[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3661 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 3661

   To require the Secretary of Veterans Affairs and the Secretary of 
    Defense to give greater priority to research on the exposure of 
   veterans of Operation Desert Shield and Operation Desert Storm to 
   biological agents or chemical weapons, other toxic agents such as 
    depleted uranium and organophosphates, pyridostigmine bromide, 
  vaccines, oil well fire pollution, and other potentially hazardous 
   substances, to require the Director of the National Institutes of 
  Health to monitor, through a comprehensive database, the resulting 
 effects of such exposure on those veterans' health and their clinical 
  progress in order to identify and provide appropriate and effective 
               medical treatment, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 1, 1998

 Mr. Kennedy of Massachusetts (for himself, Mr. Shays, Mr. Filner, Mr. 
    Quinn, Mr. Moakley, Mr. Sanders, Mr. Gutierrez, Mr. Peterson of 
Minnesota, Ms. Brown of Florida, Ms. Carson, Mr. Olver, Ms. Rivers, Mr. 
 Markey, Mr. Frank of Massachusetts, Mr. Kennedy of Rhode Island, Mr. 
Neal of Massachusetts, Mr. Waxman, Mr. McGovern, Mr. Burton of Indiana, 
 Mr. Tierney, Mrs. Maloney of New York, Mr. Delahunt, Mr. Lantos, Mr. 
 Underwood, Mr. Romero-Barcelo, Mr. Clement, Mr. Frost, Ms. Slaughter, 
   Mr. Moran of Virginia, Mr. Hastings of Florida, Mr. McIntosh, Mr. 
   Meehan, Mr. Rodriguez, Mr. Davis of Illinois, and Ms. Velazquez) 
 introduced the following bill; which was referred to the Committee on 
   Veterans' Affairs, and in addition to the Committees on National 
 Security, and Commerce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   To require the Secretary of Veterans Affairs and the Secretary of 
    Defense to give greater priority to research on the exposure of 
   veterans of Operation Desert Shield and Operation Desert Storm to 
   biological agents or chemical weapons, other toxic agents such as 
    depleted uranium and organophosphates, pyridostigmine bromide, 
  vaccines, oil well fire pollution, and other potentially hazardous 
   substances, to require the Director of the National Institutes of 
  Health to monitor, through a comprehensive database, the resulting 
 effects of such exposure on those veterans' health and their clinical 
  progress in order to identify and provide appropriate and effective 
               medical treatment, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Persian Gulf War 
Veterans' Health and Medical Research Act of 1998''.
    (b) Table of Contents.--

Sec. 1. Short title; table of contents.
Sec. 2. Management by National Institutes of Health of research on 
                            illnesses of Gulf War veterans.
Sec. 3. Database for tracking the health status, clinical progress, and 
                            medical treatment of Gulf War veterans.
Sec. 4. Semiannual report on research programs.
Sec. 5. General Accounting Office annual assessment and report.
Sec. 6. Research protocol and training.
Sec. 7. Outreach.
Sec. 8. Definitions.

SEC. 2. MANAGEMENT BY NATIONAL INSTITUTES OF HEALTH OF RESEARCH ON 
              ILLNESSES OF GULF WAR VETERANS.

    (a) National Institutes of Health.--The Director of the National 
Institutes of Health shall establish and manage research activities 
within the Department of Defense and Department of Veterans Affairs in 
order to ensure that a greater priority is given to--
            (1) research on finding effective treatment for ill Gulf 
        War veterans; and
            (2) research on exposure to all potentially hazardous 
        substances and diseases encountered by members of the Armed 
        Forces mobilized or deployed in support of combat operations in 
        the areas of responsibility of the United States Central 
        Command and the United States European Command during the 
        period beginning on August 2, 1990, and ending on December 31, 
        1991, including (among others) chemical and biological warfare 
        agents, pyridostigmine bromide, vaccinations, and any other 
        manmade or naturally occurring toxic substances or disease 
        vectors to which Gulf War veterans were exposed.
    (b) Research Timetable.--The Director shall develop a plan for the 
research to be carried out pursuant to subsection (a). The Director 
shall begin to develop the plan not later than 60 days after the date 
of the enactment of this Act and shall implement the plan not later 
than 60 days after the completion of the development of the plan.
    (c) Identification of Substances to Which Veterans May Have Been 
Exposed.--Research to be carried out pursuant to subsection (a) shall 
include identification of all potentially hazardous substances, natural 
or manmade (including biological or chemical agents, other toxic agents 
(including, among others, depleted uranium and organophosphates), 
pyridostigmine bromide, and vaccines), to which members of the Armed 
Forces may have been exposed by reason of service in the areas of 
responsibility of the United States Central Command and the United 
States European Command during the period beginning on August 2, 1990, 
and ending on December 31, 1991.
    (d) Identification of Illnesses.--Research to be carried out 
pursuant to subsection (a) shall include identification of all 
illnesses (diagnosed and undiagnosed) that Gulf War veterans are 
experiencing. The Director shall review and summarize the relevant 
scientific evidence regarding the occurrence of such illnesses among 
Gulf War veterans and among other populations considered appropriate 
for comparison. Matters to be reviewed and compared with respect to 
those illnesses include symptoms, mortality rates, and reproductive 
health problems ( including birth defects).
    (e) List of Chronic Illnesses That Provide Valid Models of 
Successful Treatment.--As part of the management of research under this 
section, the Director shall compile a list of chronic illnesses for 
which valid models of successful treatment are provided, as identified 
by--
            (1) scientific data and literature;
            (2) the views of Gulf War veterans of the efficacy of the 
        treatment;
            (3) the views of private-sector medical specialists 
        involved in researching Gulf War illnesses; and
            (4) the views of private-sector medical clinicians treating 
        Gulf War veterans.
    (f) Interagency Agreements.--The Secretary of Defense and the 
Secretary of Veterans Affairs shall each enter into an agreement with 
the Secretary of Health and Human Services to provide for the 
implementation of this section. The agreements shall ensure that the 
Director of the National Institutes of Health has the authority 
necessary to carry out the responsibilities of the Director under this 
section.

SEC. 3. DATABASE FOR TRACKING THE HEALTH STATUS, CLINICAL PROGRESS, AND 
              MEDICAL TREATMENT OF GULF WAR VETERANS .

    (a) Establishment of the Database.--
            (1) Establishment.--The Director of the National Institutes 
        of Health shall establish a single comprehensive database and 
        monitoring system for the collection, storage, and analysis of 
        data covering all Gulf War veterans in order to monitor the 
        health status and clinical progress of those veterans for the 
        purpose of identifying appropriate and effective treatment 
        needed to improve their health.
            (2) Separate tracking for veterans receiving medical 
        care.--In the database under paragraph (1), the Director shall 
        identify and track separately those Gulf War veterans who--
                    (A) are receiving medical care from the Secretary 
                of Veterans Affairs;
                    (B) are receiving medical care from the Secretary 
                of Defense; and
                    (C) are receiving medical care in the private 
                sector.
            (3) Public availability of information in database.--With 
        the exception of information protected under section 552b of 
        title 5, United States Code (popularly known as the ``Privacy 
        Act''), information in the database shall be made available to 
        the public through the Internet World Wide Web and other 
        appropriate electronic and printed means.
            (4) Required consultation.--The Director shall establish 
        the database in consultation with the Secretary of Veterans 
        Affairs and the Secretary of Defense.
            (5) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as may be necessary to establish 
        and carry out the database under paragraph (1).
    (b) Matters To Be Included in Database.--The database shall 
include--
            (1) all diagnosed and undiagnosed illnesses, symptoms, and 
        syndromes of Gulf War veterans, including fibromyalgias, 
        rheumatic ailments, skin ulcers, sinus diseases, 
        gastrointestinal or digestive diseases (especially Crohn's 
        colitis, ulcerative colitis, and inflammatory bowel disorders), 
        respiratory diseases, neurocognitive disorders, kidney stones, 
        reproductive illnesses, abnormalities, and birth defects;
            (2) relevant medical data on illnesses reported by the 
        spouses and children of Gulf War veterans, including, among 
        other matters, reports of reproductive illnesses, 
        abnormalities, and birth defects since 1990; and
            (3) the medical treatment provided Gulf War veterans for--
                    (A) any undiagnosed illness; and
                    (B) any illness for which the Director of the 
                National Institutes of Health (pursuant to section 2) 
                identified a valid model of treatment.
    (c) Tracking Capacity.--The database shall be developed so that it 
has the capacity to track and analyze--
            (1) the illnesses referred to in subsection (b)(1);
            (2) the treatments referred to in subsection (b)(3); and
            (3) the progress of the treatments as viewed by Gulf War 
        veterans.
    (d) Data To Be Included.--The database shall include the following:
            (1) Information in the Persian Gulf War Veterans Health 
        Registry established under section 702 of the Persian Gulf War 
        Veterans' Health Status Act (title VII of Public Law 102-585; 
        38 U.S.C. 527 note).
            (2) Information in the Comprehensive Clinical Evaluation 
        Program for Veterans established under section 734 of the 
        National Defense Authorization Act for Fiscal Years 1992 and 
        1993 (10 U.S.C. 1074 note).
            (3) Information derived from other examinations and 
        treatment provided to veterans who served in the Southwest Asia 
        theater of operations during the period specified in section 
        8(1).
            (4) Information derived from other examinations and 
        treatment provided current members of the Armed Forces 
        (including members on active duty and members of the reserve 
        components) who served in that theater of operations during 
that period.
            (5) Information derived from other examinations and 
        treatment provided to Gulf War veterans who receive medical 
        care in the private sector.
            (6) Information derived from physicians' Current Procedure 
        Terminology (CPT) and the Department of Health and Human 
        Services-approved International Classification of Diseases with 
        Clinical Modification (ICD-9-CM) codes in the Persian Gulf 
        veterans' medical charges and medical bills, from any medical 
        treatments and examinations provided to Persian Gulf veterans, 
        even if they are not registered in the registry referred to in 
        paragraph (1) and are not covered by the Comprehensive Clinical 
        Evaluation Program for Veterans referred to in paragraph (2).
            (7) Information pertaining to causes of death, health 
        claims, and diagnoses of Gulf War veterans contained in the 
        Department of Veterans Affairs' Beneficiary Identification and 
        Records Locator Subsystem (BIRLS).
            (8) Such other information as the Secretary of Veterans 
        Affairs or the Secretary of Defense considers appropriate for 
        inclusion in the database, including information regarding 
        persons who underwent preparations to deploy to the Southwest 
        Asia theater of operations but were not deployed.
            (9) Such other information as the Director of the National 
        Institutes of Health, based upon the advice of health 
        professionals, scientists, and epidemiologists, considers 
        appropriate for inclusion in the database, including 
        information regarding persons who underwent preparations to 
        deploy to the Southwest Asia theater of operations but were not 
        deployed.
    (e) Implementation of Database.--(1) Not later than 90 days after 
the date of the enactment of this Act, the Director of the National 
Institutes of Health shall submit for comment and evaluation a plan for 
the development of the database to the following:
            (A) The Comptroller General.
            (B) The designated congressional committees.
            (C) Representatives of Gulf War veterans, including (among 
        others) the veterans' service organizations, with special 
        emphasis on those organizations formed on behalf of Persian 
        Gulf veterans.
    (2) The Director of the National Institutes of Health shall modify 
the database plan according to the evaluations received from the 
entities specified in subparagraphs (A), (B), and (C) of paragraph (1) 
and shall, not later than 60 days after receiving the evaluations, 
implement the plan as modified.
    (3) The Director shall carry out paragraphs (1) and (2) in 
consultation with the Secretary of Veterans Affairs and the Secretary 
of Defense.
    (4) The database shall become operational no later than six months 
after the date of the enactment of this Act.
    (f) Compilation and Analysis of Information in Database.--The 
Director of the National Institutes of Health shall compile and 
analyze, on an ongoing basis, all clinical data in the database under 
subsection (a) that is likely to be scientifically useful in 
determining the association, if any, between the illnesses (including 
diagnosed illnesses and undiagnosed illnesses) of Gulf War veterans 
covered by such data and exposure to biological or chemical agents, 
other toxic agents (including depleted uranium and organophosphates), 
pyridostigmine bromide, vaccines, and any other potentially hazardous 
substance.
    (g) Annual Report.--Not later than January 31 of each year after 
the database is operational, the Director of the National Institutes of 
Health shall submit to the designated congressional committees a report 
containing--
            (1) with respect to the data compiled in accordance with 
        subsection (b) during the preceding year--
                    (A) an analysis of the data;
                    (B) a discussion of the types, incidence, and 
                prevalence of the disabilities and illnesses identified 
                through such data;
                    (C) an explanation for the incidence and prevalence 
                of such disabilities and illnesses;
                    (D) other reasonable explanations for the incidence 
                and prevalence of such disabilities and illnesses; and
                    (E) an analysis of the scientific validity of 
                drawing conclusions from the incidence and prevalence 
                of such disabilities and illnesses, as evidenced by 
                such data, about any association between such 
                disabilities and illnesses, as the case may be, and 
                exposure to biological or chemical agents, other toxic 
                agents (including depleted uranium and 
                organophosphates), pyridostigmine bromide, vaccines, 
                and any other potentially hazardous substance; and
            (2) with respect to the most current information regarding 
        treatment models identified under section 2(e)--
                    (A) an analysis of the information;
                    (B) the results of any consultation between such 
                Secretaries regarding the implementation of such 
                treatment models in the health care systems of the 
                Department of Veterans Affairs and the Department of 
                Defense; and
                    (C) in the event either such Secretary determines 
                not to implement such treatment models, an explanation 
                for such determination and the views of the Director of 
                the National Institutes of Health regarding such 
                determination.

SEC. 4. SEMIANNUAL REPORT ON RESEARCH PROGRAMS.

    The Secretary of Defense and Secretary of Veterans Affairs shall 
submit to the designated congressional committees a semiannual joint 
report on their research progress concerning the health of Gulf War 
veterans and the health status of the veterans being tracked in the 
database under section 3.

SEC. 5. GENERAL ACCOUNTING OFFICE ANNUAL ASSESSMENT AND REPORT.

    (a) Annual Assessments.--(1) The Comptroller General shall carry 
out--
            (A) an assessment each year of the establishment and 
        management of research during the preceding calendar year by 
        the Director of the National Institutes of Health under section 
        2;
            (B) an assessment each year to determine whether the 
        Secretary of Veterans Affairs and the Secretary of Defense are 
        effectively and efficiently allocating funds toward research 
        protocols required by the Director of the National Institutes 
        of Health; and
            (C) an assessment each year of the establishment, 
        maintenance, and use during the preceding calendar year of the 
        database established under section 3.
    (2) If the Comptroller General finds under paragraph (1)(B) that 
funds are not being allocated according to the Director's guidelines, 
the Comptroller General shall make recommendations to the Congress to 
reappropriate funds or to take such other action as is appropriate and 
necessary to ensure that the research protocols are carried out. The 
recommendations of the Comptroller General shall be stated each year in 
the annual report under subsection (b).
    (b) Report.--Not later than March 15 each year, the Comptroller 
General shall submit to the designated congressional committees a 
report on the assessments under subsection (a) for the preceding 
calendar year.

SEC. 6. RESEARCH PROTOCOL AND TRAINING.

    (a) Treatment Protocols.--The Director of the National Institutes 
of Health shall review the research findings under section 2, and the 
database findings under section 3, as those findings become available 
or not less often than annually. The purpose of those reviews shall be 
to develop new treatment protocols for individual and multiple toxic 
exposures. The Director shall provide the treatment protocols so 
developed--
            (1) to the Secretary of Veterans Affairs and the Secretary 
        of Defense, who shall ensure that those protocols are made 
        available to attending physicians in their respective 
        departments; and
            (2) to attending physicians in the private sector as 
        provided in section 7(d)(1).
    (b) Training Program.--
            (1) In general.--The Director of the National Institutes of 
        Health shall provide a program of training for physicians of 
        the Department of Veterans Affairs and Department of Defense to 
        train those physicians in treatment protocols for persons 
        exposed to acute and low-level toxic substances. The Director 
        shall carry out the program through the Director of the 
        National Institute of Environmental Health Sciences.
            (2) Training entity.--The training program shall be 
        conducted by an appropriate entity outside the Government which 
        is experienced in treating persons exposed to toxic substances.
            (3) Content of program.--The Director shall ensure that the 
        training program includes training for the entire range of 
        medical and scientific disciplines in the course curricula as 
        they pertain to diagnosing and treating individual and multiple 
        toxic exposures, with special emphasis placed on understanding 
        the effects of repeated low-level exposures to single and 
        multiple toxic substances.
            (4) Goal for training.--The Secretary of Veterans Affairs 
        and the Secretary of Defense shall seek to ensure that not less 
        than 15 percent of the attending physicians within their 
        respective departments participate in the training program.
            (5) Timetable for program.--The training program shall be 
        implemented not later than one year after the date of the 
        enactment of this Act. Not later than 90 days after the date of 
        the enactment of this Act, the Director shall identify the 
        course content for the training program and not later than 30 
        days thereafter shall issue a request for proposals for a 
        contract for the training program. The Director shall enter 
        into such a contract not later than 120 days after issuing the 
        request for proposals.
    (c) Renewal of Training Program.--Whenever the Director determines 
that there have been new research results that warrant additional 
training as described in subsection (b), the Director shall provide for 
an additional training program to be made available in the same manner 
as provided in subsection (b).
    (d) Continuing Education Program.--The Director shall ensure that 
the training program contains a continuing education component in order 
to provide training for new attending physicians of the Department of 
Veterans Affairs and the Department of Defense.
    (e) Reimbursement.--A training program under this section shall be 
conducted on a reimbursable basis.

SEC. 7. OUTREACH.

    (a) Outreach Program by Director of National Institutes of 
Health.--
            (1) Required outreach program.--The Director of the 
        National Institutes of Health shall carry out an ongoing 
        program to provide Gulf War veterans the information described 
        in subsection (c).
            (2) Required consultation.--The Director shall carry out 
        the outreach program in consultation with--
                    (A) the Secretary of Veterans Affairs and the 
                Secretary of Defense; and
                    (B) representatives of Gulf War veterans.
    (b) Ombudsman.--
            (1) In general.--As part of the outreach program under 
        subsection (a), the Director shall establish an ombudsman 
        program to facilitate addressing complaints of Gulf War 
        veterans regarding treatment for health risks described in 
        subsection (c)(1).
            (2) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as may be necessary to carry out 
        the ombudsman program under paragraph (1).
    (c) Covered Information.--Information under this subsection is 
information relating to--
            (1) the health risks, if any, resulting from exposure to 
        biological or chemical agents, other toxic agents (including 
        depleted uranium and organophosphates), pyridostigmine bromide, 
        vaccines, and any other potentially hazardous substance due to 
        service in, or mobilization in support of, combat operations in 
        the areas of responsibility of the United States Central 
        Command and the United States European Command during the 
        period beginning on August 2, 1990, and ending on December 31, 
        1991; and
            (2) any health services, medical care, or benefits that are 
        or become available with respect to such health risks.
    (d) Public Availability of Research Findings.--
            (1) Public availability.--The Director of the National 
        Institutes of Health shall ensure that all research findings 
        from research activities covered by this Act, and all treatment 
        protocols developed pursuant to section 6, are made available 
        to the public through the Internet World Wide Web, peer-
        reviewed medical journals, and other appropriate medical 
        channels. The Director shall publish reliable, relevant, and 
        objective medical data regarding diseases of Gulf War veterans. 
        Peer review of that research shall include at least one 
        representative from each of the veterans' service 
        organizations.
            (2) Required consultation.--The Director shall carry out 
        paragraph (1) in consultation with the Secretary of Veterans 
        Affairs and the Secretary of Defense.

SEC. 8. DEFINITIONS.

    For the purposes of this Act:
            (1) The term ``Gulf War veteran'' means a veteran or member 
        of the Armed Forces who during the period beginning on August 
        2, 1990, and ending on December 31, 1991, while serving on 
        active duty--
                    (A) served in the area of responsibility of the 
                United States Central Command or the United States 
                European Command; or
                    (B) while outside either such area of 
                responsibility--
                            (i) received an inoculation in anticipation 
                        of deployment to either such area of 
                        responsibility; or
                            (ii) handled equipment or supplies returned 
                        from either such area of responsibility after 
                        Operation Desert Storm.
            (2) The term ``designated congressional committees'' means 
        the following:
                    (A) The Committee on Veterans' Affairs and the 
                Committee on Armed Services of the Senate.
                    (B) The Committee on Veterans' Affairs and the 
                Committee on National Security of the House of 
                Representatives.
                                 <all>