[Congressional Record Volume 142, Number 115 (Wednesday, July 31, 1996)]
[Senate]
[Pages S9300-S9304]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DASCHLE (for himself, Mr. Rockefeller, Mr. Kerry, Mr. 
        Wellstone, Ms. Mikulski, Mr. Byrd, Mr. Dodd, Mr. Conrad, Mr. 
        Inouye, Mr. Pell, Mr. Simon, Mr. Feingold, Mr. Breaux, Mrs. 
        Boxer, Mr. Dorgan, Mrs. Feinstein, Mr. Glenn, Mr. Harkin, Mr. 
        Robb, and Mr. Kennedy):
  S. 2008. A bill to amend title 38, United States Code, to provide 
benefits for certain children of Vietnam veterans who are born with 
spina bifida, and for other purposes; to the Committee on Veterans 
Affairs.


                 The Agent Orange Benefits Act of 1996

  Mr. DASCHLE. Mr. President, today, with 19 of my colleagues, I am 
introducing the Agent Orange Benefits Act of 1996. This legislation is 
an important step toward easing the burden of innocent, indirect 
victims of our country's use of agent orange during the Vietnam war. 
The bill would extend health care and related benefits, including a 
monthly monetary allowance, to Vietnam veterans' children suffering 
from spina bifida--a serious neural tube birth defect that requires 
lifelong care.
  This bill is a necessary followup to the Agent Orange Act of 1991, 
which I coauthored with Senators Kerry and Cranston and Representative 
Lane Evans and which unanimously passed the Senate. Among other things, 
the Agent Orange Act required the Department of Veterans Affairs [VA] 
to contract with the Institute of Medicine [IOM], which is part of the 
National Academy of Sciences [NAS], to conduct a scientific review of 
all evidence pertaining to exposure to agent orange and other 
herbicides used in Vietnam and the subsequent occurrence of disease and 
other health-related conditions. The law required an initial report, 
which was issued by NAS in 1993, followed by biennial updates for 10 
years. The first update was published by NAS last March.
  In accordance with the law, Vietnam veterans are not required to 
prove exposure to agent orange; the law presumes that all military 
personnel who served in Vietnam were exposed to agent orange. The 
Secretary is to provide presumptive disability compensation for 
diseases suffered by Vietnam veterans whenever he determines, based on 
all credible evidence, including the congressionally mandated NAS 
reports, that a positive association exists between exposure and the 
occurrence of such diseases in humans. For purposes of this law, a 
positive association must be found to exist whenever credible evidence 
for an association is equal to or outweighs the credible evidence 
against the association.
  We have been struggling for decades to provide compensation and 
health care for Vietnam veterans--and, if warranted, their children--
for health problems associated with exposure to agent orange. Since 
1985, Vietnam veterans have been eligible for free VA health care for 
conditions believed to be related to exposure to agent orange. Vietnam 
veterans are also eligible for presumptive disability compensation for 
several diseases, including chloracne and various cancers, associated 
with exposure to agent orange or other herbicides used in Vietnam. Most 
recently, in response to the March NAS report, the Secretary of 
Veterans Affairs awarded service-connected disability compensation for 
prostate cancer and acute and subacute peripheral neuropathy.
  An area of key concern to Vietnam veterans has been what they believe 
to be a high rate of birth defects in the children born to them since 
their service in Vietnam. The Agent Orange Act of 1991 specifically 
mandated that the area of reproductive disorders and birth defects be 
given special attention to determine whether or not compensatory action 
is warranted. The March NAS report showed new evidence suggesting a 
link between exposure to agent orange and the occurrence of spina 
bifida in Vietnam veterans' children. The report also noted that there 
is growing evidence, though not as strong as the evidence on spina 
bifida at this point, suggestive of an increase in other birth defects 
among Vietnam veterans' children.
  In response to the NAS report, the Secretary of Veterans Affairs 
assembled an interdepartmental task force, which consulted with 
interested veterans' service organizations and experts in spina bifida, 
to review the NAS findings and make policy recommendations to the 
Secretary.
  In May, the Secretary delivered to the President several policy 
recommendations based on the VA's review of the NAS report. These 
included recommendations to add prostate cancer and acute and subacute 
peripheral neuropathy to the list of presumptive diseases, and, if 
authority were granted, to treat spina bifida in veterans' children in 
the same manner. The VA does not currently have the authority to 
provide benefits to veterans' children. Subsequently, President Clinton 
announced that the administration would propose legislation to provide 
an appropriate remedy for Vietnam veterans' children who suffer from 
spina bifida. This bill reflects that effort.
  Clearly, the Government's responsibility does not end once veterans 
return from war. Effects of combat, even those passed down through 
reproductive disorders, are a direct result of our decisions to place 
our Nation's men and women in harm's way. We have a moral 
responsibility to help veterans whose children suffer from spina bifida 
and to meet those children's health care needs.
  It should be noted that spina bifida is a devastating, irreversible 
birth defect resulting from the failure of the spine to properly close 
early in pregnancy. It requires lifelong medical treatment, and the 
cost of caring for a child with spina bifida can be financially 
devastating for families. While spina bifida affects approximately one 
of every 1,000 newborns in the United States, a study of Vietnam 
veterans that was included in the NAS report showed three spina bifida 
cases in a group of only 792 infants of Vietnam veterans--a 
statistically significant result.
  The Agent Orange Benefits Act of 1996 would provide health care, 
limited vocational rehabilitation, and a monthly stipend to Vietnam 
veterans' children with spina bifida based on the severity of each 
child's condition. It includes the provision of essential medical care 
and case management services to coordinate health and social services 
for the child.
  Unfortunately, the NAS report confirmed what Vietnam veterans have 
long feared: the Vietnam war continues to claim innocent victims. 
Nothing can erase the physical and psychological wounds of the war, 
but, by providing limited benefits to affected children, the Agent 
Orange Benefits Act of 1996 will allow us to heal some of the lingering 
scars from Vietnam.
  The NAS report also serves as a valuable reminder that the impact of 
any war is felt decades beyond the final shots. Just as reproductive 
disorders and birth defects in their children have been among Vietnam 
veterans' greatest health concerns, health problems in their children 
is of great concern to veterans who served in the Gulf war. We must be 
prepared to learn from the scientific effort on agent orange and apply 
these lessons to the effort to discover the true health effects of 
environmental hazards on the men and women who served in the Gulf and 
on their children. Based on the NAS report's findings related to spina 
bifida in the children of Vietnam veterans,

[[Page S9301]]

the VA is establishing a reproductive outcomes research center to 
investigate potential environmental hazards of military service. I look 
forward to seeing those efforts come to fruition, and I am hopeful they 
will help us provide answers to the many outstanding questions in this 
area.
  I applaud the President and Secretary Jesse Brown, along with my 
colleagues who have been committed to this fight for years, for working 
together to develop a proposal that adequately addresses the needs of 
these children and their families, and for providing modest 
compensation for a wrong that can never fully be righted.
  With the passage of this legislation, we can begin to fulfill our 
promise to these most innocent victims and their families. Vietnam 
veterans' families have suffered for decades and now live with the pain 
of knowing that their military service may have jeopardized the health 
and welfare of their children. The very least we can do is ease their 
burden by providing this limited assistance and care.
  Mr. President, I ask unanimous consent that the text of the bill, a 
summary of the bill, a letter of support from the administration, and a 
table from the NAS report that explains the four-tiered classification 
system for agent orange-related illnesses, be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2008

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

     SECTION 1. REFERENCES TO TITLE 38, UNITED STATES CODE.

       Except as otherwise expressly provided, whenever in this 
     Act an amendment or repeal is expressed in terms of an 
     amendment or repeal is expressed in terms of an amendment to, 
     or repeal of, a section or other provision, the reference 
     shall be considered to be made to a section or other 
     provision of title 38, United States Code.

     SEC. 2. BENEFITS FOR THE CHILDREN OF VIETNAM VETERANS WHO ARE 
                   BORN WITH SPINA BIFIDA.

       (a) Short Title.--This section may be cited as the ``Agent 
     Orange Benefits Act of 1996.''
       (b) Establishment of New Chapter 18.--Part II is amended by 
     inserting after chapter 17 the following new chapter:

  ``CHAPTER 18--BENEFITS FOR THE CHILDREN OF VIETNAM VETERANS WHO ARE 
                         BORN WITH SPINA BIFIDA

     ``Sec.
     ``1801. Purpose.
     ``1802. Definitions.
     ``1803. Health care.
     ``1804. Vocational training.
     ``1805. Monetary allowance.
     ``1806. Effective date of Awards.

     SEC. ``1801. PURPOSE.

       ``The purpose of this chapter is to provide for the special 
     needs of certain children of Vietnam veterans who were born 
     with the birth defect spina bifida, possibly as the result of 
     the exposure of one or both parents to herbicides during 
     active service in the Republic of Vietnam during the Vietnam 
     era, through the provision of health care, vocational 
     training, and monetary benefits.

     ``SEC. 1802. DEFINITIONS.

       ``For the purposes of this chapter--
       ``(1) The term `child' means a natural child of a Vietnam 
     veteran, regardless of age or marital status, who was 
     conceived after the date on which the veteran first entered 
     the Republic of Vietnam during the Vietnam era.
       ``(2) The term `Vietnam veteran' means a veteran who, 
     during active military, naval, or air service, served in the 
     Republic of Vietnam during the Vietnam era.
       ``(3) The term `spina bifida' means all forms of spina 
     bifida other than spina bifida occulta.

     ``SEC. 1803. HEALTH CARE.

       ``(a) In accordance with regulations the Secretary shall 
     prescribe, the Secretary shall provide such health care under 
     this chapter as the Secretary determines is needed to a child 
     of a Vietnam veteran who is suffering from spina bifida, for 
     any disability associated with such condition.
       ``(b) The Secretary may provide health care under this 
     section directly or by contract or other arrangement with a 
     health care provider.
       ``(c) For the purposes of this section--
       ``(1) the term `health care' means home care, hospital 
     care, nursing home care, outpatient care, preventive care, 
     habilitative and rehabilitative care, case management, and 
     respite care, and includes the training of appropriate 
     members of a child's family or household in the care of the 
     child and provision of such pharmaceuticals, supplies, 
     equipment, devices, appliances, assistive technology, direct 
     transportation costs to and from approved sources of health 
     care authorized under this section, and other materials as 
     the Secretary determines to be necessary.
       ``(2) the term `health care provider' includes, but is not 
     limited to, specialized spina bifida clinics, health-care 
     plans, insurers, organizations, institutions, or any other 
     entity or individual who furnishes health care services that 
     the Secretary determines are covered under this section.
       ``(3) the term `home care' means outpatient care, 
     habilitative and rehabilitative care, preventive health 
     services, and health-related services furnished to an 
     individual in the individual's home or other place of 
     residence.
       ``(4) the term `hospital care' means care and treatment for 
     a disability furnished to an individual who has been admitted 
     to a hospital as a patient.
       ``(5) the term `nursing home care' means care and treatment 
     for a disability furnished to an individual who has been 
     admitted to a nursing home as a resident.
       ``(6) the term `outpatient care' means care and treatment 
     of a disability, and preventive health services, furnished to 
     an individual other than hospital care or nursing home care.
       ``(7) the term `preventive care' means care and treatment 
     furnished to prevent disability or illness, including 
     periodic examinations, immunizations, patient health 
     education, and such other services as the Secretary 
     determines are necessary to provide effective and economical 
     preventive health care.
       ``(8) the term `habilitative and rehabilitative care' means 
     such professional, counseling, and guidance services and 
     treatment programs (other than vocational training under 
     section 1804 of this title) as are necessary to develop, 
     maintain, or restore, to the maximum extent, the functioning 
     of a disabled person.
       ``(9) the term `respite care' means care furnished on a 
     intermittent basis in a Department facility for a limited 
     period to an individual who resides primarily in a private 
     residence when such care will help the individual to continue 
     residing in such private residence.

     ``SEC. 1804. VOCATIONAL TRAINING.

       ``(a) Pursuant to such regulations as the Secretary may 
     prescribe, the Secretary may provide vocational training 
     under this section to a child of a Vietnam veteran who is 
     suffering from spina bifida if the Secretary determines that 
     the achievement of a vocational goal by such child is 
     reasonably feasible.
       ``(b)(1) If a child elects to pursue a program of 
     vocational training under this section, the program shall be 
     designed in consultation with the child in order to meet the 
     child's individual needs and shall be set forth in an 
     individualized written plan of vocational rehabilitation.
       ``(2)(A) Subject to subparagraph (B) of this paragraph, a 
     vocational training program under this subsection shall 
     consist of such vocationally oriented services and 
     assistance, including such placement and post-placement 
     services and personal and work adjustment training, as 
     the Secretary determines are necessary to enable the child 
     to prepare for and participate in vocational training or 
     employment.
       ``(B) A vocational training program under this subsection--
       ``(i) may not exceed 24 months unless, based on a 
     determination by the Secretary that an extension is necessary 
     in order for the child to achieve a vocational goal 
     identified (before the end of the first 24 months of such 
     program) in the written plan formulated for the child, the 
     Secretary grants an extension for a period not to exceed 24 
     months;
       ``(ii) may not include the provision of any loan or 
     subsistence allowance or any automobile adaptive equipment; 
     and
       ``(iii) may include a program of education at an 
     institution of higher learning only in a case in which the 
     Secretary determines that the program involved is 
     predominantly vocational in content.
       ``(c)(1) A child who is pursuing a program of vocational 
     training under this section who is also eligible for 
     assistance under a program under chapter 35 of this title may 
     not receive assistance under both of such programs 
     concurrently but shall elect (in such form and manner as the 
     Secretary may prescribe) under which program to receive 
     assistance.
       ``(2) The aggregate period for which a child may receive 
     assistance under this section and chapter 35 of this title 
     may not exceed 48 months (or the part-time equivalent 
     thereof).

     ``SEC. 1805. MONETARY ALLOWANCE.

       ``(a) The Secretary shall pay a monthly allowance under 
     this chapter to any child of a Vietnam veteran for disability 
     resulting from spina bifida suffered by such child.
       ``(b) The amount of the allowance paid under this section 
     shall be based on the degree of disability suffered by a 
     child as determined in accordance with such schedule for 
     rating disabilities resulting from spina bifida as the 
     Secretary may prescribe. The Secretary shall, in prescribing 
     the rating schedule for the purposes of this section, 
     establish three levels of disability upon which the amount of 
     the allowance provided by this section shall be based. The 
     allowance shall be $200 per month for the lowest level of 
     disability prescribed, $700 per month for the intermediate 
     level of disability prescribed, and $1,200 per month for 
     the highest level of disability prescribed.
       ``(c)(1) Whenever there is an increase in benefit amounts 
     payable under title II of the Social Security Act (42 U.S.C. 
     401 et seq.) as a result of a determination under section

[[Page S9302]]

     215(i) of such Act (42 U.S.C. 415(i)), the Secretary shall, 
     effective on the date of such increase in benefit amounts, 
     increase each rate of allowance under this section, as such 
     rates were in effect immediately prior to the date of such 
     increase in benefits payable under title II of the Social 
     Security Act, by the same percentage as the percentage by 
     which such benefit amounts are increased.
       ``(2) Whenever there is an increase in the rates of the 
     allowance payable under this section, the Secretary shall 
     publish such rates in the Federal Register.
       ``(3) Whenever such rates are so increased, the Secretary 
     may round such rates in such manner as the Secretary 
     considers equitable and appropriate for ease of 
     administration.
       ``(d) Notwithstanding any other provision of law, receipt 
     by a child of an allowance under this section shall not 
     impair, infringe, or otherwise affect the right of such child 
     to receive any other benefit to which the child may otherwise 
     be entitled under any law administered by the Secretary, nor 
     shall such receipt impair, infringe, or otherwise affect the 
     right of any individual to receive any benefit to which he or 
     she is entitled under any law administered by the Secretary 
     that is based on the child's relationship to such individual.
       ``(e) Notwithstanding any other provision of law, the 
     allowance paid to a child under this section shall not be 
     considered income or resources in determining eligibility for 
     or the amount of benefits under any Federal or federally 
     assisted program.

     ``SEC. 1806. EFFECTIVE DATE OF AWARDS.

       ``Effective date for an award for benefits under this 
     chapter shall be fixed in accordance with the facts found, 
     but shall not be earlier than the date of receipt of 
     application therefor.''.
       (c) Effective Date.--The amendments made by this section 
     shall become effective on October 1, 1996.
       (d) Clerical Amendment.--The tables of chapters before part 
     I and at the beginning of part II are each amended by 
     inserting after the item referring to chapter 17 the 
     following new item:

``18. Benefits for children of Vietnam veterans who are born with spina 
    bifida..................................................1801''.....

     SEC. 3. CLARIFICATION OF ENTITLEMENT FOR BENEFITS FOR 
                   DISABILITY RESULTING FROM TREATMENT OR 
                   VOCATIONAL SERVICES PROVIDED BY DEPARTMENT OF 
                   VETERANS AFFAIRS.

       (a) Section 1151 is amended--
       (1) by striking out the first sentence and inserting in 
     lieu thereof the following:
       ``(a) Compensation under this chapter and dependency and 
     indemnity compensation under chapter 13 of this title shall 
     be awarded for qualifying additional disability to or death 
     of a veteran in the same manner as if such additional 
     disability or death were service-connected. For purposes of 
     this section, additional disability or death is qualifying 
     only if it was not the result of the veteran's willful 
     misconduct and--
       ``(1) it was caused by hospital care, medical or surgical 
     treatment, or examination furnished the veteran under any law 
     administered by the Secretary, either by a Department 
     employee or in a Department facility as defined in section 
     1701(3)(A) of this title, where the additional disability or 
     death proximately resulted--
       ``(A) from carelessness, negligence, lack of proper skill, 
     error in judgment, or similar instance of fault on the part 
     of the Department in furnishing the hospital care, medical or 
     surgical treatment, or examination; or
       ``(B) from an event not reasonably foreseeable; or
       ``(2) it was incurred as a proximate result of the 
     provision of training and rehabilitation services by the 
     Secretary (including by a service-provider used by the 
     Secretary for such purpose under section 3115 of this title) 
     as part of an approved rehabilitation program under chapter 
     31 of this title.''; and
       (2) in the second sentence--
       (A) by redesignating that sentence as subsection (b);
       (B) by striking out ``, aggravation,'' both places it 
     appears; and
       (C) by striking out ``sentence'' and substituting in lieu 
     thereof ``subsection''.
       (b) The amendments made by subsection (a) shall govern all 
     administrative and judicial determinations of eligibility for 
     benefits under section 1151 of title 38, United States Code, 
     made with respect to claims filed on or after the date of 
     enactment of this Act, including those based on original 
     applications and applications seeking to reopen, revise, 
     reconsider, or otherwise readjudicate on any basis claims for 
     benefits under section 1151 of that title or predecessor 
     provisions of law.
                                                                    ____


  Agent Orange Benefits for Vietnam Veterans' Children Suffering From 
                              Spina Bifida

       The Agent Orange Act of 1996 would extend health care and 
     related benefits, including a monthly monetary allowance, to 
     Vietnam veterans' children suffering from spina bifida--a 
     serious neural tube birth defect that requires life-long 
     care--provided the children were conceived after the veterans 
     began their service in Vietnam.


                               background

       A March National Academy of Sciences (NAS) report cited new 
     evidence that supports a link between exposure to Agent 
     Orange and the occurrence of spina bifida in children of 
     veterans who served in Vietnam. This report was required by 
     the Agent Orange Act of 1991.
       Since 1985, Vietnam veterans have been eligible for free VA 
     health care for conditions believed to be related to exposure 
     to Agent Orange. Veterans' disability compensation for 
     several Agent Orange-related illnesses--including non-
     Hodgkin's lymphoma, soft-tissue sarcoma, Hodgkin's disease, 
     chloracne, respiratory cancers, and multiple myeloma--has 
     been awarded as a result of either congressional or VA 
     action, some of which was based on a 1993 NAS report. Earlier 
     this year, Secretary Brown and the President, in response to 
     the March NAS report, extended service-connected benefits to 
     veterans suffering from prostate cancer and acute and sub-
     acute peripheral neuropathy.
       Reproductive disorders and birth defects in their children 
     have been among veterans' greatest Agent Orange-related 
     health concerns. This legislation is necessary because, while 
     the VA has recommended that spina bifida in veterans' 
     offspring be service-connected, the VA does not currently 
     have the authority to extend health care or other benefits to 
     children of veterans.


                                  cost

       CBO has not yet provided an estimate for this proposal. 
     However, costs would be offset by overturning the Gardner 
     case, which would limit the VA's liability for non-
     malpractice-related injuries occurring in VA facilities. This 
     non-controversial provision was included in Democratic and 
     Republican budget proposals for FY 96. Excess savings would 
     be directed to deficit reduction.


                role of the national academy of sciences

       The Agent Orange Act of 1991 directed the VA to contract 
     with the National Academy of Sciences to conduct for 10 years 
     biennial, comprehensive evaluations of the scientific and 
     medical information regarding the health effects of exposure 
     to Agent Orange and other herbicides used in Vietnam.
       The first report, ``Veterans and Agent Orange: Health 
     Effects of Herbicides Used in Vietnam,'' was published in 
     1993. It created the following categories to classify the 
     level of association between certain health conditions and 
     exposure to Agent Orange: Category I (``sufficient evidence 
     of an association''); category II (``limited/suggestive 
     evidence of an association''); category III (``inadequate/
     insufficient evidence to determine whether an association 
     exists''); category IV (``limited/suggestive evidence of NO 
     association'').
       Following the 1993 report, the VA began to compensate 
     Vietnam veterans suffering from three diseases in categories 
     I and II that had not been service-connected through previous 
     congressional or administrative action: porphyria cutanea 
     tarda, respiratory cancers, and multiple myeloma.
       The 1996 update, which was issued in March, confirmed many 
     of the findings in the 1993 report, and found new evidence to 
     link spina bifida in veterans' children with exposure to 
     Agent Orange. The NAS panel placed ``spina bifida in 
     offspring'' in category II, supporting a connection between 
     birth defects and military service. The NAS report currently 
     places birth defects other than spina bifida in category III.
       After reviewing the NAS report and other information, the 
     VA has recommended that all remaining conditions in 
     categories I and II, including spina bifida, be service-
     connected.
                                                                    ____



                            The Secretary of Veterans Affairs,

                                     Washington, DC, July 5, 1996.
     Hon. Christopher S. (Kit) Bond,
     Chairman, Subcommittee on VA, HUD, and Independent Agencies, 
         Committee on Appropriations, U.S. Senate, Washington, DC.
       Dear Mr. Chairman: I am pleased to share with you a copy of 
     legislation we provided earlier today to Senator Daschle. 
     This legislation, the ``Agent Orange Benefits Act of 1996,'' 
     would provide benefits to certain children of Vietnam 
     veterans who are born with the birth defect spinal bifida. 
     Enacting this legislation is a Presidential priority.
       Under Public Law 102-4, and with the benefit of a National 
     Academy of Sciences report, I determined that a positive 
     association exists between the exposure of Vietnam veterans 
     to herbicides (such as a Agent Orange) and spinal bifida in 
     their children. In approving this determination, the 
     President promised to submit ``an appropriate remedy'' for 
     these veterans' children. This legislation fulfills that 
     commitment. It provides for health care, vocational training, 
     and monthly monetary allowance for these children.
       As set forth in the legislation, the Administration 
     proposes to offset the costs associated with these new 
     benefits with a savings proposal that would effectively 
     reverse the U.S. Supreme Court decision in Gardner v. Brown 
     which held that monthly VA disability compensation must be 
     paid for any additional disability or death attributable to 
     VA medical treatment even if VA was not negligent in 
     providing that care.
       Enactment of this legislation is a top Presidential 
     priority. I strongly urge the Senate to include it in the 
     earliest appropriate legislative vehicle.
       Thank you for your assistance in ensuring prompt and 
     immediate action on this important legislation.
       The Office of Management and Budget has advised that there 
     is no objection from the standpoint of the Administration's 
     program to the presentation of this letter.
           Sincerely,
     Jesse Brown.
                                                                    ____


[[Page S9303]]

                           Executive Summary


TABLE 1-1--Updated Summary of findings in occupational, Environmental, 
and Veterans Studies Regarding the Association Between Specific Health 
                  problems and Exposure to Herbicides

     Sufficient evidence of an association
       Evidence is sufficient to conclude that there is a positive 
     association. That is, a positive association has been 
     observed between herbicides and the outcome in studies in 
     which chance, bias, and confounding could be ruled out with 
     reasonable confidence. For example, if several small studies 
     that are free from bias and confounding show an association 
     that is consistent in magnitude and direction, there may be 
     sufficient evidence for an association. There is sufficient 
     evidence of an association between exposure to herbicides and 
     the following health outcomes: Soft-tissue sarcoma; Non-
     Hodgkin's lymphoma; Hodgkin's disease; Chlorance.
     Limited/suggestive evidence of an association
       Evidence is suggestive of an association between herbicides 
     and the outcome but is limited because chance, bias, and 
     confounding could not be ruled out with confidence. For 
     example, at least one high-quality study shows a positive 
     association, but the results of other studies are 
     inconsistent. There is limited/suggestive evidence of an 
     association between exposure to herbicides and the following 
     health outcomes: Respiratory cancers (lung, larynx, trachea); 
     Prostate cancer; Multiple myeloma; Acute and subacute 
     peripheral neuropathy (new disease category); Spina bifida 
     (new disease category); Porphyria cutanea tarda (category 
     change in 1996).
     Inadequate/insufficient evidence to determine whether an 
         association exists
       The available studies are of insufficient quality, 
     consistency, or statistical power to permit a conclusion 
     regarding the presence or absence of an association. For 
     example, studies fail to control for confounding, have 
     inadequate exposure assessment, or fail to address latency. 
     There is inadequate or insufficient evidence to determine 
     whether an association exists between exposure to herbicides 
     and the following health outcomes: Hepatobiliary cancers; 
     Nasal/nasopharyngeal cancer; Bone cancer; Female reproductive 
     cancers (cervical, uterine, ovarian); Breast cancer; Renal 
     cancer; Testicular cancer; Leukemia; spontaneous abortion; 
     Birth defects (other than spina bifida); Neonatal/infant 
     death and stillbirths; Low birthweight; Childhood cancer in 
     offspring; Abnormal sperm parameters and infertility; 
     cognitive and neuropsychiatric disorders; Motor/coordination 
     dysfunction; Chronic peripheral nervous system disorders; 
     Metabolic and digestive disorders (diabetes, changes in liver 
     enzymes, lipid abnormalities, ulcers); Immune system 
     disorders (immune suppression and autoimmunity); Circulatory 
     disorders; Respiratory disorders; Skin cancer (category 
     change in 1996).
     Limited/suggestive evidence of no association
       Several adequate studies, covering the full range of levels 
     of exposure that human beings are known to encounter, are 
     mutually consistent in not showing a positive association 
     between exposure to herbicides and the outcome at any level 
     of exposure. A conclusion of ``no association'' is inevitably 
     limited to the conditions, level of exposure, and length of 
     observation covered by the available studies. In addition, 
     the possibility of a very small elevation in risk at the 
     levels of exposure studied can never be excluded. There is 
     limited/suggestive evidence of no association between 
     exposure to herbicides and the following health outcomes: 
     Gastrointestinal tumors (stomach cancer, pancreatic cancer, 
     colon cancer, rectal cancer); Bladder cancer; Brain tumors.

       Note: ``Herbicides'' refers to the major herbicides used in 
     Vietnam: 2,4-D (2,4-dichlorophenoxyacetic acid); 2,4,5-T 
     (2,4,5-trichlorophenoxyacetic acid) and its contaminant TCDD 
     (2,3,7,8-tetrachlorodibenzo-p-dioxin); cacodylic acid; and 
     picloram. The evidence regarding association is drawn from 
     occupational and other studies in which subjects were exposed 
     to a variety of herbicides and herbicide components.

  Mr. BYRD. Mr. President, I am proud to cosponsor the legislation 
introduced by the able Democratic leader, Senator Daschle, which 
provides health care and assistance to the children of Vietnam veterans 
who suffer from spina bifida. This legislation provides the needed 
authority for the Department of Veterans Affairs to treat these 
children for their service-connected disabilities arising from their 
father's exposure to agent orange during the Vietnam conflict. This is 
an unprecedented but appropriate action, since scientific research is 
now sufficiently sophisticated to allow us to understand the effects of 
toxic exposures on ourselves and on future generations.
  As a result of the Agent Orange Act of 1991, the Department of 
Veterans Affairs and the National Academy of Sciences have at regular 
intervals reviewed the ongoing research on Agent Orange exposure. The 
report update issued this spring found ``limited/suggestive evidence'' 
linking the birth defect spina bifida to agent orange exposure. The 
report notes that all three epidemiologic studies reviewed suggest an 
association between herbicide exposure and increased risk of spina 
bifida in offspring. It further notes that in contrast to most other 
diseases, for which the strongest data have been from occupationally 
exposed workers, these studies focused on Vietnam veterans. All the 
studies were judged to be of relatively high quality, although they did 
suffer from some methodologic limitations.
  On the basis of this finding, Secretary Jesse Brown recommended that 
a service connection be granted to Vietnam veterans' children with 
spina bifida. It is the right decision, and I applaud him for it. The 
research and the legislation are long overdue for families that have 
been struggling for some twenty years. Some one has observed that 
``procrastination is the thief of time.'' These children and their 
families have already lost time, lost long years of doubt and 
wondering, of financial hardship that they bore alone because the 
government procrastinated in investigating and acknowledging its role 
in this tragedy. The legislation introduced today by Senator Daschle 
attempts to correct that injustice, and I commend him for it. The poet 
Edward Young (1683-1796) has said: ``Be wise today; 'tis madness to 
defer.'' Support this legislation, take responsibility for the tragic 
aftermath of our involvement in Vietnam, and take care of these 
children.
  Mr. KERRY. Mr. President, I am pleased to join my distinguished 
colleague from South Dakota, Senator Daschle, in cosponsoring the Agent 
Orange Benefits Act of 1996. This bill takes another crucial step 
forward in repaying our debt to those who have served their country and 
are still suffering as a result of their service in Vietnam many years 
ago. In May, President Clinton announced that legislation would be 
proposed to aid Vietnam veterans' children who suffer from the disease 
spina bifida. This bill fulfills that commitment by recognizing and 
accepting natural responsibility for one of the serious health care 
needs of veterans' families that stem from the tragic effects of agent 
orange.
  Senator Daschle and I and many others have worked for the past decade 
to try to bring to a fair and just resolution the questions surrounding 
agent orange and the effects it has had on the men and women who 
faithfully served this country. I know that there is still controversy 
about the effects of agent orange. There may always be controversy, 
just as there may always be controversy about the Vietnam war itself. 
But we must set aside the controversy--or put it behind us--to enable 
suffering children to receive the care and treatment they need when 
that suffering can be followed back to a service person's exposure to 
agent orange.
  After years of hard work, I believe we have reached an acceptable 
consensus on the effects of agent orange through numerous studies--and 
independent scientific reviews of the many studies--which have been 
made on the effects of this dangerous chemical that contains deadly 
dioxin. I might add that it has been 30 years since agent orange was 
sprayed in Vietnam and we must stop debating over the bias of each 
individual analyzing the information. As I said back in May of 1988, 
``It is offensive to veterans to tell them that there is not enough 
`scientific evidence' to justify compensation * * * The evidence is in 
their own bodies, and even worse, in the bodies of their children.''
  We have made great strides in reaching a consensus in some areas of 
health care for Vietnam veterans. Since 1985, Vietnam veterans have 
been eligible for free health care from the Veterans Administration for 
conditions that are related to exposure to agent orange. Veterans' 
disability compensation has been awarded to veterans affected by 
several agent orange-related illnesses including non-Hodgkins lymphoma, 
soft tissue sarcoma, Hodgkin's disease, chloracne, respiratory cancers, 
multiple myeloma, and, most recently, prostate cancer and acute and 
subacute peripheral neuropathy.
  Today, Mr. President, we are addressing a particularly heinous effect 
of agent orange--an effect that unfortunately will carry the legacy of 
the Vietnam war to yet another generation. The bill we are introducing 
today would extend health care and related

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benefits to children of Vietnam veterans who suffer from spina bifida, 
a serious neural tube birth defect that requires life-long care--
provided, of course, the children were conceived after the veterans 
began their service in Vietnam.
  The National Academy of Sciences released a report in March of this 
year, citing new evidence supporting the link between exposure to agent 
orange and the occurrence of spina bifida in children of veterans who 
served in Vietnam. This report, Mr. President, warrants our action.
  Both the President and the Secretary of Veterans Affairs, Jesse 
Brown, have asked that spina bifida in veterans' offspring be 
considered service connected. However, the VA currently does not have 
the authority to extend the health care and other related benefits to 
these children that they so greatly need. This bill will grant the VA 
the necessary authority to finally start providing needed care to these 
children who are suffering.
  Mr. President, these are children whose misery stems from physical 
damage caused to one of their parents who was fighting for this country 
in Vietnam. We should do no less than provide them with the care and 
treatment they need. We must not make some of the children of our 
Vietnam veterans the last victims of the Vietnam war. I urge my 
colleagues to support this bill.
                                 ______