraph (1)(A), and any 
information on the individual under paragraph (1)(B), may not be 
included in the Registry without the approval of the applicable 
veteran.
    ``(3) The total number of individuals referred to in paragraph 
(1)(A) who may be listed in the Registry may not exceed 10,000.
    ``(4) The Secretary shall maintain the Registry so as to treat 
information on any individual referred to in paragraph (1)(A) as 
information on that individual and on the applicable veteran.
    ``(b) Diagnostic Tests, Health Examinations, and Counseling.--(1) 
The Secretary shall, upon request, perform diagnostic tests of and 
provide a health examination and consultation and counseling to any 
individual who asserts under subsection (a)(1)(A)(iii) that an illness 
or disorder of the individual is directly related to the illness of a 
veteran as described in that subsection. The purpose of the 
examination, diagnostic test, and consultation is to gather information 
on the illness or disorder and the possible contagious or genetic 
methods of transmission of the illness or disorder.
    ``(2) The Secretary may conduct any additional health examinations 
and diagnostic tests of an individual referred to in paragraph (1) as 
the Secretary determines appropriate in order to carry out the purpose 
of this subsection.
    ``(3) The Secretary may perform diagnostic tests and provide 
examinations and consultations and counseling under this subsection 
through facilities of the Department of Veterans Affairs or at or 
through contract with non-Department facilities.
    ``(c) Definitions.--For the purposes of this section, the terms 
`child' and `spouse' have the meanings given such terms in paragraphs 
(4) and (31) of section 101 of title 38, United States Code, 
respectively.''.

SEC. 6. CLARIFICATION OF SCOPE OF HEALTH EXAMINATIONS PROVIDED FOR 
              VETERANS ELIGIBLE FOR INCLUSION IN HEALTH-RELATED 
              REGISTRIES.

    Section 703 of the Persian Gulf War Veterans' Health Status Act 
(title VII of Public Law 102-585; 38 U.S.C. 527 note) is amended--
            (1) by inserting ``(including diagnostic tests)'' after 
        ``examination'' each place it appears other than subsection 
        (a)(1)(A);
            (2) in subsection (a)(1)(A)--
                    (A) by inserting ``(including any appropriate 
                diagnostic tests)'' after ``a health examination''; and
                    (B) by inserting ``and the tests'' after ``the 
                examination''; and
            (3) in subsection (a)(2), by inserting ``(including any 
        diagnostic tests)'' after ``examinations''.

SEC. 7. REQUIREMENT FOR MINIMUM NUMBER OF FULL-TIME EQUIVALENT 
              POSITIONS.

    (a) Findings.--Congress makes the following findings:
            (1) Under proposals for national health care reform, the 
        Department of Veterans Affairs will be required to provide 
        health care services to veterans on a competitive basis with 
        other health care providers.
            (2) The elimination of positions from the Department that 
        the Office of Management and Budget has scheduled to occur in 
        fiscal years 1995 through 1999 would prevent the Department 
        from meeting the responsibilities of the Department to provide 
        health care to veterans under law and from maintaining the 
        quality of health care that is currently provided to veterans.
    (b) Minimum Number of FTEE Positions.--Notwithstanding any other 
provision of law, the number of full-time equivalent positions in the 
Department of Veterans Affairs during the period beginning on the date 
of the enactment of this Act and ending on September 30, 1999, may not 
(except as provided in subsection (d)) be less than 224,377.
    (c) Determination of Number of Positions.--In determining the 
number of full-time equivalent positions in the Department of Veterans 
Affairs during a fiscal year for purposes of ensuring under section 
5(b) of the Federal Workforce Restructuring Act of 1994 (Public Law 
103-226; 108 Stat. 115; 5 U.S.C. 3101 note) that the total number of 
full-time equivalent positions in all agencies of the Federal 
Government during a fiscal year covered by that section does not exceed 
the limit prescribed for that fiscal year under that section, the total 
number of full-time equivalent positions in the Department of Veterans 
Affairs during that fiscal year shall be the number equal to--
            (1) the number of such positions in the Department during 
        that fiscal year, reduced by
            (2) the sum of--
                    (A) the number of such positions in the Department 
                during that fiscal year that are filled by employees 
                whose salaries and benefits are paid primarily from 
                funds other than appropriated funds; and
                    (B) the number of such positions held during that 
                fiscal year by persons involved in medical care cost 
                recovery activities under section 1729 of title 38, 
                United States Code.
    (d) Reductions Below Minimum.--The Secretary of Veterans Affairs 
shall not be required to make a reduction in the number of full-time 
equivalent positions in the Department unless such reduction--
            (1) is necessary due to a reduction in funds available to 
        the Department; or
            (2) is required under a law that is enacted after the date 
        of the enactment of this Act and that refers specifically to 
        this section.
    (e) Annual Report.--The Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and the House of Representatives an 
annual report, through the year 2000, on the number and type of full-
time equivalent positions in the Department that are reduced under this 
section. The report shall include a justification for the reductions 
and shall be submitted with the materials provided in support of the 
budget for the Department contained in the President's budget submitted 
to Congress for a fiscal year pursuant to section 1105 of title 31, 
United States Code.

SEC. 8. ENHANCED AUTHORITY TO CONTRACT FOR NECESSARY SERVICES.

    Section 8110(c) of title 38, United States Code, is amended by 
striking out paragraph (7) and inserting in lieu thereof the following:
    ``(7) Paragraphs (1) through (6) shall not be in effect during 
fiscal years 1995 through 1999.
    ``(8) During the period covered by paragraph (7), whenever an 
activity at a Department health-care facility is converted from 
performance by Federal employees to performance by employees of a 
contractor of the Government, the Secretary shall--
            ``(A) require in the contract for the performance of such 
        activity that the contractor, in hiring employees for the 
        performance of the contract, give priority to former employees 
        of the Department who have been displaced by the award of the 
        contract; and
            ``(B) provide to such former employees of the Department 
        all possible assistance in obtaining other Federal employment 
        or entrance into job training and retraining programs.
    ``(9) The Secretary shall include in the Secretary's annual report 
to Congress under section 529 of this title, for each fiscal year 
covered by paragraph (7), a report on the use during the year covered 
by the report of contracting-out authority made available by reason of 
paragraph (7). The Secretary shall include in each such report a 
description of each use of such authority, together with the rationale 
for the use of such authority and the effect of the use of such 
authority on patient care and on employees of the Department.''.

SEC. 9. STUDY OF ALTERNATIVE ORGANIZATIONAL STRUCTURES FOR EFFECTIVE 
              PROVISION OF HEALTH CARE.

    (a) Requirement.--The Secretary of Veterans Affairs shall enter 
into an agreement with an appropriate non-Federal entity under which 
the entity shall carry out a study of the feasibility and advisability 
of alternative organizational structures, such as the establishment of 
a wholly-owned Government corporation or a Government-sponsored 
enterprise, for the effective provision of health care services to 
veterans.
    (b) Submission of Report.--The Secretary shall submit to the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report on the study required under subsection (a) not 
later than one year after the date of the enactment of this Act.
    (c) Authorization of Funds.--There is hereby authorized to be 
appropriated for the Department of Veterans Affairs the sum of 
$1,000,000 for the purposes of carrying out the study required under 
subsection (a).
            Amend the title so as to read: ``To amend title 38, United 
        States Code, to clarify the definition of `disease' for 
        purposes of the entitlement of veterans to benefits under such 
        title, to revise and improve the assessment of the health 
        consequences of the service during the Persian Gulf War, and 
        for other purposes.''.
S 2330 RS----2