II

103D CONGRESS

2D SESSION S. 2178

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 SENATE OF THE UNITED STATES

JUNE 10 (legislative day, JUNE 7), 1994

Mr. DASCHLE (for himself and Mr. AKAKA) introduced the following bill;

which was read twice and 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,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Persian Gulf War Vet5 erans’ Compensation Act of 1994’’.

6 SEC. 2. CONGRESSIONAL FINDINGS.

7 The Congress makes the following findings:

8 (1) The United States bears responsibility for

9 the care and treatment of illnesses and disabilities

10 connected with service in the Armed Forces. When
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1 the etiology of a specific condition occurring in vet2 erans is unknown, it is the Government’s responsibil3 ity to give veterans the benefit of the doubt and to

4 provide appropriate treatment and compensation

5 until the scientific evidence warrants otherwise.

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

7 the Armed Forces (A) were exposed to numerous po8 tentially toxic substances (including fumes and

9 smoke from petrochemicals and depleted uranium),

10 to infectious agents, to chemoprophylactic agents,

11 and to indigenous diseases, (B) received multiple im12 munizations and (C) may have been exposed to var13 ious chemical and biological warfare agents. Threats

14 of enemy use of chemical and biological weapons

15 heightened the psychological stress otherwise associ16 ated with the military operation.

17 (3) Significant numbers of veterans of the Per18 sian Gulf War are suffering from illnesses, or are ex19 hibiting symptoms of illnesses, that cannot (as of the

20 enactment of this Act) be diagnosed or clearly de21 fined. As a result, many of these conditions or ill22 nesses are not considered to be service connected for

23 purposes of benefits administered by the Secretary

24 of Veterans Affairs.
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1 (4) The Technology Assessment Workshop on

2 the Persian Gulf Experience and Health conducted

3 by the National Institutes of Health found that the

4 complex biological, chemical, physical, and psycho5 logical environment of the Southwest Asia theater of

6 operations produced complex adverse health effects

7 in Persian Gulf War veterans and that it appears as

8 if there is no single condition or illness among af9 fected Persian Gulf War veterans, but rather mul10 tiple illnesses with overlapping symptoms and

11 causes.

12 (5) That workshop concluded that the data con13 cerning the range and intensity of exposure to toxic

14 substances by military personnel in the Southwest

15 Asia theater of operations are very limited and that

16 such data were collected only after a considerable

17 delay.

18 (6) In response to concerns regarding the

19 health care needs of Persian Gulf War veterans, par20 ticularly those who suffer from undiagnosable condi21 tions or illnesses, the Congress, in Public Law 102–

22 585, directed the establishment of the Persian Gulf

23 War Veterans Health Registry, authorized health ex24 aminations for Persian Gulf War veterans, and pro25 vided for the National Academy of Sciences to con-
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1 duct a comprehensive review and assessment of in2 formation regarding the health consequences of mili3 tary service in the theater of operations during the

4 Persian Gulf War and to develop recommendations

5 for research on such health consequences. In Public

6 Law 103–210, Congress authorized the Department

7 of Veterans Affairs to provide health care services on

8 a priority basis to Persian Gulf War veterans. In

9 Public Law 103–160, Congress provided funding for

10 the establishment of a specialized environmental

11 medical facility for the conduct of research into the

12 potential health effects of low-level chemical expo13 sure and for research on the potential health effects

14 of battlefield exposure to depleted uranium.

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

16 noted that well-designed epidemiological studies have

17 not been conducted to link the conditions or illnesses

18 of the military personnel with exposures in the thea19 ter of operations during the Persian Gulf War and

20 found that the absence of such studies has hampered

21 efforts to provide treatment and compensation to

22 veterans of the Persian Gulf War. Accordingly, fur23 ther research and studies should be undertaken to

24 determine the underlying causes of the illnesses suf25 fered by Persian Gulf War veterans and, pending
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1 the outcome of such research, veterans who are seri2 ously ill and whose illness may be related to their

3 military service should receive compensation benefits

4 to offset the impairment in earnings capacities they

5 may be experiencing.

6 SEC. 3. PURPOSES.

7 The purposes of this Act are—

8 (1) to require the Secretary of Veterans Affairs

9 to provide compensation to Persian Gulf War veter10 ans who have disabilities resulting from an illness or

11 illnesses that cannot (as of the enactment of this

12 Act) be diagnosed or defined and for which other

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

14 identified until such time as scientific evidence dem15 onstrates that the illnesses are unrelated to military

16 service during the Persian Gulf War;

17 (2) to require the Secretary of Veterans Affairs

18 to develop case assessment protocols and case defini19 tions for such illnesses;

20 (3) to establish an outreach program to Persian

21 Gulf War veterans and their families to inform them

22 of ongoing research activities as well as the services

23 and benefits for which they are eligible; and

24 (4) to authorize further research activities, in25 cluding an epidemiological study, on the health risks
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1 and effects of military service in the Southwest thea2 ter of operations during the Persian Gulf War.

3 SEC. 4. DEVELOPMENT OF CASE ASSESSMENT PROTOCOLS

4 AND CASE DEFINITIONS.

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

6 The Secretary of Veterans Affairs shall develop and imple7 ment a uniform case assessment protocol that will ensure

8 thorough assessment, diagnosis, and treatment of all Per9 sian Gulf War veterans suffering from illnesses the origins

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

11 and that may be attributable to service in the Southwest

12 Asia theater of operations during the Persian Gulf War.

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

14 implemented before the end of the 120-day period begin15 ning on the date of the enactment of this Act, the Sec16 retary shall, before the end of such period, submit to the

17 Committees on Veterans’ Affairs of the Senate and House

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

19 not yet been developed.

20 (b) CASE DEFINITIONS.—(1) The Secretary shall de21 velop case definitions or diagnoses for illnesses, the origins

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

23 and that may be associated with service in the Persian

24 Gulf War.
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1 (2) If such case definitions and diagnoses are not de2 veloped before the end of the 120-day period beginning

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

4 shall, before the end of such period, submit to the Commit5 tees on Veterans’ Affairs of the Senate and House of Rep6 resentatives a report as to why such case definitions and

7 diagnoses have not yet been developed.

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

9 carried out in consultation with the Secretary of Defense

10 and the Secretary of Health and Human Services.

11 SEC. 5. OUTREACH TO PERSIAN GULF VETERANS.

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

13 shall implement a comprehensive outreach program to in14 form Persian Gulf War veterans and their families of the

15 medical care and other benefits that may be provided by

16 the Department of Veterans Affairs and the Department

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

18 (b) NEWSLETTER.—The outreach program shall in19 clude a newsletter which shall be updated and distributed

20 at least annually and shall be distributed to the veterans

21 listed on the Persian Gulf War Veterans Health Registry.

22 The newsletter shall include summaries of the status and

23 findings of Government sponsored research on illnesses of

24 Persian Gulf War veterans and their families as well as

25 on benefits available to such individuals through the De-
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1 partment of Veterans Affairs. The newsletter shall be pre2 pared in consultation with veterans service organizations.

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

4 shall include establishment of a toll-free telephone number

5 to provide Persian Gulf War veterans and their families

6 information on the Persian Gulf War Veterans Health

7 Registry, health care and other benefits provided by the

8 Department of Veterans Affairs, and such other informa9 tion as the Secretary considers appropriate. Such toll-free

10 telephone number shall be established not later than 90

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

12 SEC. 6. COMPENSATION FOR DISABILITIES RESULTING

13 FROM ILLNESSES ASSOCIATED WITH SERV14 ICE DURING THE PERSIAN GULF WAR.

15 (a) IN GENERAL.—

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

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

18 following new section:

19 ‘‘§ 1117. Compensation for conditions or illnesses of

20 unknown origin associated with service

21 during the Persian Gulf War

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

23 subchapter to a Persian Gulf War veteran suffering from

24 a disability resulting from an undiagnosed illness, or com25 bination of illness, that becomes manifest to a degree of
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1 10 percent or more within three years of separation from

2 active military, naval, or air service.

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

4 the date of the enactment of this section, preliminary reg5 ulations governing the award of such compensation.

6 ‘‘(2) The percentage of disability that equals 10 per7 cent shall be described as ‘mild impairment of social and

8 industrial adaptability’.

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

10 or 100 percent rating shall be described as ‘demonstra11 tively unable to obtain or retain substantial gainful em12 ployment’.

13 ‘‘(4) In determining the rating schedule for such dis14 ability, the Secretary should examine analogous ratings.

15 ‘‘(5) In determining eligibility for compensation

16 under this section, the Secretary shall give due consider17 ation to ‘lay evidence’, including testimony provided by the

18 claimant, supporting witnesses, and independent medical

19 experts.

20 ‘‘(c) Not later than 60 days after the date on which

21 the Secretary issues any proposed regulations pursuant to

22 this section, the Secretary shall issue final regulations

23 under this section. Such regulations shall be effective on

24 the date of issuance.
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1 ‘‘(d) A disability for which compensation under this

2 section is awarded shall be considered to be service con3 nected for purposes of all other laws of the United States.

4 ‘‘(e) Compensation may not be paid under this sec5 tion for a disability occurring in a veteran—

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

7 that the disability was not incurred by the veteran

8 in the Southwest Asia theater of operations during

9 the Persian Gulf War; or

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

11 to establish that an intercurrent injury or illness

12 which is a recognized cause of the disability was suf13 fered by the veteran between the date of the veter14 an’s most recent departure from the Southwest Asia

15 theater of operations while on active duty and the

16 onset of the disability.

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

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

19 in the Armed Forces in the Southwest Asia theater of op20 erations during the Persian Gulf War.

21 ‘‘(g) Payments shall be made under this section to

22 a veteran until such time as the scientific evidence dem23 onstrates that the illnesses for which compensation is

24 awarded under this section are not connected to service

25 in the Southwest Asia theater of operations during the
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1 Persian Gulf War. The Secretary may cease payments

2 under this section only after providing a report describing

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

4 for ceasing such payments, at least 90 days before imple5 mentation of such action to the Committees on Veterans

6 Affairs of the Senate and House of Representatives.

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

8 not preclude a veteran from receiving retroactive com9 pensation for a benefit claim that was filed before the date

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

11 illnesses are later found to be service connected.

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

13 compensation under this section adjudicated on a priority

14 basis at a single Department facility in order to better

15 ensure the consistency of rating decisions.

16 ‘‘(j) The Secretary shall have all claims for service17 connected benefits connected to an undiagnosable illness

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

19 denied before the date of the enactment of this section

20 reopened and adjudicated as original claims. In such a

21 case, the date of claim shall be considered to be the date

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

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

24 such chapter is amended by inserting after the item

25 relating to section 1116 the following new item:
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‘‘1117. Presumption of service connection for illnesses associated with the Persian Gulf War.’’.

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

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

3 effect on October 1, 1994.

4 SEC. 7. RESULTS OF EXAMINATIONS AND TREATMENT OF

5 PERSIAN GULF WAR VETERANS WITH

6 UNDIAGNOSABLE ILLNESSES.

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

8 Affairs shall enter into an agreement with the Secretary

9 of Defense to have access to all clinical data of the Depart10 ment of Defense on veterans of the Persian Gulf War who

11 remain on active duty.

12 (b) ONGOING COMPILATION OF DATA.—The Sec13 retary of Veterans Affairs shall compile and analyze, on

14 a continuing basis, all clinical data obtained on veterans

15 of the Persian Gulf War in connection with examinations

16 and treatment furnished by the Department of Veterans

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

18 to be scientifically useful in determining the association

19 between the undiagnosable illnesses of veterans and their

20 service in the Southwest Asia theater of operations during

21 the Persian Gulf War, and (2) to be useful in the develop22 ment of case assessment protocols or case definitions.
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1 (c) ANNUAL REPORT.—The Secretary shall submit to

2 the Committees on Veterans’ Affairs of the Senate and

3 House of Representatives an annual report containing—

4 (1) the information compiled in accordance with

5 subsection (b);

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

7 (3) a discussion of the incidence of illnesses

8 identified or treated by the Department of Veterans

9 Affairs in the case of veterans referred to in sub10 section (b); and

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

12 of such illnesses and disabilities.

13 SEC. 8. EPIDEMIOLOGICAL RESEARCH.

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

15 shall enter into a contract for the conduct of an epidemio16 logical study designed to assess both the short- and long17 term health consequences of service in the Southwest Asia

18 theater of operations during the Persian Gulf War on vet19 erans of the Persian Gulf War and their immediate family

20 members.

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

22 enter into an agreement with the National Academy of

23 Sciences for the Medical Follow-Up Agency (MFUA) of

24 the Institute of Medicine of the Academy for (A) the re25 view of proposals to conduct the research specified in sub-
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1 section (a), (B) oversight of such research, and (C) review

2 of the research findings.

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

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

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

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

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

12 into, notice in writing identifying the organization with

13 which the Secretary intends to enter into the agreement.

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

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

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

18 that the Secretary, in consultation with the National

19 Academy of Sciences and the contractor, considers rel20 evant to the study.

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

22 date of the enactment of this Act, the Secretary shall sub23 mit to the Committees on Veterans Affairs of the Senate

24 and House of Representatives a report on the status of

25 the contract specified in subsection (a).
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1 (e) AUTHORIZATION.—There is authorized to be ap2 propriated to the Department $7,500,000 for each of fis3 cal years 1995 through 2000 for the conduct of the re4 search specified in subsection (a). In addition to amounts

5 for such research appropriated pursuant to the preceding

6 sentence, the Secretary may provide funds for such re7 search from any funds appropriated for any fiscal year

8 after fiscal year 1994 for the purpose of research spon9 sored by the Department.

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

11 the Secretary shall submit to the Committees on Veterans

12 Affairs of the Senate and House of Representatives a re13 port accompanying the budget for that year containing—

14 (1) the methodology and status of the study

15 specified in subsection (a); and

16 (2) any preliminary analyses of the information

17 compiled in accordance with subsection (a), includ18 ing that provided by the National Academy of

19 Sciences.

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

21 the Secretary shall submit to the Committees on Veterans

22 Affairs of the Senate and House of Representatives a re23 port accompanying the budget containing—

24 (1) the methodology of the study specified in

25 subsection (a);
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1 (2) the analysis of the information compiled in

2 accordance with subsection (a), including that pro3 vided by the National Academy of Sciences;

4 (3) a discussion of incidence of illnesses ob5 served in veterans of the Persian Gulf War and their

6 families;

7 (4) the National Academy of Sciences conclu8 sions concerning the health consequences of service

9 in the Southwest Asia theater of operations during

10 the Persian Gulf War on veterans and their imme11 diate family members; and

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

13 of such illnesses and disabilities and recommenda14 tions for future action.

15 SEC. 9. AUTHORIZATION FOR OTHER RESEARCH.

16 There is authorized to be appropriated to the Depart17 ment of Veterans Affairs $5,000,000 for each of fiscal

18 years 1995 through 1998 for the conduct of research

19 which the Secretary, in consultation with the Secretary of

20 Defense and the Secretary of Health and Human Services,

21 determines could advance understanding of health risks

22 and effects of service during the Persian Gulf War and

23 the means of treating those health effects.

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