II

103D CONGRESS

2D SESSION H. R. 4386

IN THE SENATE OF THE UNITED STATES

AUGUST 9 (legislative day, AUGUST 8), 1994

Received; read twice and referred to the Committee on Veterans’ Affairs

OCTOBER 7 (legislative day, SEPTEMBER 12), 1994

Committee discharged

AN ACT

To amend title 38, United States Code, authorizing the Secretary of Veterans Affairs to provide compensation to

veterans suffering from disabilities resulting from illnesses attributed to service in the Persian Gulf theater

of operations during the Persian Gulf War, to provide

for increased research into illnesses reported by Persian

Gulf War veterans, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Veterans’ Persian Gulf

5 War Benefits Act’’.

6 SEC. 2. CONGRESSIONAL FINDINGS.

7 The Congress makes the following findings:
2

•HR 4386 CDS

1 (1) During the Persian Gulf War, members of

2 the Armed Forces were exposed to numerous poten3 tially toxic substances, including fumes and smoke

4 from military operations, oil well fires, diesel ex5 haust, paints, pesticides, depleted uranium, infec6 tious agents, chemoprophylactic agents, and indige7 nous diseases, and were also given multiple immuni8 zations. It is not known whether these

9 servicemembers were exposed to chemical or biologi10 cal warfare agents. However, threats of enemy use

11 of chemical and biological warfare heightened the

12 psychological stress associated with the military op13 eration.

14 (2) Significant numbers of veterans of the Per15 sian Gulf War are suffering from illnesses, or are ex16 hibiting symptoms of illness, that cannot now be di17 agnosed or clearly defined. As a result, many of

18 these conditions or illnesses are not considered to be

19 service connected under current law for purposes of

20 benefits administered by the Department of Veter21 ans Affairs.

22 (3) The Technology Assessment Workshop on

23 the Persian Gulf Experience and Health conducted

24 by the National Institutes of Health concluded that

25 the complex biological, chemical, physical, and psy-
3

•HR 4386 CDS

1 chological environment of the Southwest Asia thea2 ter of operations produced complex adverse health

3 effects in Persian Gulf War veterans and that it ap4 pears that no single disease entity or syndrome ex5 ists. Rather, it appears that the illnesses suffered by

6 those veterans result from multiple illnesses with

7 overlapping symptoms and causes that have yet to

8 be defined.

9 (4) That workshop concluded that the data con10 cerning the range and intensity of exposure to toxic

11 substances by military personnel in the Southwest

12 Asia theater of operations are very limited and that

13 such data were collected only after a considerable

14 delay.

15 (5) In response to concerns regarding the

16 health-care needs of Persian Gulf War veterans, par17 ticularly those who suffer from illnesses or condi18 tions for which no diagnosis has been made, the

19 Congress, in Public Law 102–585, directed the es20 tablishment of a Persian Gulf War Veterans Health

21 Registry, authorized health examinations for veter22 ans of the Persian Gulf War, and provided for the

23 National Academy of Sciences to conduct a com24 prehensive review and assessment of information re25 garding the health consequences of military service
4

•HR 4386 CDS

1 in the Persian Gulf theater of operations and to de2 velop recommendations on avenues for research re3 garding such health consequences. In Public Law

4 103–210, the Congress authorized the Department

5 of Veterans Affairs to provide health care services on

6 a priority basis to Persian Gulf War veterans. The

7 Congress also provided in Public Law 103–160 (the

8 National Defense Authorization Act for Fiscal Year

9 1994) for the establishment of a specialized environ10 mental medical facility for the conduct of research

11 into the possible health effects of exposure to low

12 levels of hazardous chemicals, especially among Per13 sian Gulf veterans, and for research into the possible

14 health effects of battlefield exposure in such veterans

15 to depleted uranium.

16 (6) Further research and studies must be un17 dertaken to determine the underlying causes of the

18 illnesses suffered by Persian Gulf War veterans and,

19 pending the outcome of such research, veterans who

20 are seriously ill as the result of such illnesses should

21 be given the benefit of the doubt and be provided

22 compensation benefits to offset the impairment in

23 earnings capacities they may be experiencing.

24 SEC. 3. PURPOSES.

25 The purposes of this Act are—
5

•HR 4386 CDS

1 (1) to provide compensation to Persian Gulf

2 War veterans who suffer disabilities resulting from

3 illnesses that cannot now be diagnosed or defined,

4 and for which other causes cannot be identified,

5 (2) to require the Secretary of Veterans Affairs

6 to develop at the earliest possible date case assess7 ment strategies and definitions or diagnoses of such

8 illnesses,

9 (3) to promote greater outreach to Persian Gulf

10 War veterans and their families to inform them of

11 ongoing research activities, as well as the services

12 and benefits to which they are currently entitled,

13 and

14 (4) to ensure that research activities and ac15 companying surveys of Persian Gulf War veterans

16 are appropriately funded and undertaken by the De17 partment of Veterans Affairs.

18 SEC. 4. DEVELOPMENT OF CASE ASSESSMENT PROTOCOL

19 AND CASE DEFINITIONS.

20 (a) IN GENERAL.—The Secretary of Veterans Affairs

21 shall—

22 (1) develop and implement at the earliest pos23 sible date a uniform case assessment protocol that

24 will ensure thorough assessment, diagnosis, and

25 treatment of all Persian Gulf War veterans suffering
6

•HR 4386 CDS

1 from illness attributed to service in the Southwest

2 Asia theater of operations during the Persian Gulf

3 War; and

4 (2) develop at the earliest possible date case

5 definitions or diagnoses for illnesses associated with

6 such service.

7 (b) CONSULTATION.—Development of a uniform case

8 assessment protocol under subsection (a)(1) and develop9 ment of case definitions or diagnoses under subsection

10 (a)(2) shall be carried out by the Secretary of Veterans

11 Affairs in consultation with the Secretary of Defense and

12 the Secretary of Health and Human Services.

13 (c) REPORTS.—The Secretary shall submit to the

14 Committees on Veterans’ Affairs of the Senate and House

15 of Representatives an annual report on the status of the

16 activities required by this section. The first such report

17 shall be submitted not later than six months after the date

18 of the enactment of this Act.

19 SEC. 5. PROVISION OF INFORMATION TO VETERANS OF

20 THE PERSIAN GULF WAR.

21 (a) OUTREACH PROGRAM.—The Secretary of Veter22 ans Affairs shall develop and implement a comprehensive

23 outreach program and information system to provide Per24 sian Gulf War veterans and their families with information

25 regarding the following:
7

•HR 4386 CDS

1 (1) The Persian Gulf War Veterans Health

2 Registry established by the Persian Gulf War Veter3 ans’ Health Status Act (38 U.S.C. 527 note).

4 (2) Access to health services and health-related

5 benefits provided by or under the auspices of the

6 Department of Veterans Affairs, including—

7 (A) marriage and family counseling avail8 able under section 121 of the Veterans’ Medical

9 Programs Amendments of 1992 (38 U.S.C.

10 1712A note);

11 (B) health care available under section

12 1710(e)(1)(C) of title 38, United States Code;

13 and

14 (C) health examinations, consultation, and

15 counseling available under section 703 of the

16 Persian Gulf War Veterans’ Health Status Act

17 (38 U.S.C. 527 note).

18 (3) Compensation and benefits related to dis19 abilities resulting from service in the Persian Gulf

20 War, including disabilities resulting from illness that

21 resulted from such service.

22 (4) Significant developments in research relat23 ing to the health consequences of service in the Per24 sian Gulf War.
8

•HR 4386 CDS

1 (5) Any other information that the Secretary

2 determines to be appropriate.

3 (b) TOLL-FREE TELEPHONE NUMBER.—The infor4 mation system required by subsection (a) shall include the

5 establishment and staffing of a toll-free telephone number

6 for the use of such veterans and their families.

7 (c) FURTHER INFORMATION.—Section 702(f) of the

8 Persian Gulf War Veterans’ Health Status Act (38 U.S.C.

9 527 note) is amended to read as follows:

10 ‘‘(f) ONGOING OUTREACH TO INDIVIDUALS LISTED

11 IN REGISTRY.—(1) The Secretary of Veterans Affairs

12 shall notify each individual listed in the Registry or, in

13 the case of such an individual who is deceased, the surviv14 ing spouse, children, or parents of such individual, at least

15 quarterly, by newsletter or by other means that the Sec16 retary determines to be appropriate, of—

17 ‘‘(A) the status and findings of federally spon18 sored research relating to the illnesses of individuals

19 who served as members of the Armed Forces in the

20 Persian Gulf theater of operations during the Per21 sian Gulf War or to the illnesses of the family mem22 bers of such individuals;

23 ‘‘(B) compensation and benefits, including

24 health care and other health-related benefits, that

25 may be provided by the Department of Veterans Af-
9

•HR 4386 CDS

1 fairs or the Department of Defense to an individual

2 who served as a member of the Armed Forces in the

3 Persian Gulf theater of operations during the Per4 sian Gulf War or, in the case of such an individual

5 who is deceased, to the surviving spouse, children, or

6 parents of such an individual; and

7 ‘‘(C) any other information that the Secretary

8 determines to be appropriate.

9 ‘‘(2) In preparing the newsletter or other means used

10 to provide information as required by paragraph (1), the

11 Secretary shall consult with veterans’ service organiza12 tions.

13 ‘‘(3) The requirement of paragraph (1) shall not

14 apply regarding notification of any individual if that indi15 vidual makes a written request to the Secretary of Veter16 ans Affairs that the notification not be provided.’’.

17 SEC. 6. COMPENSATION BENEFITS FOR DISABILITY RE18 SULTING FROM ILLNESS ATTRIBUTED TO

19 SERVICE DURING THE PERSIAN GULF WAR.

20 (a) IN GENERAL.—(1) Chapter 11 of title 38, United

21 States Code, is amended by adding at the end of sub22 chapter II the following new section:
10

•HR 4386 CDS

1 ‘‘§ 1117. Compensation for disabilities associated with

2 Persian Gulf War

3 ‘‘(a) The Secretary shall pay compensation under this

4 subchapter to a Persian Gulf veteran suffering from a

5 chronic disability resulting from an undiagnosed illness (or

6 combination of undiagnosed illnesses) that became mani7 fest to a degree of 10 percent or more before the later

8 of (1) October 1, 1996, or (2) the end of the two-year

9 period beginning on the last date on which the veteran

10 performed active military, naval, or air service in the

11 Southwest Asia theater of operations while on active duty.

12 ‘‘(b) A disability for which compensation under this

13 subchapter is payable shall be considered to be service con14 nected for purposes of all other laws of the United States.

15 ‘‘(c) Compensation may not be paid under this sec16 tion with respect to a disability occurring in a veteran—

17 ‘‘(1) where there is affirmative evidence that

18 the disability was not incurred by the veteran during

19 service in the Persian Gulf theater of operations

20 during the Persian Gulf War; or

21 ‘‘(2) where there is affirmative evidence to es22 tablish that an intercurrent injury or illness which is

23 a recognized cause of the disability was suffered by

24 the veteran between the date of the veteran’s most

25 recent departure from that theater of operations

26 while on active duty and the onset of the disability.
11

•HR 4386 CDS

1 ‘‘(d) The Secretary may not make payments under

2 this section with respect to a disability for which com3 pensation is paid under this section for any month after

4 the month during which the Secretary determines that

5 such disability was not incurred as the result of service

6 in the Southwest Asia theater of operations during the

7 Persian Gulf War.

8 ‘‘(e) For purposes of this section, the term ‘Persian

9 Gulf veteran’ means a veteran who served on active duty

10 in the Armed Forces in the Southwest Asia theater of op11 erations during the Persian Gulf War.

12 ‘‘(f)(1) No payment may be made under this section

13 for any month that begins after the end of the three-year

14 period beginning on the date of the enactment of this sec15 tion.

16 ‘‘(2) If, before the end of such three-year period, the

17 Secretary submits to the Committees on Veterans’ Affairs

18 of the Senate and House of Representatives a report stat19 ing that, as of the date of the report, no diagnoses for

20 the illnesses referred to in subsection (a) can be made

21 based on current medical knowledge, such three-year pe22 riod shall continue for an additional three years.

23 ‘‘(3) The Secretary shall submit to those committees

24 a report addressing the issue of diagnoses of such illnesses

25 not later than April 1, 1997.’’.
12

•HR 4386 CDS

1 (2) The table of sections at the beginning of such

2 chapter is amended by inserting after the item relating

3 to section 1116 the following new item:

‘‘1117. Compensation for disabilities associated with Persian Gulf War.’’.

4 (b) EFFECTIVE DATE.—Section 1117 of title 38,

5 United States Code, as added by subsection (a), shall take

6 effect on October 1, 1994.

7 SEC. 7. AUTHORIZATION OF APPROPRIATIONS FOR PER8 SIAN GULF ILLNESS RESEARCH.

9 There is authorized to be appropriated to the Depart10 ment of Veterans Affairs $5,000,000 for each of fiscal

11 years 1995 through 1997 for the conduct of research,

12 which the Secretary of Veterans Affairs, in consultation

13 with the Secretary of Defense and the Secretary of Health

14 and Human Services, determines would advance under15 standing of health risks and effects of service during the

16 Persian Gulf War and effective means of treating such

17 health effects.

18 SEC. 8. SURVEY OF PERSIAN GULF VETERANS.

19 (a) IN GENERAL.—There is authorized to be appro20 priated to the Department of Veterans Affairs such sums

21 as are needed for fiscal year 1995 for the conduct of a

22 survey of Persian Gulf veterans to gather information on

23 the incidence and nature of health problems occurring in

24 Persian Gulf veterans and their families.
13

•HR 4386 CDS

1 (b) COORDINATION WITH DEPARTMENT OF DE2 FENSE.—The survey under subsection (a) shall be carried

3 out in coordination with the Secretary of Defense.

4 (c) PERSIAN GULF VETERAN.—For purposes of this

5 section, a Persian Gulf veteran is an individual who served

6 on active duty in the Armed Forces in the Southwest Asia

7 theater of operations during the Persian Gulf War as de8 fined in section 101(33) of title 38, United States Code.

9 SEC. 9. AUTHORIZATION FOR EPIDEMIOLOGICAL STUDIES.

10 (a) STUDY OF HEALTH CONSEQUENCES OF PERSIAN

11 GULF SERVICE.—If the National Academy of Sciences in12 cludes in the report required by section 706(b) of the Vet13 erans Health Care Act of 1992 (Public Law 102–585) a

14 finding that there is a sound basis for an epidemiological

15 study or studies on the health consequences of service in

16 the Persian Gulf theater of operations during the Persian

17 Gulf War and recommends the conduct of such a study

18 or studies, the Secretary of Veterans Affairs is authorized

19 to carry out such study.

20 (b) OVERSIGHT.—(1) The Secretary shall seek to

21 enter into an agreement with the Medical Follow-Up

22 Agency (MFUA) of the Institute of Medicine of the Na23 tional Academy of Sciences for (A) the review of proposals

24 to conduct the research referred to in subsection (a), (B)
14

•HR 4386 CDS

1 oversight of such research, and (C) review of the research

2 findings.

3 (2) If the Secretary is unable to enter into an agree4 ment under paragraph (1) with the entity specified in that

5 paragraph, the Secretary shall enter into an agreement de6 scribed in that paragraph with another appropriate sci7 entific organization which does not have a connection to

8 the Department of Veterans Affairs. In such a case, the

9 Secretary shall submit to the Committees on Veterans’ Af10 fairs of the Senate and House of Representatives, at least

11 90 days before the date on which the agreement is entered

12 into, notice in writing identifying the organization with

13 which the Secretary intends to enter into the agreement.

14 (c) ACCESS TO DATA.—The Secretary shall enter into

15 agreements with the Secretary of Defense and the Sec16 retary of Health and Human Services to make available

17 for the purposes of any study described in subsection (a)

18 all data that the Secretary, in consultation with the Na19 tional Academy of Sciences and the contractor, considers

20 relevant to the study.

21 (d) AUTHORIZATION.—There are authorized to be ap22 propriated to the Department such sums as are necessary

23 for the conduct of studies described in subsection (a).
15

•HR 4386 CDS

1 SEC. 10. EXTENSION OF MARRIAGE AND FAMILY COUNSEL2 ING AVAILABILITY FOR PERSIAN GULF WAR

3 VETERANS.

4 (a) IN GENERAL.—Section 121(a) of the Veterans’

5 Medical Programs Amendments of 1992 (38 U.S.C.

6 1712A note) is amended by striking out ‘‘September 30,

7 1994’’ and inserting in lieu thereof ‘‘December 31, 1998’’.

8 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

9 121(g) of the Veterans’ Medical Programs Amendments

10 of 1992 (38 U.S.C. 1712A note) is amended by striking

11 out ‘‘and 1994’’ and inserting in lieu thereof ‘‘through

12 1999’’.

13 SEC. 11. COST-SAVINGS PROVISIONS.

14 (a) ELECTION OF DEATH PENSION BY SURVIVING

15 SPOUSE.—Section 1317 of title 38, United States Code,

16 is amended—

17 (1) by striking out ‘‘No person’’ and inserting

18 in lieu thereof ‘‘(a) Except as provided in subsection

19 (b), no person’’; and

20 (2) by adding at the end the following:

21 ‘‘(b) A surviving spouse who is eligible for dependency

22 and indemnity compensation by reason of any death occur23 ring after December 31, 1956, may elect to receive death

24 pension instead of such compensation.’’.

25 (b) POLICY REGARDING COST-OF-LIVING ADJUST26 MENT IN COMPENSATION RATES FOR FISCAL YEAR
16

•HR 4386 CDS

1 1995.—The fiscal year 1995 cost-of-living adjustments in

2 the rates of and limitations for compensation payable

3 under chapter 11 of title 38, United States Code, and of

4 dependency and indemnity compensation payable under

5 chapter 13 of such title will be no more than a percentage

6 equal to the percentage by which benefit amounts payable

7 under title II of the Social Security Act (42 U.S.C. 401

8 et seq.) are increased effective December 1, 1994, as a

9 result of a determination under section 215(i) of such Act

10 (42 U.S.C. 415(i)), with all increased monthly rates and

11 limitations (other than increased rates or limitations equal

12 to a whole dollar amount) rounded down to the next lower

13 dollar.

Passed the House of Representatives August 8,

1994.

Attest: DONNALD K. ANDERSON,

Clerk.

HR 4386 CDS——2