103D CONGRESS

2D SESSION H. R. 4386

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:

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

9 the Armed Forces were exposed to numerous poten10 tially toxic substances, including fumes and smoke

11 from military operations, oil well fires, diesel ex12 haust, paints, pesticides, depleted uranium, infec13 tious agents, chemoprophylactic agents, and indige-
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1 nous diseases, and were also given multiple immuni2 zations. It is not known whether these

3 servicemembers were exposed to chemical or biologi4 cal warfare agents. However, threats of enemy use

5 of chemical and biological warfare heightened the

6 psychological stress associated with the military op7 eration.

8 (2) Significant numbers of veterans of the Per9 sian Gulf War are suffering from illnesses, or are ex10 hibiting symptoms of illness, that cannot now be di11 agnosed or clearly defined. As a result, many of

12 these conditions or illnesses are not considered to be

13 service connected under current law for purposes of

14 benefits administered by the Department of Veter15 ans Affairs.

16 (3) The Technology Assessment Workshop on

17 the Persian Gulf Experience and Health conducted

18 by the National Institutes of Health concluded that

19 the complex biological, chemical, physical, and psy20 chological environment of the Southwest Asia thea21 ter of operations produced complex adverse health

22 effects in Persian Gulf War veterans and that it ap23 pears that no single disease entity or syndrome ex24 ists. Rather, it appears that the illnesses suffered by

25 those veterans result from multiple illnesses with
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1 overlapping symptoms and causes that have yet to

2 be defined.

3 (4) That workshop concluded that the data con4 cerning the range and intensity of exposure to toxic

5 substances by military personnel in the Southwest

6 Asia theater of operations are very limited and that

7 such data were collected only after a considerable

8 delay.

9 (5) In response to concerns regarding the

10 health-care needs of Persian Gulf War veterans, par11 ticularly those who suffer from illnesses or condi12 tions for which no diagnosis has been made, the

13 Congress, in Public Law 102–585, directed the es14 tablishment of a Persian Gulf War Veterans Health

15 Registry, authorized health examinations for veter16 ans of the Persian Gulf War, and provided for the

17 National Academy of Sciences to conduct a com18 prehensive review and assessment of information re19 garding the health consequences of military service

20 in the Persian Gulf theater of operations and to de21 velop recommendations on avenues for research re22 garding such health consequences. In Public Law

23 103–210, the Congress authorized the Department

24 of Veterans Affairs to provide health care services on

25 a priority basis to Persian Gulf War veterans. The
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1 Congress also provided in Public Law 103–160 (the

2 National Defense Authorization Act for Fiscal Year

3 1994) for the establishment of a specialized environ4 mental medical facility for the conduct of research

5 into the possible health effects of exposure to low

6 levels of hazardous chemicals, especially among Per7 sian Gulf veterans, and for research into the possible

8 health effects of battlefield exposure in such veterans

9 to depleted uranium.

10 (6) Further research and studies must be un11 dertaken to determine the underlying causes of the

12 illnesses suffered by Persian Gulf War veterans and,

13 pending the outcome of such research, veterans who

14 are seriously ill as the result of such illnesses should

15 be given the benefit of the doubt and be provided

16 compensation benefits to offset the impairment in

17 earnings capacities they may be experiencing.

18 SEC. 3. PURPOSES.

19 The purposes of this Act are—

20 (1) to provide compensation to Persian Gulf

21 War veterans who suffer disabilities resulting from

22 illnesses that cannot now be diagnosed or defined,

23 and for which other causes cannot be identified,

24 (2) to require the Secretary of Veterans Affairs

25 to develop at the earliest possible date case assess-
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1 ment strategies and definitions or diagnoses of such

2 illnesses,

3 (3) to promote greater outreach to Persian Gulf

4 War veterans and their families to inform them of

5 ongoing research activities, as well as the services

6 and benefits to which they are currently entitled,

7 and

8 (4) to ensure that research activities and ac9 companying surveys of Persian Gulf War veterans

10 are appropriately funded and undertaken by the De11 partment of Veterans Affairs.

12 SEC. 4. DEVELOPMENT OF CASE ASSESSMENT PROTOCOL

13 AND CASE DEFINITIONS.

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

15 shall—

16 (1) develop and implement at the earliest pos17 sible date a uniform case assessment protocol that

18 will ensure thorough assessment, diagnosis, and

19 treatment of all Persian Gulf War veterans suffering

20 from illness attributed to service in the Southwest

21 Asia theater of operations during the Persian Gulf

22 War; and

23 (2) develop at the earliest possible date case

24 definitions or diagnoses for illnesses associated with

25 such service.
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1 (b) CONSULTATION.—Development of a uniform case

2 assessment protocol under subsection (a)(1) and develop3 ment of case definitions or diagnoses under subsection

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

5 Affairs in consultation with the Secretary of Defense and

6 the Secretary of Health and Human Services.

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

8 Committees on Veterans’ Affairs of the Senate and House

9 of Representatives an annual report on the status of the

10 activities required by this section. The first such report

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

12 of the enactment of this Act.

13 SEC. 5. PROVISION OF INFORMATION TO VETERANS OF

14 THE PERSIAN GULF WAR.

15 (a) OUTREACH PROGRAM.—The Secretary of Veter16 ans Affairs shall develop and implement a comprehensive

17 outreach program and information system to provide Per18 sian Gulf War veterans and their families with information

19 regarding the following:

20 (1) The Persian Gulf War Veterans Health

21 Registry established by the Persian Gulf War Veter22 ans’ Health Status Act (38 U.S.C. 527 note).

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

24 benefits provided by or under the auspices of the

25 Department of Veterans Affairs, including—
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1 (A) marriage and family counseling avail2 able under section 121 of the Veterans’ Medical

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

4 1712A note);

5 (B) health care available under section

6 1710(e)(1)(C) of title 38, United States Code;

7 and

8 (C) health examinations, consultation, and

9 counseling available under section 703 of the

10 Persian Gulf War Veterans’ Health Status Act

11 (38 U.S.C. 527 note).

12 (3) Compensation and benefits related to dis13 abilities resulting from service in the Persian Gulf

14 War, including disabilities resulting from illness that

15 resulted from such service.

16 (4) Significant developments in research relat17 ing to the health consequences of service in the Per18 sian Gulf War.

19 (5) Any other information that the Secretary

20 determines to be appropriate.

21 (b) TOLL-FREE TELEPHONE NUMBER.—The infor22 mation system required by subsection (a) shall include the

23 establishment and staffing of a toll-free telephone number

24 for the use of such veterans and their families.
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1 (c) FURTHER INFORMATION.—Section 702(f) of the

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

3 527 note) is amended to read as follows:

4 ‘‘(f) ONGOING OUTREACH TO INDIVIDUALS LISTED

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

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

7 the case of such an individual who is deceased, the surviv8 ing spouse, children, or parents of such individual, at least

9 quarterly, by newsletter or by other means that the Sec10 retary determines to be appropriate, of—

11 ‘‘(A) the status and findings of federally spon12 sored research relating to the illnesses of individuals

13 who served as members of the Armed Forces in the

14 Persian Gulf theater of operations during the Per15 sian Gulf War or to the illnesses of the family mem16 bers of such individuals;

17 ‘‘(B) compensation and benefits, including

18 health care and other health-related benefits, that

19 may be provided by the Department of Veterans Af20 fairs or the Department of Defense to an individual

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

22 Persian Gulf theater of operations during the Per23 sian Gulf War or, in the case of such an individual

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

25 parents of such an individual; and
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1 ‘‘(C) any other information that the Secretary

2 determines to be appropriate.

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

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

5 Secretary shall consult with veterans’ service organiza6 tions.

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

8 apply regarding notification of any individual if that indi9 vidual makes a written request to the Secretary of Veter10 ans Affairs that the notification not be provided.’’.

11 SEC. 6. COMPENSATION BENEFITS FOR DISABILITY RE12 SULTING FROM ILLNESS ATTRIBUTED TO

13 SERVICE DURING THE PERSIAN GULF WAR.

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

15 States Code, is amended by adding at the end of sub16 chapter II the following new section:

17 ‘‘§ 1117. Compensation for disabilities associated with

18 Persian Gulf War

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

20 subchapter to a Persian Gulf veteran suffering from a

21 chronic disability resulting from an undiagnosed illness (or

22 combination of undiagnosed illnesses) that became mani23 fest to a degree of 10 percent or more before the later

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

25 period beginning on the last date on which the veteran
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1 performed active military, naval, or air service in the

2 Southwest Asia theater of operations while on active duty.

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

4 subchapter is payable shall be considered to be service con5 nected for purposes of all other laws of the United States.

6 ‘‘(c) Compensation may not be paid under this sec7 tion with respect to a disability occurring in a veteran—

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

9 the disability was not incurred by the veteran during

10 service in the Persian Gulf theater of operations

11 during the Persian Gulf War; or

12 ‘‘(2) where there is affirmative evidence to es13 tablish that an intercurrent injury or illness which is

14 a recognized cause of the disability was suffered by

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

16 recent departure from that theater of operations

17 while on active duty and the onset of the disability.

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

19 this section with respect to a disability for which com20 pensation is paid under this section for any month after

21 the month during which the Secretary determines that

22 such disability was not incurred as the result of service

23 in the Southwest Asia theater of operations during the

24 Persian Gulf War.
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1 ‘‘(e) For purposes of this section, the term ‘Persian

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

3 in the Armed Forces in the Southwest Asia theater of op4 erations during the Persian Gulf War.

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

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

7 period beginning on the date of the enactment of this sec8 tion.

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

10 Secretary submits to the Committees on Veterans’ Affairs

11 of the Senate and House of Representatives a report stat12 ing that, as of the date of the report, no diagnoses for

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

14 based on current medical knowledge, such three-year pe15 riod shall continue for an additional three years.

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

17 a report addressing the issue of diagnoses of such illnesses

18 not later than April 1, 1997.’’.

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

20 chapter is amended by inserting after the item relating

21 to section 1116 the following new item:

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

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

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

24 effect on October 1, 1994.
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1 SEC. 7. AUTHORIZATION OF APPROPRIATIONS FOR PER2 SIAN GULF ILLNESS RESEARCH.

3 There is authorized to be appropriated to the Depart4 ment of Veterans Affairs $5,000,000 for each of fiscal

5 years 1995 through 1997 for the conduct of research,

6 which the Secretary of Veterans Affairs, in consultation

7 with the Secretary of Defense and the Secretary of Health

8 and Human Services, determines would advance under9 standing of health risks and effects of service during the

10 Persian Gulf War and effective means of treating such

11 health effects.

12 SEC. 8. SURVEY OF PERSIAN GULF VETERANS.

13 (a) IN GENERAL.—There is authorized to be appro14 priated to the Department of Veterans Affairs such sums

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

16 survey of Persian Gulf veterans to gather information on

17 the incidence and nature of health problems occurring in

18 Persian Gulf veterans and their families.

19 (b) COORDINATION WITH DEPARTMENT OF DE20 FENSE.—The survey under subsection (a) shall be carried

21 out in coordination with the Secretary of Defense.

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

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

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

25 theater of operations during the Persian Gulf War as de26 fined in section 101(33) of title 38, United States Code.
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1 SEC. 9. AUTHORIZATION FOR EPIDEMIOLOGICAL STUDIES.

2 (a) STUDY OF HEALTH CONSEQUENCES OF PERSIAN

3 GULF SERVICE.—If the National Academy of Sciences in4 cludes in the report required by section 706(b) of the Vet5 erans Health Care Act of 1992 (Public Law 102–585) a

6 finding that there is a sound basis for an epidemiological

7 study or studies on the health consequences of service in

8 the Persian Gulf theater of operations during the Persian

9 Gulf War and recommends the conduct of such a study

10 or studies, the Secretary of Veterans Affairs is authorized

11 to carry out such study.

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

13 enter into an agreement with the Medical Follow-Up

14 Agency (MFUA) of the Institute of Medicine of the Na15 tional Academy of Sciences for (A) the review of proposals

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

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

18 findings.

19 (2) If the Secretary is unable to enter into an agree20 ment under paragraph (1) with the entity specified in that

21 paragraph, the Secretary shall enter into an agreement de22 scribed in that paragraph with another appropriate sci23 entific organization which does not have a connection to

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

25 Secretary shall submit to the Committees on Veterans’ Af26 fairs of the Senate and House of Representatives, at least
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1 90 days before the date on which the agreement is entered

2 into, notice in writing identifying the organization with

3 which the Secretary intends to enter into the agreement.

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

5 agreements with the Secretary of Defense and the Sec6 retary of Health and Human Services to make available

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

8 all data that the Secretary, in consultation with the Na9 tional Academy of Sciences and the contractor, considers

10 relevant to the study.

11 (d) AUTHORIZATION.—There are authorized to be ap12 propriated to the Department such sums as are necessary

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

14 SEC. 10. EXTENSION OF MARRIAGE AND FAMILY COUNSEL15 ING AVAILABILITY FOR PERSIAN GULF WAR

16 VETERANS.

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

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

19 1712A note) is amended by striking out ‘‘September 30,

20 1994’’ and inserting in lieu thereof ‘‘December 31, 1998’’.

21 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

22 121(g) of the Veterans’ Medical Programs Amendments

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

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

25 1999’’.
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1 SEC. 11. COST-SAVINGS PROVISIONS.

2 (a) ELECTION OF DEATH PENSION BY SURVIVING

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

4 is amended—

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

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

7 (b), no person’’; and

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

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

10 and indemnity compensation by reason of any death occur11 ring after December 31, 1956, may elect to receive death

12 pension instead of such compensation.’’.

13 (b) POLICY REGARDING COST-OF-LIVING ADJUST14 MENT IN COMPENSATION RATES FOR FISCAL YEAR

15 1995.—The fiscal year 1995 cost-of-living adjustments in

16 the rates of and limitations for compensation payable

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

18 dependency and indemnity compensation payable under

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

20 equal to the percentage by which benefit amounts payable

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

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

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

24 (42 U.S.C. 415(i)), with all increased monthly rates and

25 limitations (other than increased rates or limitations equal
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1 to a whole dollar amount) rounded down to the next lower

2 dollar.

Passed the House of Representatives August 8,

1994.

Attest:

Clerk.

103D CONGRESS

2D SESSION H. R. 4386

AN ACT

To amend title 38, United States Code, authorizing

War veterans, and for other purposes.search into illnesses reported by Persian GulfPersian Gulf War, to provide for increased rethe Persian Gulf theater of operations during theresulting from illnesses attributed to service inpensation to veterans suffering from disabilitiesthe Secretary of Veterans Affairs to provide com-