Calendar No. 691

103D CONGRESS

2D SESSION S. 2330

[Report No. 103–386]

A BILL

To amend title 38, United States Code, to provide

for other purposes.compensation for service-connected diseases, andpurposes of entitlement of veterans to disabilitythat undiagnosed illnesses constitute diseases for

SEPTEMBER 28 (legislative day, SEPTEMBER 12), 1994

Reported with an amendment and an amendment to the

title
II

Calendar No. 691

103D CONGRESS

2D SESSION S. 2330

[Report No. 103–386]

To amend title 38, United States Code, to provide that undiagnosed illnesses

constitute diseases for purposes of entitlement of veterans to disability

compensation for service-connected diseases, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JULY 27 (legislative day, JULY 20), 1994

Mr. ROCKEFELLER (for himself, Mr. MURKOWSKI, Mr. DECONCINI, Mr.

MITCHELL, Mr. GRAHAM, Mr. AKAKA, Mr. DASCHLE, Mr. CAMPBELL,

Mr. THURMOND, Mr. SIMPSON, Mr. SPECTER, Mr. JEFFORDS, Mr. SARBANES, Mr. SMITH, Mr. WOFFORD, Mr. HOLLINGS, Mr. COCHRAN, Mr.

BINGAMAN, Mr. DURENBERGER, Mr. DODD, Mr. MOYNIHAN, Mr. KENNEDY, Mrs. MURRAY, Mr. DOLE, Mr. BIDEN, Mr. PELL, Mr. GREGG, Mr.

STEVENS, Mr. LOTT, Mr. INOUYE, Mrs. KASSEBAUM, Mr. COHEN, Mr.

ROBB, Mr. WELLSTONE, Mr. LAUTENBERG, Mr. BOND, Mr. SIMON, and

Mr. KOHL) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs

SEPTEMBER 28 (legislative day, SEPTEMBER 12), 1994

Reported by Mr. ROCKEFELLER, with an amendment and an amendment to

the title

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

A BILL

To amend title 38, United States Code, to provide that

undiagnosed illnesses constitute diseases for purposes of
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entitlement of veterans to disability compensation for

service-connected diseases, 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. CLARIFICATION OF RELATIONSHIP BETWEEN

4 UNDIAGNOSED ILLNESS AND DISEASE FOR

5 PURPOSES OF ENTITLEMENT TO DISABILITY

6 COMPENSATION.

7 (a) WARTIME DISABILITY COMPENSATION.—Section

8 1110 of title 38, United States Code, is amended—

9 (1) by inserting ‘‘(a)’’ before ‘‘For disability’’;

10 and

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

12 ‘‘(b) For the purposes of this section, the term ‘dis13 ease’, in the case of an individual, means any deviation

14 from or interruption of the normal structure or function

15 of any part, organ, or system of the body of the individual

16 that is manifested by a symptom or sign (or symptoms

17 or signs) the etiology, pathology, and prognosis for which

18 is known or unknown.’’.

19 (b) PEACETIME DISABILITY COMPENSATION.—Sec20 tion 1131 of such title is amended—

21 (1) by inserting ‘‘(a)’’ before ‘‘For disability’’;

22 and

23 (2) by adding at the end the following:
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1 ‘‘(b) For the purposes of this section, the term ‘dis2 ease’, in the case of an individual, means any deviation

3 from or interruption of the normal structure or function

4 of any part, organ, or system of the body of the individual

5 that is manifested by a symptom or sign (or symptoms

6 or signs) the etiology, pathology, and prognosis for which

7 is known or unknown.’’.

8 (c) CONSIDERATION OF CIRCUMSTANCES OF SERV9 ICE.—Subsection (a) of section 1154 of such title is

10 amended to read as follows:

11 ‘‘(a) The Secretary shall include in the regulations

12 pertaining to service-connection of disabilities the follow13 ing provisions:

14 ‘‘(1) Additional provisions requiring that due

15 consideration be given in each case where a veteran

16 is seeking service-connection for a disability and

17 where such consideration might materially assist the

18 veteran in establishing such service-connection to—

19 ‘‘(A) the places, types, and circumstances

20 of such veteran’s service as shown by such vet21 eran’s service record, the official history of each

22 organization in which the veteran served, such

23 veteran’s medical records, and all pertinent

24 medical and lay evidence; and
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1 ‘‘(B) the common or shared experiences,

2 medical symptoms or signs, or both, of other

3 veterans (including groups of veterans) who—

4 ‘‘(i) were engaged in service similar to

5 the service of such veteran; and

6 ‘‘(ii) exhibit, or have exhibited since

7 such service, medical symptoms or signs

8 similar to the medical symptoms or signs

9 of such veteran.

10 ‘‘(2) The provisions required by section 5 of the

11 Veterans’ Dioxin and Radiation Exposure Com12 pensation Standards Act (38 U.S.C. 1154 note).’’.

13 SECTION 1. CLARIFICATION OF DEFINITION OF DISEASE

14 FOR PURPOSES OF ENTITLEMENT TO DIS15 ABILITY COMPENSATION.

16 (a) WARTIME DISABILITY COMPENSATION.—Section

17 1110 of title 38, United States Code, is amended—

18 (1) by inserting ‘‘(a)’’ before ‘‘For disability’’;

19 and

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

21 ‘‘(b) For the purposes of this section, the term ‘disease’

22 means any deviation from or interruption of the normal

23 structure or function of any part, organ, or system (or com24 bination thereof) of the body that is manifested by a char-
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1 acteristic set of symptoms and signs and whose etiology,

2 pathology, and prognosis may be known or unknown.’’.

3 (b) PEACETIME DISABILITY COMPENSATION.—Section

4 1131 of such title is amended—

5 (1) by inserting ‘‘(a)’’ before ‘‘For disability’’;

6 and

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

8 ‘‘(b) For the purposes of this section, the term ‘disease’

9 means any deviation from or interruption of the normal

10 structure or function of any part, organ, or system (or com11 bination thereof) of the body that is manifested by a char12 acteristic set of symptoms and signs and whose etiology,

13 pathology, and prognosis may be known or unknown.’’.

14 (c) CONSIDERATION OF CIRCUMSTANCES OF SERV15 ICE.—Subsection (a) of section 1154 of such title is amend16 ed to read as follows:

17 ‘‘(a) The Secretary shall include in the regulations per18 taining to service-connection of disabilities the following

19 provisions:

20 ‘‘(1) Additional provisions requiring that due

21 consideration be given in each case where a veteran

22 is seeking service-connection for a disability and

23 where such consideration might materially assist the

24 veteran in establishing such service-connection to—
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1 ‘‘(A) the places, types, and circumstances of

2 such veteran’s service as shown by such veteran’s

3 service record, the official history of each organi4 zation in which the veteran served, such veteran’s

5 medical records, and all pertinent medical and

6 lay evidence; and

7 ‘‘(B) the common or shared experiences,

8 medical symptoms or signs, or both, of other vet9 erans (including groups of veterans) who—

10 ‘‘(i) were engaged in service similar to

11 the service of such veteran; and

12 ‘‘(ii) exhibit, or have exhibited since

13 such service, medical symptoms or signs

14 similar to the medical symptoms or signs of

15 such veteran.

16 ‘‘(2) The provisions required by section 5 of the

17 Veterans’ Dioxin and Radiation Exposure Compensa18 tion Standards Act (38 U.S.C. 1154 note).’’.

19 SEC. 2. AUTHORITY TO INVESTIGATE AND RECOMMEND ES20 TABLISHMENT OF PRESUMPTIONS OF SERV21 ICE CONNECTION.

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

23 States Code, is amended by inserting after section 1112 the

24 following new section:
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1 ‘‘§ 1112A. Proposals for presumptions of service con2 nection

3 ‘‘(a) If the Secretary becomes aware of assertions that

4 a group of veterans who had the same or similar military

5 service suffer from or exhibit the same or similar health con6 ditions (including diseases whose etiology, pathology, and

7 prognosis is known or unknown, illnesses, or medical symp8 toms or signs) and that such health conditions are related

9 to such service, the Secretary may carry out an inquiry

10 in order to—

11 ‘‘(1) confirm that veterans who had such service

12 suffer from or exhibit such health conditions;

13 ‘‘(2) identify all veterans who had such service

14 for purposes of determining which of such veterans

15 suffer from or exhibit such health conditions; and

16 ‘‘(3) determine whether or not a presumption of

17 a service connection should be established between

18 such service and such health conditions.

19 ‘‘(b)(1) If the Secretary determines under subsection

20 (a)(3) that a presumption of a service connection should

21 be established between military service and a health condi22 tion, the Secretary shall prepare a proposal relating to the

23 establishment of that presumption.

24 ‘‘(2) A proposal relating to the establishment of a pre25 sumption of a service connection under paragraph (1) shall

26 contain the following:
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1 ‘‘(A) A description of the nature, period, and

2 geographical area or areas of the military service for

3 which the presumption should be established.

4 ‘‘(B) A description of the health condition for

5 which the presumption should be established.

6 ‘‘(C) A description of any relevant medical char7 acteristic (such as a latency period) associated with

8 the health condition.

9 ‘‘(D) A statement of the limitations, if any, on

10 the period for which the Secretary would pay com11 pensation under this chapter for disabilities resulting

12 from the health condition.

13 ‘‘(c) Upon completion of a proposal under subsection

14 (b), the Secretary shall submit to the Committees on Veter15 ans’ Affairs of the Senate and the House of Representatives

16 a report containing the proposal, together with the rec17 ommendations of the Secretary for any legislation relating

18 thereto and the reasons for such recommendations.’’.

19 (2) The table of sections at the beginning of such chap20 ter is amended by inserting after the item relating to section

21 1112 the following new item:

‘‘1112A. Proposals for presumptions of service connection.’’.

22 (b) CONFORMING AMENDMENT.—Section 1137 of such

23 title is amended by inserting ‘‘1112A,’’ after ‘‘1112,’’.

24 (c) REPORT ON ESTABLISHMENT OF PRESUMPTION

25 FOR VETERANS OF PERSIAN GULF WAR.—(1) Not later
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1 than 30 days after the date of the enactment of this Act,

2 the Secretary of Veterans Affairs shall submit to the Com3 mittees on Veterans’ Affairs of the Senate and the House

4 of Representatives a report on whether or not a presump5 tion of a service connection should be established between

6 military service in the Southwest Asia theater of operations

7 during the Persian Gulf War and any health condition of

8 veterans who engaged in such service.

9 (2) For purposes of this subsection, the term ‘‘Persian

10 Gulf War’’ has the meaning given such term in section

11 101(33) of title 38, United States Code.

12 (d) REQUIREMENTS BASED ON DETERMINATION FOR

13 ESTABLISHMENT.—(1) If the Secretary reports under sub14 section (c) that a presumption of a service connection re15 ferred to in that subsection should be established, the Sec16 retary shall—

17 (A) include in the report under that subsection

18 the matters referred to in section 1112A(b)(2) of title

19 38, United States Code, as added by subsection (a),

20 with respect to the service connection; and

21 (B) publish proposed regulations relating to the

22 establishment of a presumption of the service connec23 tion and the payment of disability compensation as

24 a result of the service connection.
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1 (2) The Secretary shall provide for public notice and

2 comment on the proposed regulations published under para3 graph (1)(B). The period of such notice and comment shall

4 be 30 days.

5 (3) The Secretary shall publish final regulations relat6 ing to the matters referred to in paragraph (1)(B) not later

7 than 30 days after the end of the period for public notice

8 and comment under paragraph (2).

9 (e) TREATMENT OF CLAIMS AND COMPENSATION.—(1)

10 An award of compensation to a veteran under the regula11 tions prescribed under subsection (d) shall not preclude the

12 veteran from receiving retroactive compensation for a bene13 fit claim that was filed before the date of the enactment

14 of this Act if the veteran’s health condition is later found

15 to be service connected.

16 (2) The Secretary shall consider having all claims for

17 compensation under such regulations adjudicated on a pri18 ority basis at a single Department facility in order to better

19 ensure the consistency of rating decisions.

20 (3) The Secretary shall have all claims for service-con21 nected benefits connected to a health condition covered by

22 such regulations that were denied before the date of the en23 actment of this Act reopened and adjudicated as original

24 claims. In such a case, the date of claim shall be considered

25 to be the date on which the original claim was filed.
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1 SEC. 3. DEVELOPMENT OF CLINICAL EVALUATION PROTO2 COLS.

3 (a) UNIFORM CLINICAL EVALUATION PROTOCOL.—(1)

4 The Secretary of Veterans Affairs shall develop and imple5 ment a uniform and comprehensive clinical evaluation pro6 tocol to provide extensive medical examinations to Persian

7 Gulf War veterans who are suffering from illnesses the ori8 gins of which are (as of the date of the enactment of this

9 Act) unknown and that may be attributable to service in

10 the Southwest Asia theater of operations during the Persian

11 Gulf War. The protocol shall include an evaluation of com12 plaints relating to illnesses involving the reproductive

13 system.

14 (2) If such a clinical assessment protocol is not imple15 mented before the end of the 120-day period beginning on

16 the date of the enactment of this Act, the Secretary shall,

17 before the end of such period, submit to the Committees on

18 Veterans’ Affairs of the Senate and the House of Representa19 tives a report as to why such a protocol has not yet been

20 developed.

21 (3)(A) The Secretary shall ensure that the evaluation

22 under the protocol developed under this section is available

23 at all Department medical centers that have the capability

24 of providing the medical assessment, diagnosis, and treat25 ment required under the protocol.
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1 (B) The Secretary may enter into contracts with non2 Department medical facilities for the provision of the eval3 uation under the protocol.

4 (C) In the case of a veteran whose residence is distant

5 from a medical center described in subparagraph (A), the

6 Secretary may provide the evaluation through a Depart7 ment medical center described in that subparagraph and

8 pay or reimburse the veteran for the cost incurred by the

9 veteran in travel to the Department medical center.

10 (4)(A) If the Secretary is unable to diagnosis the

11 symptoms or illness of a veteran provided an evaluation,

12 or if the symptoms or illness of a veteran do not respond

13 to treatment provided by the Secretary, the Secretary may

14 provide for the veteran to receive the diagnosis or treatment,

15 as the case may be, at a non-Department medical facility

16 that may have the capability of diagnosing or treating the

17 symptoms or illness of the veteran. The Secretary may pay

18 the veteran or reimburse the veteran for the costs incurred

19 by the veteran in travel to the non-Department medical fa20 cility for the diagnosis or treatment.

21 (B) The Secretary shall request from each non-Depart22 ment medical facility that provides diagnosis of or treat23 ment to a veteran under this paragraph such information

24 relating to the diagnosis or treatment as the Secretary con25 siders appropriate. The release of such information to the
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1 Secretary may be subject to such requirements for confiden2 tiality as the facility may impose.

3 (5) In each year after the implementation of the proto4 col, the Secretary shall enter into an agreement with the

5 National Academy of Sciences under which agreement ap6 propriate members of the Academy shall review the ade7 quacy of the protocol and its implementation by the Depart8 ment of Veterans Affairs.

9 (b) RELATIONSHIP TO OTHER COMPREHENSIVE CLINI10 CAL EVALUATION PROTOCOLS.—The Secretary, in consulta11 tion with the Secretary of Defense, shall ensure that the in12 formation collected through the protocol described in this

13 section is collected and maintained in a manner that per14 mits the effective and efficient cross-reference of that infor15 mation with information collected and maintained through

16 the comprehensive clinical protocols of the Department of

17 Defense for Persian Gulf War veterans.

18 SEC. 4. OUTREACH TO PERSIAN GULF VETERANS.

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

20 shall implement a comprehensive outreach program to in21 form Persian Gulf War veterans and their families of the

22 medical care and other benefits that may be provided by

23 the Department of Veterans Affairs and the Department of

24 Defense arising from service in the Persian Gulf War.
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1 (b) NEWSLETTER.—The outreach program shall in2 clude a newsletter which shall be updated and distributed

3 at least annually and shall be distributed to the veterans

4 listed on the Persian Gulf War Veterans Health Registry.

5 The newsletter shall include summaries of the status and

6 findings of Government sponsored research on illnesses of

7 Persian Gulf War veterans and their families as well as

8 on benefits available to such individuals through the De9 partment of Veterans Affairs. The newsletter shall be pre10 pared in consultation with veterans service organizations.

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

12 shall include establishment of a toll-free telephone number

13 to provide Persian Gulf War veterans and their families

14 information on the Persian Gulf War Veterans Health Reg15 istry, health care and other benefits provided by the Depart16 ment of Veterans Affairs, and such other information as the

17 Secretary considers appropriate. Such toll-free telephone

18 number shall be established not later than 90 days after

19 the date of the enactment of this Act.

20 SEC. 5. EVALUATION OF HEALTH STATUS OF SPOUSES AND

21 CHILDREN OF PERSIAN GULF WAR VETER22 ANS.

23 The Persian Gulf War Veterans’ Health Status Act

24 (title VII of Public Law 102–585; 38 U.S.C. 527 note) is
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1 amended by inserting after section 703 the following new

2 section:

3 ‘‘SEC. 703A. REGISTRATION AND HEALTH EXAMINATIONS

4 FOR CERTAIN SPOUSES AND CHILDREN OF

5 PERSIAN GULF WAR VETERANS.

6 ‘‘(a) INCLUSION OF INFORMATION ON SPOUSES AND

7 CHILDREN OF VETERANS IN REGISTRY.—(1) Subject to

8 paragraphs (2) and (3), the Persian Gulf War Veterans

9 Health Registry established under section 702 shall also in10 clude the following information:

11 ‘‘(A) In the case of any veteran listed in the Reg12 istry, the name, address, and taxpayer identification

13 number (if any) of any individual—

14 ‘‘(i) who is the spouse or child of the

15 veteran;

16 ‘‘(ii) who is suffering from an illness or dis17 order; and

18 ‘‘(iii) who asserts that the illness or disorder

19 is directly related to an illness suffered by the

20 veteran as a result of the service of the veteran

21 in the Persian Gulf theater of operations during

22 the Persian Gulf War.

23 ‘‘(B) Such medical data with respect to each

24 such individual as the Secretary determines appro25 priate in order to determine the nature and extent of
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1 the connection, if any, between the illness or disorder

2 of the individual and the illness of the veteran.

3 ‘‘(2) An individual referred to in paragraph (1)(A),

4 and any information on the individual under paragraph

5 (1)(B), may not be included in the Registry without the

6 approval of the applicable veteran.

7 ‘‘(3) The total number of individuals referred to in

8 paragraph (1)(A) who may be listed in the Registry may

9 not exceed 10,000.

10 ‘‘(4) The Secretary shall maintain the Registry so as

11 to treat information on any individual referred to in para12 graph (1)(A) as information on that individual and on the

13 applicable veteran.

14 ‘‘(b) DIAGNOSTIC TESTS, HEALTH EXAMINATIONS,

15 AND COUNSELING.—(1) The Secretary shall, upon request,

16 perform diagnostic tests of and provide a health examina17 tion and consultation and counseling to any individual who

18 asserts under subsection (a)(1)(A)(iii) that an illness or dis19 order of the individual is directly related to the illness of

20 a veteran as described in that subsection. The purpose of

21 the examination, diagnostic test, and consultation is to

22 gather information on the illness or disorder and the pos23 sible contagious or genetic methods of transmission of the

24 illness or disorder.
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1 ‘‘(2) The Secretary may conduct any additional health

2 examinations and diagnostic tests of an individual referred

3 to in paragraph (1) as the Secretary determines appro4 priate in order to carry out the purpose of this subsection.

5 ‘‘(3) The Secretary may perform diagnostic tests and

6 provide examinations and consultations and counseling

7 under this subsection through facilities of the Department

8 of Veterans Affairs or at or through contract with non-De9 partment facilities.

10 ‘‘(c) DEFINITIONS.—For the purposes of this section,

11 the terms ‘child’ and ‘spouse’ have the meanings given such

12 terms in paragraphs (4) and (31) of section 101 of title

13 38, United States Code, respectively.’’.

14 SEC. 6. CLARIFICATION OF SCOPE OF HEALTH EXAMINA15 TIONS PROVIDED FOR VETERANS ELIGIBLE

16 FOR INCLUSION IN HEALTH-RELATED REG17 ISTRIES.

18 Section 703 of the Persian Gulf War Veterans’ Health

19 Status Act (title VII of Public Law 102–585; 38 U.S.C. 527

20 note) is amended—

21 (1) by inserting ‘‘(including diagnostic tests)’’

22 after ‘‘examination’’ each place it appears other than

23 subsection (a)(1)(A);

24 (2) in subsection (a)(1)(A)—
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1 (A) by inserting ‘‘(including any appro2 priate diagnostic tests)’’ after ‘‘a health exam3 ination’’; and

4 (B) by inserting ‘‘and the tests’’ after ‘‘the

5 examination’’; and

6 (3) in subsection (a)(2), by inserting ‘‘(including

7 any diagnostic tests)’’ after ‘‘examinations’’.

8 SEC. 7. REQUIREMENT FOR MINIMUM NUMBER OF FULL9 TIME EQUIVALENT POSITIONS.

10 (a) FINDINGS.—Congress makes the following findings:

11 (1) Under proposals for national health care re12 form, the Department of Veterans Affairs will be re13 quired to provide health care services to veterans on

14 a competitive basis with other health care providers.

15 (2) The elimination of positions from the De16 partment that the Office of Management and Budget

17 has scheduled to occur in fiscal years 1995 through

18 1999 would prevent the Department from meeting the

19 responsibilities of the Department to provide health

20 care to veterans under law and from maintaining the

21 quality of health care that is currently provided to

22 veterans.

23 (b) MINIMUM NUMBER OF FTEE POSITIONS.—Not24 withstanding any other provision of law, the number of full25 time equivalent positions in the Department of Veterans Af-
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1 fairs during the period beginning on the date of the enact2 ment of this Act and ending on September 30, 1999, may

3 not (except as provided in subsection (d)) be less than

4 224,377.

5 (c) DETERMINATION OF NUMBER OF POSITIONS.—In

6 determining the number of full-time equivalent positions in

7 the Department of Veterans Affairs during a fiscal year for

8 purposes of ensuring under section 5(b) of the Federal

9 Workforce Restructuring Act of 1994 (Public Law 103–226;

10 108 Stat. 115; 5 U.S.C. 3101 note) that the total number

11 of full-time equivalent positions in all agencies of the Fed12 eral Government during a fiscal year covered by that sec13 tion does not exceed the limit prescribed for that fiscal year

14 under that section, the total number of full-time equivalent

15 positions in the Department of Veterans Affairs during that

16 fiscal year shall be the number equal to—

17 (1) the number of such positions in the Depart18 ment during that fiscal year, reduced by

19 (2) the sum of—

20 (A) the number of such positions in the De21 partment during that fiscal year that are filled

22 by employees whose salaries and benefits are

23 paid primarily from funds other than appro24 priated funds; and
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1 (B) the number of such positions held dur2 ing that fiscal year by persons involved in medi3 cal care cost recovery activities under section

4 1729 of title 38, United States Code.

5 (d) REDUCTIONS BELOW MINIMUM.—The Secretary of

6 Veterans Affairs shall not be required to make a reduction

7 in the number of full-time equivalent positions in the De8 partment unless such reduction—

9 (1) is necessary due to a reduction in funds

10 available to the Department; or

11 (2) is required under a law that is enacted after

12 the date of the enactment of this Act and that refers

13 specifically to this section.

14 (e) ANNUAL REPORT.—The Secretary shall submit to

15 the Committees on Veterans’ Affairs of the Senate and the

16 House of Representatives an annual report, through the

17 year 2000, on the number and type of full-time equivalent

18 positions in the Department that are reduced under this

19 section. The report shall include a justification for the re20 ductions and shall be submitted with the materials provided

21 in support of the budget for the Department contained in

22 the President’s budget submitted to Congress for a fiscal

23 year pursuant to section 1105 of title 31, United States

24 Code.
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1 SEC. 8. ENHANCED AUTHORITY TO CONTRACT FOR NEC2 ESSARY SERVICES.

3 Section 8110(c) of title 38, United States Code, is

4 amended by striking out paragraph (7) and inserting in

5 lieu thereof the following:

6 ‘‘(7) Paragraphs (1) through (6) shall not be in effect

7 during fiscal years 1995 through 1999.

8 ‘‘(8) During the period covered by paragraph (7),

9 whenever an activity at a Department health-care facility

10 is converted from performance by Federal employees to per11 formance by employees of a contractor of the Government,

12 the Secretary shall—

13 ‘‘(A) require in the contract for the performance

14 of such activity that the contractor, in hiring employ15 ees for the performance of the contract, give priority

16 to former employees of the Department who have been

17 displaced by the award of the contract; and

18 ‘‘(B) provide to such former employees of the De19 partment all possible assistance in obtaining other

20 Federal employment or entrance into job training

21 and retraining programs.

22 ‘‘(9) The Secretary shall include in the Secretary’s an23 nual report to Congress under section 529 of this title, for

24 each fiscal year covered by paragraph (7), a report on the

25 use during the year covered by the report of contracting26 out authority made available by reason of paragraph (7).
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1 The Secretary shall include in each such report a descrip2 tion of each use of such authority, together with the ration3 ale for the use of such authority and the effect of the use

4 of such authority on patient care and on employees of the

5 Department.’’.

6 SEC. 9. STUDY OF ALTERNATIVE ORGANIZATIONAL STRUC7 TURES FOR EFFECTIVE PROVISION OF

8 HEALTH CARE.

9 (a) REQUIREMENT.—The Secretary of Veterans Affairs

10 shall enter into an agreement with an appropriate non-Fed11 eral entity under which the entity shall carry out a study

12 of the feasibility and advisability of alternative organiza13 tional structures, such as the establishment of a wholly14 owned Government corporation or a Government-sponsored

15 enterprise, for the effective provision of health care services

16 to veterans.

17 (b) SUBMISSION OF REPORT.—The Secretary shall

18 submit to the Committees on Veterans’ Affairs of the Senate

19 and the House of Representatives a report on the study re20 quired under subsection (a) not later than one year after

21 the date of the enactment of this Act.

22 (c) AUTHORIZATION OF FUNDS.—There is hereby au23 thorized to be appropriated for the Department of Veterans

24 Affairs the sum of $1,000,000 for the purposes of carrying

25 out the study required under subsection (a).
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Amend the title so as to read: ‘‘To amend title 38,

United States Code, to clarify the definition of ‘disease’

for purposes of the entitlement of veterans to benefits

under such title, to revise and improve the assessment of

the health consequences of the service during the Persian

Gulf War, and for other purposes.’’.

S 2330 RS——2