[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1320 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                S. 1320

To provide a scientific basis for the Secretary of Veterans Affairs to 
assess the nature of the association between illnesses and exposure to 
toxic agents and environmental or other wartime hazards as a result of 
service in the Persian Gulf during the Persian Gulf War for purposes of 
 determining a service connection relating to such illnesses, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 24, 1997

 Mr. Rockefeller (for himself, Mr. Daschle, Mr. Akaka, Mr. Wellstone, 
 and Mrs. Murray) introduced the following bill; which was read twice 
           and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To provide a scientific basis for the Secretary of Veterans Affairs to 
assess the nature of the association between illnesses and exposure to 
toxic agents and environmental or other wartime hazards as a result of 
service in the Persian Gulf during the Persian Gulf War for purposes of 
 determining a service connection relating to such illnesses, 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.

    This Act may be cited as the ``Persian Gulf War Veterans Act of 
1997''.

SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR ILLNESSES ASSOCIATED WITH 
              SERVICE IN THE PERSIAN GULF DURING THE PERSIAN GULF WAR.

    (a) In General.--(1) Subchapter II of chapter 11 of title 38, 
United States Code, is amended by adding at the end the following:
``Sec. 1118. Presumptions of service connection for illnesses 
              associated with service in the Persian Gulf during the 
              Persian Gulf War
    ``(a)(1) For purposes of section 1110 of this title, and subject to 
section 1113 of this title, each illness (if any) described in 
paragraph (2) shall be considered to have been incurred in or 
aggravated by service referred to in that paragraph, notwithstanding 
that there is no record of evidence of such illness during the period 
of such service.
    ``(2) An illness referred to in paragraph (1) is any diagnosed or 
undiagnosed illness that--
            ``(A) the Secretary determines in regulations prescribed 
        under this section to warrant a presumption of service 
        connection by reason of having a positive association with 
        exposure to a biological, chemical, or other toxic agent or 
        environmental or wartime hazard known or presumed to be 
        associated with service in the Armed Forces in the Southwest 
        Asia theater of operations during the Persian Gulf War; and
            ``(B) becomes manifest within the period (if any) 
        prescribed in such regulations in a veteran who served on 
        active duty in that theater of operations during that war and 
        by reason of such service was exposed to such agent or hazard.
    ``(3) For purposes of this subsection, a veteran who served on 
active duty in the Southwest Asia theater of operations during the 
Persian Gulf War and has an illness described in paragraph (2) shall be 
presumed to have been exposed by reason of such service to the agent or 
hazard associated with the illness in the regulations prescribed under 
this section unless there is conclusive evidence to establish that the 
veteran was not exposed to the agent or hazard by reason of such 
service.
    ``(b)(1)(A) Whenever the Secretary makes a determination described 
in subparagraph (B), the Secretary shall prescribe regulations 
providing that a presumption of service connection is warranted for the 
illness covered by that determination for purposes of this section.
    ``(B) A determination referred to in subparagraph (A) is a 
determination based on sound medical and scientific evidence that a 
positive association exists between--
            ``(i) the exposure of humans to a biological, chemical, or 
        other toxic agent or environmental or wartime hazard known or 
        presumed to be associated with service in the Southwest Asia 
        theater of operations during the Persian Gulf War; and
            ``(ii) the occurrence of a diagnosed or undiagnosed illness 
        in humans.
    ``(2)(A) In making determinations for purposes of paragraph (1), 
the Secretary shall take into account--
            ``(i) the reports submitted to the Secretary by the 
        National Academy of Sciences under section 3 of the Persian 
        Gulf War Veterans Act of 1997; and
            ``(ii) all other sound medical and scientific information 
        and analyses available to the Secretary.
    ``(B) In evaluating any report, information, or analysis for 
purposes of making such determinations, the Secretary shall take into 
consideration whether the results are statistically significant, are 
capable of replication, and withstand peer review.
    ``(3) An association between the occurrence of an illness in humans 
and exposure to an agent or hazard shall be considered to be positive 
for purposes of this subsection if the credible evidence for the 
association is equal to or outweighs the credible evidence against the 
association.
    ``(c)(1)(A) Not later than 60 days after the date on which the 
Secretary receives a report from the National Academy of Sciences under 
section 3 of the Persian Gulf War Veterans Act of 1997, the Secretary 
shall determine whether or not a presumption of service connection is 
warranted for each illness (if any) covered by the report.
    ``(B) If the Secretary determines that a presumption of service 
connection is warranted, the Secretary shall, not later than 60 days 
after making the determination, issue proposed regulations setting 
forth the Secretary's determination.
    ``(C)(i) If the Secretary determines that a presumption of service 
connection is not warranted, the Secretary shall, not later than 60 
days after making the determination, publish in the Federal Register a 
notice of the determination. The notice shall include an explanation of 
the scientific basis for the determination.
    ``(ii) If an illness already presumed to be service connected under 
this section is subject to a determination under clause (i), the 
Secretary shall, not later than 60 days after publication of the notice 
under that clause, issue proposed regulations removing the presumption 
of service connection for the illness.
    ``(2) Not later than 90 days after the date on which the Secretary 
issues any proposed regulations under paragraph (1), the Secretary 
shall issue final regulations. Such regulations shall be effective on 
the date of issuance.
    ``(d) Whenever the presumption of service connection for an illness 
under this section is removed under subsection (c)--
            ``(1) a veteran who was awarded compensation for the 
        illness on the basis of the presumption before the effective 
        date of the removal of the presumption shall continue to be 
        entitled to receive compensation on that basis; and
            ``(2) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from the illness on the basis of the presumption before that 
        date shall continue to be entitled to receive dependency and 
        indemnity compensation on that basis.
    ``(e) Subsections (b) through (d) shall cease to be effective 10 
years after the first day of the fiscal year in which the National 
Academy of Sciences submits to the Secretary the first report under 
section 3 of the Persian Gulf War Veterans Act of 1997.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1117 the 
following new item:

``1118. Presumptions of service connection for illnesses associated 
                            with service in the Persian Gulf during the 
                            Persian Gulf War.''.
    (b) Conforming Amendments.--Section 1113 of title 38, United States 
Code, is amended--
            (1) by striking out ``or 1117'' each place it appears and 
        inserting in lieu thereof ``1117, or 1118''; and
            (2) in subsection (a), by striking out ``or 1116'' and 
        inserting in lieu thereof ``, 1116, or 1118''.
    (c) Compensation for Undiagnosed Gulf War Illnesses.--Section 1117 
of title 38, United States Code, is amended--
            (1) by redesignating subsections (c), (d), and (e) as 
        subsections (d), (e), and (f), respectively; and
            (2) by inserting after subsection (b) the following new 
        subsection (c):
    ``(c)(1) Whenever the Secretary determines as a result of a 
determination under section 1118(c) of this title that a presumption of 
service connection for an undiagnosed illness (or combination of 
undiagnosed illnesses) is no longer warranted under this section--
            ``(A) a veteran who was awarded compensation under this 
        section for such illness (or combination of illnesses) on the 
        basis of the presumption shall continue to be entitled to 
        receive compensation under this section on that basis; and
            ``(B) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from the disease on the basis of the presumption before that 
        date shall continue to be entitled to receive dependency and 
        indemnity compensation on that basis.
    ``(2) This subsection shall cease to be effective 10 years after 
the first day of the fiscal year in which the National Academy of 
Sciences submits to the Secretary the first report under section 3 of 
the Persian Gulf War Veterans Act of 1997.''.

SEC. 3. AGREEMENT WITH NATIONAL ACADEMY OF SCIENCES.

    (a) Purpose.--The purpose of this section is to provide for the 
National Academy of Sciences, an independent nonprofit scientific 
organization with appropriate expertise, to review and evaluate the 
available scientific evidence regarding associations between illnesses 
and exposure to toxic agents or environmental or wartime hazards 
associated with Gulf War service.
    (b) Agreement.--The Secretary of Veterans Affairs shall seek to 
enter into an agreement with the National Academy of Sciences for the 
Academy to perform the services covered by this section and sections 
4(a)(6) and 5(d). The Secretary shall seek to enter into the agreement 
not later than two months after the date of enactment of this Act.
    (c) Identification of Agents and Illnesses.--(1) Under the 
agreement under subsection (b), the National Academy of Sciences 
shall--
            (A) identify the biological, chemical, or other toxic 
        agents or environmental or wartime hazards to which members of 
        the Armed Forces who served in the Southwest Asia theater of 
        operations during the Persian Gulf War may have been exposed by 
        reason of such service; and
            (B) identify the illnesses (including diagnosed illnesses 
        and undiagnosed illnesses) that are manifest in such members.
    (2) In identifying illnesses under paragraph (1)(B), the Academy 
shall review and summarize the relevant scientific evidence regarding 
illnesses among the members described in paragraph (1)(B) and among 
other appropriate populations of individuals, including mortality, 
symptoms, and adverse reproductive health outcomes among such members 
and individuals.
    (d) Determinations of Associations Between Agents and Illnesses.--
(1) For each agent or hazard and illness identified under subsection 
(c), the National Academy of Sciences shall determine, to the extent 
that available scientific data permit meaningful determinations--
            (A) whether a statistical association exists between 
        exposure to the agent or hazard and the illness, taking into 
        account the strength of the scientific evidence and the 
        appropriateness of the scientific methodology used to detect 
        the association;
            (B) the increased risk of the illness among human 
        populations exposed to the agent or hazard; and
            (C) whether a plausible biological mechanism or other 
        evidence of a causal relationship exists between exposure to 
        the agent or hazard and the illness.
    (2) The Academy shall include in its reports under subsection (h) a 
full discussion of the scientific evidence and reasoning that led to 
its conclusions under this subsection.
    (e) Review of Potential Treatment Models for Certain Illnesses.--
Under the agreement under subsection (b), the National Academy of 
Sciences shall separately review, for each chronic undiagnosed illness 
identified under subsection (c)(1)(B) and for any chronic illness that 
the Academy determines to warrant the review, the available scientific 
data in order to identify empirically valid models of treatment for 
such illnesses which employ successful treatment modalities for 
populations with similar symptoms.
    (f) Recommendations for Additional Scientific Studies.--(1) Under 
the agreement under subsection (b), the National Academy of Sciences 
shall make any recommendations that it considers appropriate for 
additional scientific studies (including studies relating to treatment 
models) to resolve areas of continuing scientific uncertainty relating 
to the health consequences of exposure to toxic agents or environmental 
or wartime hazards associated with Gulf War service.
    (2) In making recommendations for additional studies, the Academy 
shall consider the available scientific data, the value and relevance 
of the information that could result from such studies, and the cost 
and feasibility of carrying out such studies.
    (g) Subsequent Reviews.--(1) Under the agreement under subsection 
(b), the National Academy of Sciences shall conduct on a periodic and 
ongoing basis additional reviews of the evidence and data relating to 
its activities under this section.
    (2) As part of each review under this subsection, the Academy 
shall--
            (A) conduct as comprehensive a review as is practicable of 
        the evidence referred to in subsection (c) and the data 
        referred to in subsections (d), (e), and (f) that became 
        available since the last review of such evidence and data under 
        this section; and
            (B) make its determinations on the basis of the results of 
        such review and all other reviews conducted for the purposes of 
        this section.
    (h) Reports.--(1) Under the agreement under subsection (b), the 
National Academy of Sciences shall submit to the committees and 
officials referred to in paragraph (4) periodic written reports 
regarding the Academy's activities under the agreement.
    (2) The first report under paragraph (1) shall be transmitted not 
later than 18 months after the date of enactment of this Act. That 
report shall include--
            (A) the determinations and discussion referred to in 
        subsection (d);
            (B) the results of the review of models of treatment under 
        subsection (e); and
            (C) any recommendations of the Academy under subsection 
        (f).
    (3)(A) Reports shall be submitted under this subsection at least 
once every two years, as measured from the date of the report under 
paragraph (2).
    (B) In any report under this subsection (other than the report 
under paragraph (2)), the Academy may specify an absence of meaningful 
developments in the scientific or medical community with respect to the 
activities of the Academy under this section during the 2-year period 
preceding the date of such report.
    (4) Reports under this subsection shall be submitted to the 
following:
            (A) The designated congressional committees.
            (B) The Secretary of Veterans Affairs.
            (C) The Secretary of Defense.
    (i) Sunset.--This section shall cease to be effective 10 years 
after the last day of the fiscal year in which the National Academy of 
Sciences submits the first report under subsection (h).
    (j) Alternative Contract Scientific Organization.--(1) If the 
Secretary is unable within the time period set forth in subsection (b) 
to enter into an agreement with the National Academy of Sciences for 
the purposes of this section on terms acceptable to the Secretary, the 
Secretary shall seek to enter into an agreement for the purposes of 
this section with another appropriate scientific organization that is 
not part of the Government and operates as a not-for-profit entity and 
that has expertise and objectivity comparable to that of the National 
Academy of Sciences.
    (2) If the Secretary enters into such an agreement with another 
organization, any reference in this section and in section 1118 of 
title 38, United States Code (as added by section 2), to the National 
Academy of Sciences shall be treated as a reference to the other 
organization.

SEC. 4. MONITORING OF HEALTH STATUS AND TREATMENT OF PERSIAN GULF WAR 
              VETERANS.

    (a) Information Data Base.--(1) The Secretary of Veterans Affairs 
shall, in consultation with the Secretary of Defense, develop a plan 
for the establishment and operation of a single computerized 
information data base for the collection, storage, and analysis of 
information on--
            (A) the diagnosed and undiagnosed illnesses suffered by 
        current and former members of the Armed Forces who served in 
        the Southwest Asia theater of operations during the Persian 
        Gulf War; and
            (B) the treatment provided such members for--
                    (i) any chronic undiagnosed illnesses; and
                    (ii) any chronic illnesses for which the National 
                Academy of Sciences has identified a valid model of 
                treatment pursuant to its review under section 3(e).
    (2) The plan shall provide for the commencement of the operation of 
the data base not later than 18 months after the date of enactment of 
this Act.
    (3) The Secretary shall ensure in the plan that the data base 
provides the capability of monitoring and analyzing information on--
            (A) the illnesses covered by paragraph (1)(A);
            (B) the treatments covered by paragraph (1)(B); and
            (C) the efficacy of such treatments.
    (4) In order to meet the requirement under paragraph (3), the plan 
shall ensure that the data base includes the following:
            (i) 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).
            (ii) 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).
            (iii) Information derived from other examinations and 
        treatment provided veterans who served in the Southwest Asia 
        theater of operations during the Persian Gulf War.
            (iv) 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 war.
            (v) Such other information as the Secretary of Veterans 
        Affairs and the Secretary of Defense consider appropriate.
    (5) Not later than one year after the date of enactment of this 
Act, the Secretary shall submit the plan developed under paragraph (1) 
to the following:
            (A) The designated congressional committees.
            (B) The Secretary of Veterans Affairs.
            (C) The Secretary of Defense.
            (D) The National Academy of Sciences.
    (6)(A) The agreement under section 3 shall require the evaluation 
of the plan developed under paragraph (1) by the National Academy of 
Sciences. The Academy shall complete the evaluation of the plan not 
later than 90 days after the date of its submittal to the Academy under 
paragraph (5).
    (B) Upon completion of the evaluation, the Academy shall submit a 
report on the evaluation to the committees and individuals referred to 
in subparagraphs (A) through (D) of paragraph (5).
    (7) Not later than 90 days after receipt of the report under 
paragraph (6), the Secretary shall--
            (A) modify the plan in light of the evaluation of the 
        Academy in the report; and
            (B) commence implementation of the plan as so modified.
    (b) Compilation and Analysis of Information in Database.--(1) The 
Secretary of Veterans Affairs shall compile and analyze, on an ongoing 
basis, all clinical data in the data base 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 veterans covered by such data and exposure to 
toxic agents or environmental or wartime hazards associated with Gulf 
War service.
    (2) The Secretary of Defense shall compile and analyze, on an 
ongoing basis, all clinical data in the data base that is likely to be 
scientifically useful in determining the association, if any, between 
the illnesses (including diagnosed illnesses and undiagnosed illnesses) 
of current members of the Armed Forces (including members on active 
duty and members of the reserve components) and exposure to such agents 
or hazards.
    (c) Annual Report.--Not later than April 1 of each year after a 
year in which the Secretary of Veterans Affairs and the Secretary of 
Defense carry out activities under subsection (b), the Secretaries 
shall jointly 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, incidences, 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 a toxic agent or environmental or wartime 
                hazard associated with Gulf War service; and
            (2) with respect to the most current information received 
        under section 3(h) regarding treatment models reviewed under 
        section 3(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.

SEC. 5. SCIENTIFIC RESEARCH FEASIBILITY STUDIES PROGRAM.

    (a) Establishment of Program.--The Secretary of Veterans Affairs, 
the Secretary of Defense, and the Secretary of Health and Human 
Services shall jointly carry out a program to provide for the conduct 
of studies of the feasibility of conducting additional scientific 
research on health hazards resulting from exposure to toxic agents or 
environmental or wartime hazards associated with Gulf War service.
    (b) Program Requirements.--(1) Under the program under subsection 
(a), the Secretaries shall, pursuant to criteria prescribed pursuant to 
paragraph (2), jointly award contracts or furnish financial assistance 
to non-Government entities for the conduct of studies referred to in 
subsection (a).
    (2) The Secretaries shall jointly prescribe criteria for--
            (A) the selection of entities to be awarded contracts or to 
        receive financial assistance under the program; and
            (B) the approval of studies to be conducted under such 
        contracts or with such financial assistance.
    (c) Report.--The Secretaries shall jointly report the results of 
studies conducted under the program to the designated congressional 
committees.
    (d) Consultation With National Academy of Sciences.--(1) To the 
extent provided under the agreement entered into by the Secretary of 
Veterans Affairs and the National Academy of Sciences under section 3--
            (A) the Secretary shall consult with the Academy regarding 
        the establishment and administration of the program under 
        subsection (a); and
            (B) the Academy shall review the studies conducted under 
        contracts awarded pursuant to the program and the studies 
        conducted with financial assistance furnished pursuant to the 
        program.
    (2) The agreement shall require the Academy to submit any 
recommendations that the Academy considers appropriate regarding any 
studies reviewed for purposes of this subsection to the following:
            (A) The designated congressional committees.
            (B) The Secretary of Veterans Affairs.
            (C) The Secretary of Defense.
            (D) The Secretary of Health and Human Services.

SEC. 6. OUTREACH.

    (a) Outreach by Secretary of Veterans Affairs.--The Secretary of 
Veterans Affairs shall, in consultation with the Secretary of Defense 
and the Secretary of Health and Human Services, carry out an ongoing 
program to provide veterans who served in the Southwest Asia theater of 
operations during the Persian Gulf War the information described in 
subsection (c).
    (b) Outreach by Secretary of Defense.--The Secretary of Defense 
shall, in consultation with the Secretary of Veterans Affairs and the 
Secretary of Health and Human Services, carry out an ongoing program to 
provide 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 war the information described in 
subsection (c).
    (c) Covered Information.--Information under this subsection is 
information relating to--
            (1) the health risks, if any, resulting from exposure to 
        toxic agents or environmental or wartime hazards associated 
        with Gulf War service; and
            (2) any services or benefits available with respect to such 
        health risks.

SEC. 7. DEFINITIONS.

    In this Act:
            (1) The term ``toxic agent or environmental or wartime 
        hazard associated with Gulf War service'' means a biological, 
        chemical, or other toxic agent or environmental or wartime 
        hazard that is known or presumed to be associated with service 
        in the Armed Forces in the Southwest Asia theater of operations 
        during the Persian Gulf War.
            (2) The term ``designated congressional committees'' means 
        the following:
                    (A) The Committees on Veterans' Affairs and Armed 
                Services of the Senate.
                    (B) The Committees on Veterans' Affairs and 
                National Security of the House of Representatives.
                                 <all>