Union Calendar No. 364

103D CONGRESS

2D SESSION H. R. 4386

[Report No. 103–669]

A BILL

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 comAUGUST 4, 1994

Reported with an amendment, committed to the Commitordered to be printed tee of the Whole House on the State of the Union, and
IB

Union Calendar No. 364

103D CONGRESS

2D SESSION H. R. 4386

[Report No. 103–669]

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.

IN THE HOUSE OF REPRESENTATIVES

MAY 11, 1994

Mr. MONTGOMERY (for himself, Mr. SLATTERY, Mr. ROWLAND, Mr. BILIRAKIS, Mr. KENNEDY, Mr. CLEMENT, Mr. STEARNS, Mr. BISHOP, Mr.

PARKER, Mr. KREIDLER, Mr. HALL of Ohio, Mr. TEJEDA, Mr. STUMP,

Mr. APPLEGATE, Mr. BACHUS of Alabama, Mr. SANGMEISTER, Mr. JACOBS, Mr. GONZALEZ, Mr. COOPER, Mr. EDWARDS of Texas, Mr. KYL,

Mr. TAYLOR of Mississippi, Mr. BROWN of Ohio, Ms. BROWN of Florida,

Mr. SWETT, Mr. SMITH of New Jersey, Mr. QUINN, Mr. BEVILL, Mr.

CANADY, Mr. COLLINS of Georgia, Mr. MCHALE, Mr. HEFNER, Mr.

MACHTLEY, Mr. COYNE, Mrs. JOHNSON of Connecticut, Mr. GORDON,

Mr. SKELTON, Mr. WALSH, Mr. RAHALL, Mrs. MEEK of Florida, Mr.

BOEHLERT, Mr. CALLAHAN, Mr. MYERS of Indiana, Mr. MCCURDY, Mr.

ORTON, Mrs. LLOYD, Mr. ACKERMAN, Mr. ORTIZ, Mr. BATEMAN, Mr.

DELLUMS, Mr. CAMP, Mr. HOCHBRUECKNER, Mr. WELDON, Mr. LIPINSKI, Mr. PETE GEREN of Texas, Mr. PRICE of North Carolina, Mr. GENE

GREEN of Texas, Mr. FILNER, Mr. FROST, Mr. BURTON of Indiana, Mr.

HANCOCK, Mr. RIDGE, Mr. KINGSTON, Mr. LANCASTER, Mr. BROWDER,

Mr. HUTCHINSON, Mr. BUYER, Mr. SHAW, Mr. CRAMER, Mr.

FINGERHUT, Mr. WILSON, Mr. LEWIS of Florida, Mrs. VUCANOVICH, Mr.

PICKETT, Mr. FARR, Mr. JOHNSON of Georgia, Mr. TRAFICANT, Mr.

CARR of Michigan, Mr. FRANK of Massachusetts, Mr. COLEMAN, Mr.

DEAL, Mrs. SCHROEDER, Mr. RICHARDSON, Mr. EVERETT, Mr. SOLOMON, Mr. CUNNINGHAM, Mr. BROWN of California, Mr. SAXTON, Mr.

LEWIS of California, Mr. LAUGHLIN, Mr. MINGE, Mr. TORKILDSEN, Mr.

HUNTER, Mr. BARLOW, Mr. WILLIAMS, Mr. KLEIN, Mr. GREENWOOD,
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Mr. BARCA of Wisconsin, Mr. WHITTEN, Mr. SCHIFF, Mr. BARCIA of

Michigan, Mr. DOOLEY, Mr. ROSE, Mr. PALLONE, Mr. DEFAZIO, Mr.

BACCHUS of Florida, Mr. DE LA GARZA, Mrs. MORELLA, Mr. CLAY, Mr.

OBERSTAR, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. DURBIN, Mr.

DE LUGO, Mr. MICHEL, Mr. QUILLEN, Mr. HANSEN, Mr. MILLER of

California, Mr. BAKER of Louisiana, Mr. BONILLA, Mr. MANN, Mr. PETERSON of Florida, Mr. ENGEL, Mr. LAFALCE, Mr. INGLIS of South

Carolina, Mr. MOAKLEY, Mr. SYNAR, Mr. NEAL of North Carolina, Mr.

DIAZ-BALART, Mr. BARRETT of Wisconsin, Mr. LEVY, Mr. GILMAN, Mr.

STUPAK, Mr. SHAYS, Mr. SPENCE, Ms. KAPTUR, Mrs. MALONEY, Mr.

WASHINGTON, Mr. MINETA, Mr. GUNDERSON, Mr. THORNTON, Mr.

DUNCAN, Mr. KING, Mr. TUCKER, Mr. FALEOMAVAEGA, Mr. TORRES,

Mr. GINGRICH, Mr. PASTOR, Mr. NEAL of Massachusetts, Mr. JOHNSON

of South Dakota, Mr. HOAGLAND, Mr. DIXON, Mr. ROMERO BARCELO ́,

Mr. THOMPSON of Mississippi, Mr. EMERSON, Mr. LINDER, Mr.

TORRICELLI, Mr. CALVERT, Ms. FURSE, Ms. ENGLISH of Arizona, Mr.

JEFFERSON, Mr. STRICKLAND, Mr. STENHOLM, Mr. PAYNE of Virginia,

Mr. CHAPMAN, Mr. MCNULTY, Mrs. CLAYTON, Mr. HALL of Texas, Mrs.

BYRNE, Ms. PRYCE of Ohio, and Mr. EVANS) introduced the following

bill; which was referred to the Committee on Veterans’ Affairs

AUGUST 4, 1994

Reported with an amendment, committed to the Committee of the Whole

House on the State of the Union, and ordered to be printed

[Strike out all after the enacting clause and insert the part printed in italic]

[For text of introduced bill, see copy of bill as introduced on May 11, 1994]

A BILL

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,
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1 SECTION 1. SHORT TITLE.

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

3 War Benefits Act’’.

4 SEC. 2. CONGRESSIONAL FINDINGS.

5 The Congress makes the following findings:

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

7 the Armed Forces were exposed to numerous poten8 tially toxic substances, including fumes and smoke

9 from military operations, oil well fires, diesel exhaust,

10 paints, pesticides, depleted uranium, infectious

11 agents, chemoprophylactic agents, and indigenous dis12 eases, and were also given multiple immunizations. It

13 is not known whether these servicemembers were ex14 posed to chemical or biological warfare agents. How15 ever, threats of enemy use of chemical and biological

16 warfare heightened the psychological stress associated

17 with the military operation.

18 (2) Significant numbers of veterans of the Per19 sian Gulf War are suffering from illnesses, or are ex20 hibiting symptoms of illness, that cannot now be di21 agnosed or clearly defined. As a result, many of these

22 conditions or illnesses are not considered to be service

23 connected under current law for purposes of benefits

24 administered by the Department of Veterans Affairs.

25 (3) The Technology Assessment Workshop on the

26 Persian Gulf Experience and Health conducted by the
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1 National Institutes of Health concluded that the com2 plex biological, chemical, physical, and psychological

3 environment of the Southwest Asia theater of oper4 ations produced complex adverse health effects in Per5 sian Gulf War veterans and that it appears that no

6 single disease entity or syndrome exists. Rather, it

7 appears that the illnesses suffered by those veterans

8 result from multiple illnesses with overlapping symp9 toms and causes that have yet to be defined.

10 (4) That workshop concluded that the data con11 cerning the range and intensity of exposure to toxic

12 substances by military personnel in the Southwest

13 Asia theater of operations are very limited and that

14 such data were collected only after a considerable

15 delay.

16 (5) In response to concerns regarding the health17 care needs of Persian Gulf War veterans, particularly

18 those who suffer from illnesses or conditions for which

19 no diagnosis has been made, the Congress, in Public

20 Law 102–585, directed the establishment of a Persian

21 Gulf War Veterans Health Registry, authorized health

22 examinations for veterans of the Persian Gulf War,

23 and provided for the National Academy of Sciences to

24 conduct a comprehensive review and assessment of in25 formation regarding the health consequences of mili-
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1 tary service in the Persian Gulf theater of operations

2 and to develop recommendations on avenues for re3 search regarding such health consequences. In Public

4 Law 103–210, the Congress authorized the Depart5 ment of Veterans Affairs to provide health care serv6 ices on a priority basis to Persian Gulf War veterans.

7 The Congress also provided in Public Law 103–160

8 (the National Defense Authorization Act for Fiscal

9 Year 1994) for the establishment of a specialized envi10 ronmental medical facility for the conduct of research

11 into the possible health effects of exposure to low levels

12 of hazardous chemicals, especially among Persian

13 Gulf veterans, and for research into the possible health

14 effects of battlefield exposure in such veterans to de15 pleted uranium.

16 (6) Further research and studies must be under17 taken to determine the underlying causes of the ill18 nesses 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 com22 pensation benefits to offset the impairment in earn23 ings capacities they may be experiencing.

24 SEC. 3. PURPOSES.

25 The purposes of this Act are—
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1 (1) to provide compensation to Persian Gulf War

2 veterans who suffer disabilities resulting from illnesses

3 that cannot now be diagnosed or defined, and for

4 which other causes cannot be identified,

5 (2) to require the Secretary of Veterans Affairs

6 to develop at the earliest possible date case assessment

7 strategies and definitions or diagnoses of such ill8 nesses,

9 (3) to promote greater outreach to Persian Gulf

10 War veterans and their families to inform them of on11 going research activities, as well as the services and

12 benefits to which they are currently entitled, and

13 (4) to ensure that research activities and accom14 panying surveys of Persian Gulf War veterans are

15 appropriately funded and undertaken by the Depart16 ment of Veterans Affairs.

17 SEC. 4. DEVELOPMENT OF CASE ASSESSMENT PROTOCOL

18 AND CASE DEFINITIONS.

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

20 shall—

21 (1) develop and implement at the earliest pos22 sible date a uniform case assessment protocol that will

23 ensure thorough assessment, diagnosis, and treatment

24 of all Persian Gulf War veterans suffering from ill-
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1 ness attributed to service in the Southwest Asia thea2 ter of operations during the Persian Gulf War; and

3 (2) develop at the earliest possible date case defi4 nitions or diagnoses for illnesses associated with such

5 service.

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

7 assessment protocol under subsection (a)(1) and develop8 ment of case definitions or diagnoses under subsection

9 (a)(2) shall be carried out by the Secretary of Veterans Af10 fairs in consultation with the Secretary of Defense and the

11 Secretary of Health and Human Services.

12 (c) REPORTS.—The Secretary shall submit to the Com13 mittees on Veterans’ Affairs of the Senate and House of

14 Representatives an annual report on the status of the activi15 ties required by this section. The first such report shall be

16 submitted not later than six months after the date of the

17 enactment of this Act.

18 SEC. 5. PROVISION OF INFORMATION TO VETERANS OF THE

19 PERSIAN GULF WAR.

20 (a) OUTREACH PROGRAM.—The Secretary of Veterans

21 Affairs shall develop and implement a comprehensive out22 reach program and information system to provide Persian

23 Gulf War veterans and their families with information re24 garding the following:
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1 (1) The Persian Gulf War Veterans Health Reg2 istry established by the Persian Gulf War Veterans’

3 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 De6 partment 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 disabil19 ities resulting from service in the Persian Gulf War,

20 including disabilities resulting from illness that re21 sulted from such service.

22 (4) Significant developments in research relating

23 to the health consequences of service in the Persian

24 Gulf War.
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1 (5) Any other information that the Secretary de2 termines to be appropriate.

3 (b) TOLL-FREE TELEPHONE NUMBER.—The informa4 tion system required by subsection (a) shall include the es5 tablishment and staffing of a toll-free telephone number for

6 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 IN

11 REGISTRY.—(1) The Secretary of Veterans Affairs shall no12 tify each individual listed in the Registry or, in the case

13 of such an individual who is deceased, the surviving spouse,

14 children, or parents of such individual, at least quarterly,

15 by newsletter or by other means that the Secretary deter16 mines 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 Persian

21 Gulf War or to the illnesses of the family members of

22 such individuals;

23 ‘‘(B) compensation and benefits, including health

24 care and other health-related benefits, that may be

25 provided by the Department of Veterans Affairs or the
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1 Department of Defense to an individual who served as

2 a member of the Armed Forces in the Persian Gulf

3 theater of operations during the Persian Gulf War or,

4 in the case of such an individual who is deceased, to

5 the surviving spouse, children, or parents of such an

6 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 organizations.

12 ‘‘(3) The requirement of paragraph (1) shall not apply

13 regarding notification of any individual if that individual

14 makes a written request to the Secretary of Veterans Affairs

15 that the notification not be provided.’’.

16 SEC. 6. COMPENSATION BENEFITS FOR DISABILITY RE17 SULTING FROM ILLNESS ATTRIBUTED TO

18 SERVICE DURING THE PERSIAN GULF WAR.

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

20 States Code, is amended by adding at the end of subchapter

21 II the following new section:

22 ‘‘§ 1117. Compensation for disabilities associated with

23 Persian Gulf War

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

25 subchapter to a Persian Gulf veteran suffering from a
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1 chronic disability resulting from an undiagnosed illness (or

2 combination of undiagnosed illnesses) that became manifest

3 to a degree of 10 percent or more before the later of (1)

4 October 1, 1996, or (2) the end of the two-year period begin5 ning on the last date on which the veteran performed active

6 military, naval, or air service in the Southwest Asia theater

7 of operations while on active duty.

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

9 subchapter is payable shall be considered to be service con10 nected for purposes of all other laws of the United States.

11 ‘‘(c) Compensation may not be paid under this section

12 with respect to a disability occurring in a veteran—

13 ‘‘(1) where there is affirmative evidence that the

14 disability was not incurred by the veteran during

15 service in the Persian Gulf theater of operations dur16 ing the Persian Gulf War; or

17 ‘‘(2) where there is affirmative evidence to estab18 lish that an intercurrent injury or illness which is a

19 recognized cause of the disability was suffered by the

20 veteran between the date of the veteran’s most recent

21 departure from that theater of operations while on ac22 tive duty and the onset of the disability.

23 ‘‘(d) The Secretary may not make payments under this

24 section with respect to a disability for which compensation

25 is paid under this section for any month after the month
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1 during which the Secretary determines that such disability

2 was not incurred as the result of service in the Southwest

3 Asia theater of operations during the Persian Gulf War.

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

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

6 in the Armed Forces in the Southwest Asia theater of oper7 ations during the Persian Gulf War.

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

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

10 period beginning on the date of the enactment of this sec11 tion.

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

13 Secretary submits to the Committees on Veterans’ Affairs

14 of the Senate and House of Representatives a report stating

15 that, as of the date of the report, no diagnoses for the ill16 nesses referred to in subsection (a) can be made based on

17 current medical knowledge, such three-year period shall con18 tinue for an additional three years.

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

20 a report addressing the issue of diagnoses of such illnesses

21 not later than April 1, 1997.’’.

22 (2) The table of sections at the beginning of such chap23 ter is amended by inserting after the item relating to section

24 1116 the following new item:

‘‘1117. Compensation for disabilities associated with Persian Gulf War.’’.
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1 (b) EFFECTIVE DATE.—Section 1117 of title 38, Unit2 ed States Code, as added by subsection (a), shall take effect

3 on October 1, 1994.

4 SEC. 7. AUTHORIZATION OF APPROPRIATIONS FOR PER5 SIAN GULF ILLNESS RESEARCH.

6 There is authorized to be appropriated to the Depart7 ment of Veterans Affairs $5,000,000 for each of fiscal years

8 1995 through 1997 for the conduct of research, which the

9 Secretary of Veterans Affairs, in consultation with the Sec10 retary of Defense and the Secretary of Health and Human

11 Services, determines would advance understanding of health

12 risks and effects of service during the Persian Gulf War and

13 effective means of treating such health effects.

14 SEC. 8. SURVEY OF PERSIAN GULF VETERANS.

15 (a) IN GENERAL.—There is authorized to be appro16 priated to the Department of Veterans Affairs such sums

17 as are needed for fiscal year 1995 for the conduct of a sur18 vey of Persian Gulf veterans to gather information on the

19 incidence and nature of health problems occurring in Per20 sian Gulf veterans and their families.

21 (b) COORDINATION WITH DEPARTMENT OF DE22 FENSE.—The survey under subsection (a) shall be carried

23 out in coordination with the Secretary of Defense.

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

25 section, a Persian Gulf veteran is an individual who served
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1 on active duty in the Armed Forces in the Southwest Asia

2 theater of operations during the Persian Gulf War as de3 fined in section 101(33) of title 38, United States Code.

4 SEC. 9. AUTHORIZATION FOR EPIDEMIOLOGICAL STUDIES.

5 (a) STUDY OF HEALTH CONSEQUENCES OF PERSIAN

6 GULF SERVICE.—If the National Academy of Sciences in7 cludes in the report required by section 706(b) of the Veter8 ans Health Care Act of 1992 (Public Law 102–585) a find9 ing that there is a sound basis for an epidemiological study

10 or studies on the health consequences of service in the Per11 sian Gulf theater of operations during the Persian Gulf War

12 and recommends the conduct of such a study or studies, the

13 Secretary of Veterans Affairs is authorized to carry out such

14 study.

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

16 into an agreement with the Medical Follow-Up Agency

17 (MFUA) of the Institute of Medicine of the National Acad18 emy of Sciences for (A) the review of proposals to conduct

19 the research referred to in subsection (a), (B) oversight of

20 such research, and (C) review of the research findings.

21 (2) If the Secretary is unable to enter into an agree22 ment under paragraph (1) with the entity specified in that

23 paragraph, the Secretary shall enter into an agreement de24 scribed in that paragraph with another appropriate sci25 entific organization which does not have a connection to
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1 the Department of Veterans Affairs. In such a case, the Sec2 retary shall submit to the Committees on Veterans’ Affairs

3 of the Senate and House of Representatives, at least 90 days

4 before the date on which the agreement is entered into, no5 tice in writing identifying the organization with which the

6 Secretary intends to enter into the agreement.

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

8 agreements with the Secretary of Defense and the Secretary

9 of Health and Human Services to make available for the

10 purposes of any study described in subsection (a) all data

11 that the Secretary, in consultation with the National Acad12 emy of Sciences and the contractor, considers relevant to

13 the study.

14 (d) AUTHORIZATION.—There are authorized to be ap15 propriated to the Department such sums as are necessary

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

17 SEC. 10. EXTENSION OF MARRIAGE AND FAMILY COUNSEL18 ING AVAILABILITY FOR PERSIAN GULF WAR

19 VETERANS.

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

21 Medical Programs Amendments of 1992 (38 U.S.C. 1712A

22 note) is amended by striking out ‘‘September 30, 1994’’ and

23 inserting in lieu thereof ‘‘December 31, 1998’’.

24 (b) AUTHORIZATION OF APPROPRIATIONS.—Section

25 121(g) of the Veterans’ Medical Programs Amendments of
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1 1992 (38 U.S.C. 1712A note) is amended by striking out

2 ‘‘and 1994’’ and inserting in lieu thereof ‘‘through 1999’’.

3 SEC. 11. COST-SAVINGS PROVISIONS.

4 (a) ELECTION OF DEATH PENSION BY SURVIVING

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

6 amended—

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

8 lieu thereof ‘‘(a) Except as provided in subsection (b),

9 no person’’; and

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

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

12 and indemnity compensation by reason of any death occur13 ring after December 31, 1956, may elect to receive death

14 pension instead of such compensation.’’.

15 (b) POLICY REGARDING COST-OF-LIVING ADJUSTMENT

16 IN COMPENSATION RATES FOR FISCAL YEAR 1995.—The

17 fiscal year 1995 cost-of-living adjustments in the rates of

18 and limitations for compensation payable under chapter 11

19 of title 38, United States Code, and of dependency and in20 demnity compensation payable under chapter 13 of such

21 title will be no more than a percentage equal to the percent22 age by which benefit amounts payable under title II of the

23 Social Security Act (42 U.S.C. 401 et seq.) are increased

24 effective December 1, 1994, as a result of a determination

25 under section 215(i) of such Act (42 U.S.C. 415(i)), with
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1 all increased monthly rates and limitations (other than in2 creased rates or limitations equal to a whole dollar amount)

3 rounded down to the next lower dollar.

HR 4386 RH——2