[Congressional Record Volume 144, Number 140 (Thursday, October 8, 1998)]
[Senate]
[Pages S12044-S12051]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 PERSIAN GULF WAR VETERANS ACT OF 1998

  Mr. JEFFORDS. Mr. President, I ask unanimous consent that the Senate 
proceed to the consideration of calendar No. 686, S. 2358.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The legislative clerk read as follows:

       A bill (S. 2358) to provide for the establishment of a 
     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.

  The PRESIDING OFFICER. Is there objection to the immediate 
consideration of the bill?
  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Veteran's Affairs, with 
amendments, as follows:
  (The parts of the bill intended to be stricken are shown in boldface 
brackets and the parts of the bill intended to be inserted are shown in 
italic.)

                                S. 2358

       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.

[[Page S12045]]

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 [sections 103(a)(6) and 104(d)] 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

[[Page S12046]]

     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.
       [(vi) Uranium.]
       (G) The following [ionizing] 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).

[[Page S12047]]

       (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).''.

[[Page S12048]]

                        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.

  Mr. JEFFORDS. Mr. President, I ask unanimous consent that the 
committee amendments be agreed to, the bill be read the third time and 
passed, the amendment to the title and the title, as amended, be agreed 
to, the motion to reconsider be laid upon the table, and that any 
statements relating to the bill appear at this point in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendments were agreed to.
  The bill (S. 2358), as amended, was considered read the third time, 
and passed, as follows:

                                S. 2358

       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

[[Page S12049]]

     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

[[Page S12050]]

     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

[[Page S12051]]

     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.
  The title was amended so as to read:

       A bill 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.

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