I

103D CONGRESS

2D SESSION H. R. 4540

To provide a program of compensation and health research for illnesses

arising from service in the Armed Forces during the Persian Gulf War.

IN THE HOUSE OF REPRESENTATIVES

JUNE 8, 1994

Mr. EVANS (for himself, Mr. BROWDER, Mr. DELLUMS, Mr. GUTIERREZ, Mr.

MCCLOSKEY, Mr. OBERSTAR, Mr. GONZALEZ, Mr. BROWN of California,

Mrs. SCHROEDER, Mr. FILNER, Ms. WATERS, Mr. KENNEDY, Mr. BOUCHER, Mr. FALEOMAVAEGA, Mr. HOLDEN, Mr. ACKERMAN, Mr.

HOCHBRUECKNER, Mr. WASHINGTON, Mr. CARR of Michigan, Mr. FARR

of California, Mr. FRANK of Massachusetts, Mr. COOPER, Mr. GEJDENSON, Mr. SANDERS, Ms. SLAUGHTER, Mr. SERRANO, Mr. KREIDLER, Mr.

BARLOW, Mr. TRAFICANT, Mrs. LOWEY, Mr. BARRETT of Wisconsin, Mr.

HALL of Ohio, Mr. ANDREWS of Maine, Mr. KOPETSKI, Mr. ORTON, Mr.

OLVER, Mr. UNDERWOOD, Mr. KLECZKA, Mr. EDWARDS of California,

Mr. MARKEY, Mr. JOHNSTON of Florida, Mr. JEFFERSON, Mr.

FINGERHUT, Mr. MANTON, Mr. STRICKLAND, Mr. LANCASTER, Mr. MINETA, Mr. SWETT, Mr. DEUTSCH, Mr. BONIOR, Mr. BILBRAY, Mrs.

UNSOELD, Mr. PETERSON of Florida, and Mr. RICHARDSON) introduced

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

A BILL

To provide a program of compensation and health research

for illnesses arising from service in the Armed Forces

during the Persian Gulf War.

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 ‘‘Persian Gulf War Vet3 erans’ Compensation Act of 1994’’.

4 SEC. 2. CONGRESSIONAL FINDINGS.

5 The Congress makes the following findings:

6 (1) The United States bears responsibility for

7 the care and treatment of illnesses and disabilities

8 connected with service in the Armed Forces. When

9 the etiology of a specific condition occurring in vet10 erans is unknown, it is the Government’s responsibil11 ity to give veterans the benefit of the doubt and to

12 provide appropriate treatment and compensation

13 until the scientific evidence warrants otherwise.

14 (2) During the Persian Gulf War, members of

15 the Armed Forces (A) were exposed to numerous po16 tentially toxic substances (including fumes and

17 smoke from petrochemicals and depleted uranium),

18 to infectious agents, to chemoprophylactic agents,

19 and to indigenous diseases, (B) received multiple im20 munizations and (C) may have been exposed to var21 ious chemical and biological warfare agents. Threats

22 of enemy use of chemical and biological weapons

23 heightened the psychological stress otherwise associ24 ated with the military operation.

25 (3) Significant numbers of veterans of the Per26 sian Gulf War are suffering from illnesses, or are ex-
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1 hibiting symptoms of illnesses, that cannot (as of the

2 enactment of this Act) be diagnosed or clearly de3 fined. As a result, many of these conditions or ill4 nesses are not considered to be service connected for

5 purposes of benefits administered by the Secretary

6 of Veterans Affairs.

7 (4) The Technology Assessment Workshop on

8 the Persian Gulf Experience and Health conducted

9 by the National Institutes of Health found that the

10 complex biological, chemical, physical, and psycho11 logical environment of the Southwest Asia theater of

12 operations produced complex adverse health effects

13 in Persian Gulf War veterans and that it appears as

14 if there is no single condition or illness among af15 fected Persian Gulf War veterans, but rather mul16 tiple illnesses with overlapping symptoms and

17 causes.

18 (5) That workshop concluded that the data con19 cerning the range and intensity of exposure to toxic

20 substances by military personnel in the Southwest

21 Asia theater of operations are very limited and that

22 such data were collected only after a considerable

23 delay.

24 (6) In response to concerns regarding the

25 health care needs of Persian Gulf War veterans, par-
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1 ticularly those who suffer from undiagnosable condi2 tions or illnesses, the Congress, in Public Law 102–

3 585, directed the establishment of the Persian Gulf

4 War Veterans Health Registry, authorized health ex5 aminations for Persian Gulf War veterans, and pro6 vided for the National Academy of Sciences to con7 duct a comprehensive review and assessment of in8 formation regarding the health consequences of mili9 tary service in the theater of operations during the

10 Persian Gulf War and to develop recommendations

11 for research on such health consequences. In Public

12 Law 103–210, Congress authorized the Department

13 of Veterans Affairs to provide health care services on

14 a priority basis to Persian Gulf War veterans. In

15 Public Law 103–160, Congress provided funding for

16 the establishment of a specialized environmental

17 medical facility for the conduct of research into the

18 potential health effects of low-level chemical expo19 sure and for research on the potential health effects

20 of battlefield exposure to depleted uranium.

21 (7) The workshop referred to in paragraph (4)

22 noted that well-designed epidemiological studies have

23 not been conducted to link the conditions or illnesses

24 of the military personnel with exposures in the thea25 ter of operations during the Persian Gulf War and
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1 found that the absence of such studies has hampered

2 efforts to provide treatment and compensation to

3 veterans of the Persian Gulf War. Accordingly, fur4 ther research and studies should be undertaken to

5 determine the underlying causes of the illnesses suf6 fered by Persian Gulf War veterans and, pending

7 the outcome of such research, veterans who are seri8 ously ill and whose illness may be related to their

9 military service should receive compensation benefits

10 to offset the impairment in earnings capacities they

11 may be experiencing.

12 SEC. 3. PURPOSES.

13 The purposes of this Act are—

14 (1) to require the Secretary of Veterans Affairs

15 to provide compensation to Persian Gulf War veter16 ans who have disabilities resulting from an illness or

17 illnesses that cannot (as of the enactment of this

18 Act) be diagnosed or defined and for which other

19 causes cannot (as of the enactment of this Act) be

20 identified until such time as scientific evidence dem21 onstrates that the illnesses are unrelated to military

22 service during the Persian Gulf War;

23 (2) to require the Secretary of Veterans Affairs

24 to develop case assessment protocols and case defini25 tions for such illnesses;
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1 (3) to establish an outreach program to Persian

2 Gulf War veterans and their families to inform them

3 of ongoing research activities as well as the services

4 and benefits for which they are eligible; and

5 (4) to authorize further research activities, in6 cluding an epidemiological study, on the health risks

7 and effects of military service in the Southwest thea8 ter of operations during the Persian Gulf War.

9 SEC. 4. DEVELOPMENT OF CASE ASSESSMENT PROTOCOLS

10 AND CASE DEFINITIONS.

11 (a) UNIFORM CASE ASSESSMENT PROTOCOL.—(1)

12 The Secretary of Veterans Affairs shall develop and imple13 ment a uniform case assessment protocol that will ensure

14 thorough assessment, diagnosis, and treatment of all Per15 sian Gulf War veterans suffering from illnesses the origins

16 of which are (as of the enactment of this Act) unknown

17 and that may be attributable to service in the Southwest

18 Asia theater of operations during the Persian Gulf War.

19 (2) If such a uniform case assessment protocol is not

20 implemented before the end of the 120-day period begin21 ning on the date of the enactment of this Act, the Sec22 retary shall, before the end of such period, submit to the

23 Committees on Veterans’ Affairs of the Senate and House

24 of Representatives a report as to why such a protocol has

25 not yet been developed.
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1 (b) CASE DEFINITIONS.—(1) The Secretary shall de2 velop case definitions or diagnoses for illnesses, the origins

3 of which are (as of the enactment of this Act) unknown

4 and that may be associated with service in the Persian

5 Gulf War.

6 (2) If such case definitions and diagnoses are not de7 veloped before the end of the 120-day period beginning

8 on the date of the enactment of this Act, the Secretary

9 shall, before the end of such period, submit to the Commit10 tees on Veterans’ Affairs of the Senate and House of Rep11 resentatives a report as to why such case definitions and

12 diagnoses have not yet been developed.

13 (c) CONSULTATION.—Subsections (a) and (b) shall be

14 carried out in consultation with the Secretary of Defense

15 and the Secretary of Health and Human Services.

16 SEC. 5. OUTREACH TO PERSIAN GULF VETERANS.

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

18 shall implement a comprehensive outreach program to in19 form Persian Gulf War veterans and their families of the

20 medical care and other benefits that may be provided by

21 the Department of Veterans Affairs and the Department

22 of Defense arising from service in the Persian Gulf War.

23 (b) NEWSLETTER.—The outreach program shall in24 clude a newsletter which shall be updated and distributed

25 at least annually and shall be distributed to the veterans
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1 listed on the Persian Gulf War Veterans Health Registry.

2 The newsletter shall include summaries of the status and

3 findings of Government sponsored research on illnesses of

4 Persian Gulf War veterans and their families as well as

5 on benefits available to such individuals through the De6 partment of Veterans Affairs. The newsletter shall be pre7 pared in consultation with veterans service organizations.

8 (c) TOLL-FREE NUMBER.—The outreach program

9 shall include establishment of a toll-free telephone number

10 to provide Persian Gulf War veterans and their families

11 information on the Persian Gulf War Veterans Health

12 Registry, health care and other benefits provided by the

13 Department of Veterans Affairs, and such other informa14 tion as the Secretary considers appropriate. Such toll-free

15 telephone number shall be established not later than 90

16 days after the date of the enactment of this Act.

17 SEC. 6. COMPENSATION FOR DISABILITIES RESULTING

18 FROM ILLNESSES ASSOCIATED WITH SERV19 ICE DURING THE PERSIAN GULF WAR.

20 (a) IN GENERAL.—

21 (1) Chapter 11 of title 38, United States Code,

22 is amended by adding at the end of subchapter I the

23 following new section:
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1 ‘‘§ 1117. Compensation for conditions or illnesses of

2 unknown origin associated with service

3 during the Persian Gulf War

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

5 subchapter to a Persian Gulf War veteran suffering from

6 a disability resulting from an undiagnosed illness, or com7 bination of illness, that becomes manifest to a degree of

8 10 percent or more within three years of separation from

9 active military, naval, or air service.

10 ‘‘(b)(1) The Secretary shall issue, within 90 days of

11 the date of the enactment of this section, preliminary reg12 ulations governing the award of such compensation.

13 ‘‘(2) The percentage of disability that equals 10 per14 cent shall be described as ‘mild impairment of social and

15 industrial adaptability’.

16 ‘‘(3) The percentage of disability that equals a total

17 or 100 percent rating shall be described as ‘demonstra18 tively unable to obtain or retain substantial gainful em19 ployment’.

20 ‘‘(4) In determining the rating schedule for such dis21 ability, the Secretary should examine analogous ratings.

22 ‘‘(5) In determining eligibility for compensation

23 under this section, the Secretary shall give due consider24 ation to ‘lay evidence’, including testimony provided by the

25 claimant, supporting witnesses, and independent medical

26 experts.
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1 ‘‘(c) Not later than 60 days after the date on which

2 the Secretary issues any proposed regulations pursuant to

3 this section, the Secretary shall issue final regulations

4 under this section. Such regulations shall be effective on

5 the date of issuance.

6 ‘‘(d) A disability for which compensation under this

7 section is awarded shall be considered to be service con8 nected for purposes of all other laws of the United States.

9 ‘‘(e) Compensation may not be paid under this sec10 tion for a disability occurring in a veteran—

11 ‘‘(1) where there is a preponderance of evidence

12 that the disability was not incurred by the veteran

13 in the Southwest Asia theater of operations during

14 the Persian Gulf War; or

15 ‘‘(2) where there is a preponderance of evidence

16 to establish that an intercurrent injury or illness

17 which is a recognized cause of the disability was suf18 fered by the veteran between the date of the veter19 an’s most recent departure from the Southwest Asia

20 theater of operations while on active duty and the

21 onset of the disability.

22 ‘‘(f) For purposes of this section, the term ‘Persian

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

24 in the Armed Forces in the Southwest Asia theater of op25 erations during the Persian Gulf War.
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1 ‘‘(g) Payments shall be made under this section to

2 a veteran until such time as the scientific evidence dem3 onstrates that the illnesses for which compensation is

4 awarded under this section are not connected to service

5 in the Southwest Asia theater of operations during the

6 Persian Gulf War. The Secretary may cease payments

7 under this section only after providing a report describing

8 the Secretary’s intentions, as well as the scientific basis

9 for ceasing such payments, at least 90 days before imple10 mentation of such action to the Committees on Veterans

11 Affairs of the Senate and House of Representatives.

12 ‘‘(h) Compensation awarded under this section shall

13 not preclude a veteran from receiving retroactive com14 pensation for a benefit claim that was filed before the date

15 of the enactment of this section if the veteran’s illness or

16 illnesses are later found to be service connected.

17 ‘‘(i) The Secretary shall consider having all claims for

18 compensation under this section adjudicated on a priority

19 basis at a single Department facility in order to better

20 ensure the consistency of rating decisions.

21 ‘‘(j) The Secretary shall have all claims for service22 connected benefits connected to an undiagnosable illness

23 or illnesses in veterans of the Persian Gulf War that were

24 denied before the date of the enactment of this section

25 reopened and adjudicated as original claims. In such a
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1 case, the date of claim shall be considered to be the date

2 on which the original claim was filed.’’.

3 (2) The table of sections at the beginning of

4 such chapter is amended by inserting after the item

5 relating to section 1116 the following new item:

‘‘1117. Presumption of service connection for illnesses associated with the Persian Gulf War.’’.

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

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

8 effect on October 1, 1994.

9 SEC. 7. RESULTS OF EXAMINATIONS AND TREATMENT OF

10 PERSIAN GULF WAR VETERANS WITH

11 UNDIAGNOSABLE ILLNESSES.

12 (a) ACCESS TO DATA.—The Secretary of Veterans

13 Affairs shall enter into an agreement with the Secretary

14 of Defense to have access to all clinical data of the Depart15 ment of Defense on veterans of the Persian Gulf War who

16 remain on active duty.

17 (b) ONGOING COMPILATION OF DATA.—The Sec18 retary of Veterans Affairs shall compile and analyze, on

19 a continuing basis, all clinical data obtained on veterans

20 of the Persian Gulf War in connection with examinations

21 and treatment furnished by the Department of Veterans

22 Affairs and the Department of Defense that are likely (1)

23 to be scientifically useful in determining the association

24 between the undiagnosable illnesses of veterans and their
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1 service in the Southwest Asia theater of operations during

2 the Persian Gulf War, and (2) to be useful in the develop3 ment of case assessment protocols or case definitions.

4 (c) ANNUAL REPORT.—The Secretary shall submit to

5 the Committees on Veterans’ Affairs of the Senate and

6 House of Representatives an annual report containing—

7 (1) the information compiled in accordance with

8 subsection (b);

9 (2) the Secretary’s analysis of such information;

10 (3) a discussion of the incidence of illnesses

11 identified or treated by the Department of Veterans

12 Affairs in the case of veterans referred to in sub13 section (b); and

14 (4) the Secretary’s explanation for the incidence

15 of such illnesses and disabilities.

16 SEC. 8. EPIDEMIOLOGICAL RESEARCH.

17 (a) CONTRACT.—The Secretary of Veterans Affairs

18 shall enter into a contract for the conduct of an epidemio19 logical study designed to assess both the short- and long20 term health consequences of service in the Southwest Asia

21 theater of operations during the Persian Gulf War on vet22 erans of the Persian Gulf War and their immediate family

23 members.

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

25 enter into an agreement with the National Academy of
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1 Sciences for the Medical Follow-Up Agency (MFUA) of

2 the Institute of Medicine of the Academy for (A) the re3 view of proposals to conduct the research specified in sub4 section (a), (B) oversight of such research, and (C) review

5 of the research findings.

6 (2) If the Secretary is unable to enter into an agree7 ment under paragraph (1) with the entity specified in that

8 paragraph, the Secretary shall enter into an agreement de9 scribed in that paragraph with another appropriate sci10 entific organization which does not have a connection to

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

12 Secretary shall submit to the Committees on Veterans’ Af13 fairs of the Senate and House of Representatives, at least

14 90 days before the date on which the agreement is entered

15 into, notice in writing identifying the organization with

16 which the Secretary intends to enter into the agreement.

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

18 agreements with the Secretary of Defense and the Sec19 retary of Health and Human Services to access and make

20 available to the contractor under subsection (a) all data

21 that the Secretary, in consultation with the National

22 Academy of Sciences and the contractor, considers rel23 evant to the study.

24 (d) STATUS REPORT.—Within 180 days after the

25 date of the enactment of this Act, the Secretary shall sub-
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1 mit to the Committees on Veterans’ Affairs of the Senate

2 and House of Representatives a report on the status of

3 the contract specified in subsection (a).

4 (e) AUTHORIZATION.—There is authorized to be ap5 propriated to the Department $7,500,000 for each of fis6 cal years 1995 through 2000 for the conduct of the re7 search specified in subsection (a). In addition to amounts

8 for such research appropriated pursuant to the preceding

9 sentence, the Secretary may provide funds for such re10 search from any funds appropriated for any fiscal year

11 after fiscal year 1994 for the purpose of research spon12 sored by the Department.

13 (f) ANNUAL REPORT.—For each year of the study,

14 the Secretary shall submit to the Committees on Veterans’

15 Affairs of the Senate and House of Representatives a re16 port accompanying the budget for that year containing—

17 (1) the methodology and status of the study

18 specified in subsection (a); and

19 (2) any preliminary analyses of the information

20 compiled in accordance with subsection (a), includ21 ing that provided by the National Academy of

22 Sciences.

23 (g) FINAL REPORT.—At the conclusion of the study,

24 the Secretary shall submit to the Committees on Veterans’
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1 Affairs of the Senate and House of Representatives a re2 port accompanying the budget containing—

3 (1) the methodology of the study specified in

4 subsection (a);

5 (2) the analysis of the information compiled in

6 accordance with subsection (a), including that pro7 vided by the National Academy of Sciences;

8 (3) a discussion of incidence of illnesses ob9 served in veterans of the Persian Gulf War and their

10 families;

11 (4) the National Academy of Sciences conclu12 sions concerning the health consequences of service

13 in the Southwest Asia theater of operations during

14 the Persian Gulf War on veterans and their imme15 diate family members; and

16 (5) the Secretary’s explanation for the incidence

17 of such illnesses and disabilities and recommenda18 tions for future action.

19 SEC. 9. AUTHORIZATION FOR OTHER RESEARCH.

20 There is authorized to be appropriated to the Depart21 ment of Veterans Affairs $5,000,000 for each of fiscal

22 years 1995 through 1998 for the conduct of research

23 which the Secretary, in consultation with the Secretary of

24 Defense and the Secretary of Health and Human Services,

25 determines could advance understanding of health risks
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1 and effects of service during the Persian Gulf War and

2 the means of treating those health effects.

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