[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 2358 Referred in House (RFH)]

  2d Session
                                S. 2358


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 9, 1998

             Referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 AN ACT


 
To provide for the establishment of a presumption of service-connection 
   for illnesses associated with service in the Persian Gulf War, to 
  extend and enhance certain health care authorities relating to such 
                    service, 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 Act of 1998''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
       TITLE I--SERVICE CONNECTION FOR PERSIAN GULF WAR ILLNESSES

Sec. 101. Presumption of service connection for illnesses associated 
                            with service in the Persian Gulf during the 
                            Persian Gulf War.
Sec. 102. Agreement with National Academy of Sciences.
Sec. 103. Monitoring of health status and health care of Persian Gulf 
                            War veterans.
Sec. 104. Reports on recommendations for additional scientific 
                            research.
Sec. 105. Outreach.
Sec. 106. Definitions.
  TITLE II--EXTENSION AND ENHANCEMENT OF PERSIAN GULF WAR HEALTH CARE 
                              AUTHORITIES

Sec. 201. Extension of authority to provide health care for Persian 
                            Gulf War veterans.
Sec. 202. Extension and improvement of evaluation of health status of 
                            spouses and children of Persian Gulf War 
                            veterans.
                        TITLE III--MISCELLANEOUS

Sec. 301. Assessment of establishment of independent entity to evaluate 
                            post-conflict illnesses among members of 
                            the Armed Forces and health care provided 
                            by DoD and VA before and after deployment 
                            of such members.

       TITLE I--SERVICE CONNECTION FOR PERSIAN GULF WAR ILLNESSES

SEC. 101. 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, 
        environmental or wartime hazard, or preventive medicine or 
        vaccine 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, hazard, or 
        medicine or vaccine.
    ``(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, 
hazard, or medicine or vaccine 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, 
hazard, or medicine or vaccine 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 or animals to a biological, 
        chemical, or other toxic agent, environmental or wartime 
        hazard, or preventive medicine or vaccine 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 or animals.
    ``(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 102 of the Persian 
        Gulf War Veterans Act of 1998; 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 
or animals and exposure to an agent, hazard, or medicine or vaccine 
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) Not later than 60 days after the date on which the 
Secretary receives a report from the National Academy of Sciences under 
section 102 of the Persian Gulf War Veterans Act of 1998, the Secretary 
shall determine whether or not a presumption of service connection is 
warranted for each illness, if any, covered by the report.
    ``(2) If the Secretary determines under this subsection 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.
    ``(3)(A) If the Secretary determines under this subsection 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.
    ``(B) If an illness already presumed to be service connected under 
this section is subject to a determination under subparagraph (A), the 
Secretary shall, not later than 60 days after publication of the notice 
under that subparagraph, issue proposed regulations removing the 
presumption of service connection for the illness.
    ``(4) Not later than 90 days after the date on which the Secretary 
issues any proposed regulations under this subsection, 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 102 of the Persian Gulf War Veterans Act of 1998.''.
    (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 under section 1118(c) of 
this title that a presumption of service connection for an undiagnosed 
illness (or combination of undiagnosed illnesses) previously 
established under this section is no longer warranted--
            ``(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 102 of 
the Persian Gulf War Veterans Act of 1998.''.

SEC. 102. 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, environmental or wartime hazards, or 
preventive medicines or vaccines 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 activities covered by this section and section 
103(a)(6). 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, environmental or wartime hazards, or preventive 
        medicines or vaccines 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 
chronic illnesses among the members described in paragraph (1)(A) and 
among other appropriate populations of individuals, including 
mortality, symptoms, and adverse reproductive health outcomes among 
such members and individuals.
    (d) Initial Consideration of Specific Agents.--(1) In identifying 
under subsection (c) the agents, hazards, or preventive medicines or 
vaccines to which members of the Armed Forces may have been exposed for 
purposes of the first report under subsection (i), the National Academy 
of Sciences shall consider, within the first six months after the date 
of enactment of this Act, the following:
            (A) The following organophosphorous pesticides:
                    (i) Chlorpyrifos.
                    (ii) Diazinon.
                    (iii) Dichlorvos.
                    (iv) Malathion.
            (B) The following carbamate pesticides:
                    (i) Proxpur.
                    (ii) Carbaryl.
                    (iii) Methomyl.
            (C) The carbamate pyridostigmine bromide used as nerve 
        agent prophylaxis.
            (D) The following chlorinated dydrocarbon and other 
        pesticides and repellents:
                    (i) Lindane.
                    (ii) Pyrethrins.
                    (iii) Permethrins.
                    (iv) Rodenticides (bait).
                    (v) Repellent (DEET).
            (E) The following low-level nerve agents and precursor 
        compounds at exposure levels below those which produce 
        immediately apparent incapacitating symptoms:
                    (i) Sarin.
                    (ii) Tabun.
            (F) The following synthetic chemical compounds:
                    (i) Mustard agents at levels below those which 
                cause immediate blistering.
                    (ii) Volatile organic compounds.
                    (iii) Hydrazine.
                    (iv) Red fuming nitric acid.
                    (v) Solvents.
            (G) The following sources of radiation:
                    (i) Depleted uranium.
                    (ii) Microwave radiation.
                    (iii) Radio frequency radiation.
            (H) The following environmental particulates and 
        pollutants:
                    (i) Hydrogen sulfide.
                    (ii) Oil fire byproducts.
                    (iii) Diesel heater fumes.
                    (iv) Sand micro-particles.
            (I) Diseases endemic to the region (including the 
        following):
                    (i) Leishmaniasis.
                    (ii) Sandfly fever.
                    (iii) Pathogenic escherechia coli.
                    (iv) Shigellosis.
            (J) Time compressed administration of multiple live, 
        ``attenuated'', and toxoid vaccines.
    (2) The consideration of agents, hazards, and medicines and 
vaccines under paragraph (1) shall not preclude the Academy from 
identifying other agents, hazards, or medicines or vaccines to which 
members of the Armed Forces may have been exposed for purposes of any 
report under subsection (i).
    (3) Not later than six months after the date of enactment of this 
Act, the National Academy of Science shall submit to the designated 
congressional committees a report specifying the agents, hazards, and 
medicines and vaccines considered under paragraph (1).
    (e) Determinations of Associations Between Agents and Illnesses.--
(1) For each agent, hazard, or medicine or vaccine 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, hazard, or medicine or vaccine 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 or animal 
        populations exposed to the agent, hazard, or medicine or 
        vaccine; and
            (C) whether a plausible biological mechanism or other 
        evidence of a causal relationship exists between exposure to 
        the agent, hazard, or medicine or vaccine and the illness.
    (2) The Academy shall include in its reports under subsection (i) a 
full discussion of the scientific evidence and reasoning that led to 
its conclusions under this subsection.
    (f) 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 other chronic illness 
that the Academy determines to warrant such 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.
    (g) 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, environmental 
or wartime hazards, or preventive medicines or vaccines 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.
    (h) 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 (e), (f), and (g) that became 
        available since the last review of such evidence and data under 
        this section; and
            (B) make determinations under the subsections referred to 
        in subparagraph (A) on the basis of the results of such review 
        and all other reviews previously conducted for purposes of this 
        section.
    (i) Reports.--(1) Under the agreement under subsection (b), the 
National Academy of Sciences shall submit to the committees and 
officials referred to in paragraph (5) periodic written reports 
regarding the Academy's activities under the agreement.
    (2) The first report under paragraph (1) shall be submitted 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 (e);
            (B) the results of the review of models of treatment under 
        subsection (f); and
            (C) any recommendations of the Academy under subsection 
        (g).
    (3) Reports shall be submitted under this subsection at least once 
every two years, as measured from the date of the report under 
paragraph (2).
    (4) 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 
ending on the date of such report.
    (5) 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.
    (j) 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 (i).
    (k) 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 purposes of this 
section with another appropriate scientific organization that is not 
part of the Government, operates as a not-for-profit entity, and has 
expertise and objectivity comparable to that of the National Academy of 
Sciences.
    (2) If the Secretary enters into an agreement with another 
organization under this subsection, any reference in this section, 
sections 103 and 104, and section 1118 of title 38, United States Code 
(as added by section 101), to the National Academy of Sciences shall be 
treated as a reference to such other organization.

SEC. 103. MONITORING OF HEALTH STATUS AND HEALTH CARE 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 illnesses 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 health care utilization patterns of such members 
        with--
                    (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 102(f).
    (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 health care utilization patterns referred to in 
        paragraph (1)(B); and
            (C) the changes in health status of veterans covered by 
        paragraph (1).
    (4) In order to meet the requirement under paragraph (3), the plan 
shall ensure that the data base includes the following:
            (A) 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).
            (B) 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).
            (C) Information derived from other examinations and 
        treatment provided by Department of Veterans Affairs health 
        care facilities to veterans who served in the Southwest Asia 
        theater of operations during the Persian Gulf War.
            (D) Information derived from other examinations and 
        treatment provided by military health care facilities to 
        current members of the Armed Forces (including members of the 
        active components and members of the reserve components) who 
        served in that theater of operations during that war.
            (E) 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 102 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 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) Annual Report.--Not later than April 1 each year after the year 
in which operation of the data base under subsection (a) commences, the 
Secretary of Veterans Affairs and the Secretary of Defense shall 
jointly submit to the designated congressional committees a report 
containing--
            (1) with respect to the data compiled under this section 
        during the preceding year--
                    (A) an analysis of the data;
                    (B) a discussion of the types, incidences, and 
                prevalence of the illnesses identified through such 
                data;
                    (C) an explanation for the incidence and prevalence 
                of such illnesses; and
                    (D) other reasonable explanations for the incidence 
                and prevalence of such illnesses; and
            (2) with respect to the most current information received 
        under section 102(i) regarding treatment models reviewed under 
        section 102(f)--
                    (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. 104. REPORTS ON RECOMMENDATIONS FOR ADDITIONAL SCIENTIFIC 
              RESEARCH.

    (a) Reports.--Not later than 90 days after the date on which the 
Secretary of Veterans Affairs receives any recommendations from the 
National Academy of Sciences for additional scientific studies under 
section 102(g), the Secretary of Veterans Affairs, Secretary of 
Defense, and Secretary of Health and Human Services shall jointly 
submit to the designated congressional committees a report on such 
recommendations, including whether or not the Secretaries intend to 
carry out any recommended studies.
    (b) Elements.--In each report under subsection (a), the Secretaries 
shall--
            (1) set forth a plan for each study, if any, that the 
        Secretaries intend to carry out; or
            (2) in case of each study that the Secretaries intend not 
        to carry out, set forth a justification for the intention not 
        to carry out such study.

SEC. 105. 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 of the 
active components 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, environmental or wartime hazards, or preventive 
        medicines or vaccines associated with Gulf War service; and
            (2) any services or benefits available with respect to such 
        health risks.

SEC. 106. DEFINITIONS.

    In this title:
            (1) The term ``toxic agent, environmental or wartime 
        hazard, or preventive medicine or vaccine associated with Gulf 
        War service'' means a biological, chemical, or other toxic 
        agent, environmental or wartime hazard, or preventive medicine 
        or vaccine 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, whether such 
        association arises as a result of single, repeated, or 
        sustained exposure and whether such association arises through 
        exposure singularly or in combination.
            (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.
            (3) The term ``Persian Gulf War'' has the meaning given 
        that term in section 101(33) of title 38, United States Code.

  TITLE II--EXTENSION AND ENHANCEMENT OF PERSIAN GULF WAR HEALTH CARE 
                              AUTHORITIES

SEC. 201. EXTENSION OF AUTHORITY TO PROVIDE HEALTH CARE FOR PERSIAN 
              GULF WAR VETERANS.

    Section 1710(e)(3)(B) of title 38, United States Code, is amended 
by striking out ``December 31, 1998'' and inserting in lieu thereof 
``December 31, 2001''.

SEC. 202. EXTENSION AND IMPROVEMENT OF EVALUATION OF HEALTH STATUS OF 
              SPOUSES AND CHILDREN OF PERSIAN GULF WAR VETERANS.

    (a) Extension.--Subsection (b) of section 107 of the Persian Gulf 
War Veterans' Benefits Act (title I of Public Law 103-446; 38 U.S.C. 
1117 note) is amended by striking out ``ending on December 31, 1998.'' 
and inserting in lieu thereof ``ending on the earlier of--
            ``(1) the date of the completion of expenditure of funds 
        available for the program under subsection (c); or
            ``(2) December 31, 2001.''.
    (b) Termination of Certain Testing and Evaluation Requirements.--
Subsection (a) of that section is amended by striking out the flush 
matter following paragraph (3).
    (c) Outreach.--Subsection (g) of that section is amended--
            (1) by inserting ``(1)'' before ``The Secretary'';
            (2) by redesignating paragraphs (1) and (2) of paragraph 
        (1), as designated by paragraph (1) of this subsection, as 
        subparagraphs (A) and (B) of that paragraph; and
            (3) by adding at the end the following new paragraphs:
    ``(2) In addition to the outreach activities under paragraph (1), 
the Secretary shall also provide outreach with respect to the 
following:
            ``(A) The existence of the program under this section.
            ``(B) The purpose of the program.
            ``(C) The availability under the program of medical 
        examinations and tests, and not medical treatment.
            ``(D) The findings of any published, peer-reviewed research 
        with respect to any associations (or lack thereof) between the 
        service of veterans in the Southwest Asia theater of operations 
        and particular illnesses or disorders of their spouses or 
        children.
    ``(3) Outreach under this subsection shall be provided any veteran 
who served as a member of the Armed Forces in the Southwest Asia 
theater of operations and who--
            ``(A) seeks health care or services at medical facilities 
        of the Department of Veterans Affairs; or
            ``(B) is or seeks to be listed in the Persian Gulf War 
        Veterans Registry.''.
    (d) Enhanced Flexibility in Examinations.--That section is further 
amended--
            (1) by redesignating subsections (i) and (j) as subsections 
        (k) and (l), respectively; and
            (2) by inserting after subsection (h) the following new 
        subsection (i):
    ``(i) Enhanced Flexibility in Examinations.--In order to increase 
the number of diagnostic tests and medical examinations under the 
program under this section, the Secretary may--
            ``(1) reimburse the primary physicians of spouses and 
        children covered by that subsection for the costs of conducting 
        such tests or examinations, with such rates of reimbursement 
        not to exceed the rates paid contract entities under subsection 
        (d) for conducting tests or examinations under the program;
            ``(2) conduct such tests or examinations of spouses covered 
        by that subsection in medical facilities of the Department; and
            ``(3) in the event travel is required in order to 
        facilitate such tests or examinations by contract entities 
        referred to in paragraph (1), reimburse the spouses and 
        children concerned for the costs of such travel and of related 
        lodging.''.
    (e) Enhanced Monitoring of Program.--That section is further 
amended by inserting after subsection (i), as amended by subsection (d) 
of this section, the following new subsection (j):
    ``(j) Enhanced Monitoring of Program.--In order to enhance 
monitoring of the program under this section, the Secretary shall 
provide for monthly reports to the Central Office of the Department on 
activities with respect to the program by elements of the Department 
and contract entities under subsection (d).''.

                        TITLE III--MISCELLANEOUS

SEC. 301. ASSESSMENT OF ESTABLISHMENT OF INDEPENDENT ENTITY TO EVALUATE 
              POST-CONFLICT ILLNESSES AMONG MEMBERS OF THE ARMED FORCES 
              AND HEALTH CARE PROVIDED BY DOD AND VA BEFORE AND AFTER 
              DEPLOYMENT OF SUCH MEMBERS.

    (a) Agreement for Assessment.--The Secretary of Veterans Affairs 
shall seek to enter into an agreement with the National Academy of 
Sciences, or other appropriate independent organization, under which 
agreement the Academy shall carry out the assessment referred to in 
subsection (b).
    (b) Assessment.--(1) Under the agreement, the Academy shall assess 
the need for and feasibility of establishing an independent entity to--
            (A) evaluate and monitor interagency coordination on issues 
        relating to the post-deployment health concerns of members of 
        the Armed Forces, including coordination relating to outreach 
        and risk communication, recordkeeping, research, utilization of 
        new technologies, international cooperation and research, 
        health surveillance, and other health-related activities;
            (B) evaluate the health care (including preventive care and 
        responsive care) provided to members of the Armed Forces both 
        before and after their deployment on military operations;
            (C) monitor and direct government efforts to evaluate the 
        health of members of the Armed Forces upon their return from 
        deployment on military operations for purposes of ensuring the 
        rapid identification of any trends in diseases or injuries 
        among such members as a result of such operations;
            (D) provide and direct the provision of ongoing training of 
        health care personnel of the Department of Defense and the 
        Department of Veterans Affairs in the evaluation and treatment 
        of post-deployment diseases and health conditions, including 
        nonspecific and unexplained illnesses; and
            (E) make recommendations to the Department of Defense and 
        the Department of Veterans Affairs regarding improvements in 
        the provision of health care referred to in subparagraph (B), 
        including improvements in the monitoring and treatment of 
        members referred to in that subparagraph.
    (2) The assessment shall cover the health care provided by the 
Department of Defense and, where applicable, by the Department of 
Veterans Affairs.
    (c) Report.--(1) The agreement shall require the Academy to submit 
to the committees referred to in paragraph (3) a report on the results 
of the assessment under this section not later than one year after the 
date of enactment of this Act.
    (2) The report shall include the following:
            (A) The recommendation of the Academy as to the need for 
        and feasibility of establishing an independent entity as 
        described in subsection (b) and a justification of such 
        recommendation.
            (B) If the Academy recommends that an entity be 
        established, the recommendations of the Academy as to--
                    (i) the organizational placement of the entity;
                    (ii) the personnel and other resources to be 
                allocated to the entity;
                    (iii) the scope and nature of the activities and 
                responsibilities of the entity; and
                    (iv) mechanisms for ensuring that any 
                recommendations of the entity are carried out by the 
                Department of Defense and the Department of Veterans 
                Affairs.
    (3) The report shall be submitted to 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.

            Passed the Senate October 8 (legislative day, October 2), 
      1998.

            Attest:

                                                    GARY SISCO,

                                                             Secretary.