II

105TH CONGRESS

1ST SESSION S. 1320

To provide a scientific basis for the Secretary of Veterans Affairs to assess

the nature of the association between illnesses and exposure to toxic

agents and environmental or other wartime hazards as a result of service

in the Persian Gulf during the Persian Gulf War for purposes of determining a service connection relating to such illnesses, and for other

purposes.

IN THE SENATE OF THE UNITED STATES

OCTOBER 24, 1997

Mr. ROCKEFELLER (for himself, Mr. DASCHLE, Mr. AKAKA, Mr. WELLSTONE,

and Mrs. MURRAY) introduced the following bill; which was read twice

and referred to the Committee on Veterans’ Affairs

A BILL

To provide a scientific basis for the Secretary of Veterans

Affairs to assess the nature of the association between

illnesses and exposure to toxic agents and environmental

or other wartime hazards as a result of service in the

Persian Gulf during the Persian Gulf War for purposes

of determining a service connection relating to such illnesses, 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 ‘‘Persian Gulf War Vet3 erans Act of 1997’’.

4 SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR ILL5 NESSES ASSOCIATED WITH SERVICE IN THE

6 PERSIAN GULF DURING THE PERSIAN GULF

7 WAR.

8 (a) IN GENERAL.—(1) Subchapter II of chapter 11

9 of title 38, United States Code, is amended by adding at

10 the end the following:

11 ‘‘§ 1118. Presumptions of service connection for ill12 nesses associated with service in the Per13 sian Gulf during the Persian Gulf War

14 ‘‘(a)(1) For purposes of section 1110 of this title, and

15 subject to section 1113 of this title, each illness (if any)

16 described in paragraph (2) shall be considered to have

17 been incurred in or aggravated by service referred to in

18 that paragraph, notwithstanding that there is no record

19 of evidence of such illness during the period of such serv20 ice.

21 ‘‘(2) An illness referred to in paragraph (1) is any

22 diagnosed or undiagnosed illness that—

23 ‘‘(A) the Secretary determines in regulations

24 prescribed under this section to warrant a presump25 tion of service connection by reason of having a posi26 tive association with exposure to a biological, chemi-
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1 cal, or other toxic agent or environmental or war2 time hazard known or presumed to be associated

3 with service in the Armed Forces in the Southwest

4 Asia theater of operations during the Persian Gulf

5 War; and

6 ‘‘(B) becomes manifest within the period (if

7 any) prescribed in such regulations in a veteran who

8 served on active duty in that theater of operations

9 during that war and by reason of such service was

10 exposed to such agent or hazard.

11 ‘‘(3) For purposes of this subsection, a veteran who

12 served on active duty in the Southwest Asia theater of op13 erations during the Persian Gulf War and has an illness

14 described in paragraph (2) shall be presumed to have been

15 exposed by reason of such service to the agent or hazard

16 associated with the illness in the regulations prescribed

17 under this section unless there is conclusive evidence to

18 establish that the veteran was not exposed to the agent

19 or hazard by reason of such service.

20 ‘‘(b)(1)(A) Whenever the Secretary makes a deter21 mination described in subparagraph (B), the Secretary

22 shall prescribe regulations providing that a presumption

23 of service connection is warranted for the illness covered

24 by that determination for purposes of this section.
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1 ‘‘(B) A determination referred to in subparagraph

2 (A) is a determination based on sound medical and sci3 entific evidence that a positive association exists be4 tween—

5 ‘‘(i) the exposure of humans to a biological,

6 chemical, or other toxic agent or environmental or

7 wartime hazard known or presumed to be associated

8 with service in the Southwest Asia theater of oper9 ations during the Persian Gulf War; and

10 ‘‘(ii) the occurrence of a diagnosed or

11 undiagnosed illness in humans.

12 ‘‘(2)(A) In making determinations for purposes of

13 paragraph (1), the Secretary shall take into account—

14 ‘‘(i) the reports submitted to the Secretary by

15 the National Academy of Sciences under section 3 of

16 the Persian Gulf War Veterans Act of 1997; and

17 ‘‘(ii) all other sound medical and scientific in18 formation and analyses available to the Secretary.

19 ‘‘(B) In evaluating any report, information, or analy20 sis for purposes of making such determinations, the Sec21 retary shall take into consideration whether the results are

22 statistically significant, are capable of replication, and

23 withstand peer review.

24 ‘‘(3) An association between the occurrence of an ill25 ness in humans and exposure to an agent or hazard shall
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1 be considered to be positive for purposes of this subsection

2 if the credible evidence for the association is equal to or

3 outweighs the credible evidence against the association.

4 ‘‘(c)(1)(A) Not later than 60 days after the date on

5 which the Secretary receives a report from the National

6 Academy of Sciences under section 3 of the Persian Gulf

7 War Veterans Act of 1997, the Secretary shall determine

8 whether or not a presumption of service connection is war9 ranted for each illness (if any) covered by the report.

10 ‘‘(B) If the Secretary determines that a presumption

11 of service connection is warranted, the Secretary shall, not

12 later than 60 days after making the determination, issue

13 proposed regulations setting forth the Secretary’s deter14 mination.

15 ‘‘(C)(i) If the Secretary determines that a presump16 tion of service connection is not warranted, the Secretary

17 shall, not later than 60 days after making the determina18 tion, publish in the Federal Register a notice of the deter19 mination. The notice shall include an explanation of the

20 scientific basis for the determination.

21 ‘‘(ii) If an illness already presumed to be service con22 nected under this section is subject to a determination

23 under clause (i), the Secretary shall, not later than 60

24 days after publication of the notice under that clause,
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1 issue proposed regulations removing the presumption of

2 service connection for the illness.

3 ‘‘(2) Not later than 90 days after the date on which

4 the Secretary issues any proposed regulations under para5 graph (1), the Secretary shall issue final regulations. Such

6 regulations shall be effective on the date of issuance.

7 ‘‘(d) Whenever the presumption of service connection

8 for an illness under this section is removed under sub9 section (c)—

10 ‘‘(1) a veteran who was awarded compensation

11 for the illness on the basis of the presumption before

12 the effective date of the removal of the presumption

13 shall continue to be entitled to receive compensation

14 on that basis; and

15 ‘‘(2) a survivor of a veteran who was awarded

16 dependency and indemnity compensation for the

17 death of a veteran resulting from the illness on the

18 basis of the presumption before that date shall con19 tinue to be entitled to receive dependency and in20 demnity compensation on that basis.

21 ‘‘(e) Subsections (b) through (d) shall cease to be ef22 fective 10 years after the first day of the fiscal year in

23 which the National Academy of Sciences submits to the

24 Secretary the first report under section 3 of the Persian

25 Gulf War Veterans Act of 1997.’’.
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1 (2) The table of sections at the beginning of such

2 chapter is amended by inserting after the item relating

3 to section 1117 the following new item:

‘‘1118. Presumptions of service connection for illnesses associated with service

in the Persian Gulf during the Persian Gulf War.’’.

4 (b) CONFORMING AMENDMENTS.—Section 1113 of

5 title 38, United States Code, is amended—

6 (1) by striking out ‘‘or 1117’’ each place it ap7 pears and inserting in lieu thereof ‘‘1117, or 1118’’;

8 and

9 (2) in subsection (a), by striking out ‘‘or 1116’’

10 and inserting in lieu thereof ‘‘, 1116, or 1118’’.

11 (c) COMPENSATION FOR UNDIAGNOSED GULF WAR

12 ILLNESSES.—Section 1117 of title 38, United States

13 Code, is amended—

14 (1) by redesignating subsections (c), (d), and

15 (e) as subsections (d), (e), and (f), respectively; and

16 (2) by inserting after subsection (b) the follow17 ing new subsection (c):

18 ‘‘(c)(1) Whenever the Secretary determines as a re19 sult of a determination under section 1118(c) of this title

20 that a presumption of service connection for an

21 undiagnosed illness (or combination of undiagnosed ill22 nesses) is no longer warranted under this section—

23 ‘‘(A) a veteran who was awarded compensation

24 under this section for such illness (or combination of
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1 illnesses) on the basis of the presumption shall con2 tinue to be entitled to receive compensation under

3 this section on that basis; and

4 ‘‘(B) a survivor of a veteran who was awarded

5 dependency and indemnity compensation for the

6 death of a veteran resulting from the disease on the

7 basis of the presumption before that date shall con8 tinue to be entitled to receive dependency and in9 demnity compensation on that basis.

10 ‘‘(2) This subsection shall cease to be effective 10

11 years after the first day of the fiscal year in which the

12 National Academy of Sciences submits to the Secretary

13 the first report under section 3 of the Persian Gulf War

14 Veterans Act of 1997.’’.

15 SEC. 3. AGREEMENT WITH NATIONAL ACADEMY OF

16 SCIENCES.

17 (a) PURPOSE.—The purpose of this section is to pro18 vide for the National Academy of Sciences, an independent

19 nonprofit scientific organization with appropriate exper20 tise, to review and evaluate the available scientific evidence

21 regarding associations between illnesses and exposure to

22 toxic agents or environmental or wartime hazards associ23 ated with Gulf War service.

24 (b) AGREEMENT.—The Secretary of Veterans Affairs

25 shall seek to enter into an agreement with the National
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1 Academy of Sciences for the Academy to perform the serv2 ices covered by this section and sections 4(a)(6) and 5(d).

3 The Secretary shall seek to enter into the agreement not

4 later than two months after the date of enactment of this

5 Act.

6 (c) IDENTIFICATION OF AGENTS AND ILLNESSES.—

7 (1) Under the agreement under subsection (b), the Na8 tional Academy of Sciences shall—

9 (A) identify the biological, chemical, or other

10 toxic agents or environmental or wartime hazards to

11 which members of the Armed Forces who served in

12 the Southwest Asia theater of operations during the

13 Persian Gulf War may have been exposed by reason

14 of such service; and

15 (B) identify the illnesses (including diagnosed

16 illnesses and undiagnosed illnesses) that are mani17 fest in such members.

18 (2) In identifying illnesses under paragraph (1)(B),

19 the Academy shall review and summarize the relevant sci20 entific evidence regarding illnesses among the members

21 described in paragraph (1)(B) and among other appro22 priate populations of individuals, including mortality,

23 symptoms, and adverse reproductive health outcomes

24 among such members and individuals.
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1 (d) DETERMINATIONS OF ASSOCIATIONS BETWEEN

2 AGENTS AND ILLNESSES.—(1) For each agent or hazard

3 and illness identified under subsection (c), the National

4 Academy of Sciences shall determine, to the extent that

5 available scientific data permit meaningful determina6 tions—

7 (A) whether a statistical association exists be8 tween exposure to the agent or hazard and the ill9 ness, taking into account the strength of the sci10 entific evidence and the appropriateness of the sci11 entific methodology used to detect the association;

12 (B) the increased risk of the illness among

13 human populations exposed to the agent or hazard;

14 and

15 (C) whether a plausible biological mechanism or

16 other evidence of a causal relationship exists between

17 exposure to the agent or hazard and the illness.

18 (2) The Academy shall include in its reports under

19 subsection (h) a full discussion of the scientific evidence

20 and reasoning that led to its conclusions under this sub21 section.

22 (e) REVIEW OF POTENTIAL TREATMENT MODELS

23 FOR CERTAIN ILLNESSES.—Under the agreement under

24 subsection (b), the National Academy of Sciences shall

25 separately review, for each chronic undiagnosed illness
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1 identified under subsection (c)(1)(B) and for any chronic

2 illness that the Academy determines to warrant the review,

3 the available scientific data in order to identify empirically

4 valid models of treatment for such illnesses which employ

5 successful treatment modalities for populations with simi6 lar symptoms.

7 (f) RECOMMENDATIONS FOR ADDITIONAL SCI8 ENTIFIC STUDIES.—(1) Under the agreement under sub9 section (b), the National Academy of Sciences shall make

10 any recommendations that it considers appropriate for ad11 ditional scientific studies (including studies relating to

12 treatment models) to resolve areas of continuing scientific

13 uncertainty relating to the health consequences of expo14 sure to toxic agents or environmental or wartime hazards

15 associated with Gulf War service.

16 (2) In making recommendations for additional stud17 ies, the Academy shall consider the available scientific

18 data, the value and relevance of the information that could

19 result from such studies, and the cost and feasibility of

20 carrying out such studies.

21 (g) SUBSEQUENT REVIEWS.—(1) Under the agree22 ment under subsection (b), the National Academy of

23 Sciences shall conduct on a periodic and ongoing basis ad24 ditional reviews of the evidence and data relating to its

25 activities under this section.
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1 (2) As part of each review under this subsection, the

2 Academy shall—

3 (A) conduct as comprehensive a review as is

4 practicable of the evidence referred to in subsection

5 (c) and the data referred to in subsections (d), (e),

6 and (f) that became available since the last review

7 of such evidence and data under this section; and

8 (B) make its determinations on the basis of the

9 results of such review and all other reviews con10 ducted for the purposes of this section.

11 (h) REPORTS.—(1) Under the agreement under sub12 section (b), the National Academy of Sciences shall submit

13 to the committees and officials referred to in paragraph

14 (4) periodic written reports regarding the Academy’s ac15 tivities under the agreement.

16 (2) The first report under paragraph (1) shall be

17 transmitted not later than 18 months after the date of

18 enactment of this Act. That report shall include—

19 (A) the determinations and discussion referred

20 to in subsection (d);

21 (B) the results of the review of models of treat22 ment under subsection (e); and

23 (C) any recommendations of the Academy

24 under subsection (f).
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1 (3)(A) Reports shall be submitted under this sub2 section at least once every two years, as measured from

3 the date of the report under paragraph (2).

4 (B) In any report under this subsection (other than

5 the report under paragraph (2)), the Academy may specify

6 an absence of meaningful developments in the scientific

7 or medical community with respect to the activities of the

8 Academy under this section during the 2-year period pre9 ceding the date of such report.

10 (4) Reports under this subsection shall be submitted

11 to the following:

12 (A) The designated congressional committees.

13 (B) The Secretary of Veterans Affairs.

14 (C) The Secretary of Defense.

15 (i) SUNSET.—This section shall cease to be effective

16 10 years after the last day of the fiscal year in which the

17 National Academy of Sciences submits the first report

18 under subsection (h).

19 (j) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA20 TION.—(1) If the Secretary is unable within the time pe21 riod set forth in subsection (b) to enter into an agreement

22 with the National Academy of Sciences for the purposes

23 of this section on terms acceptable to the Secretary, the

24 Secretary shall seek to enter into an agreement for the

25 purposes of this section with another appropriate scientific
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1 organization that is not part of the Government and oper2 ates as a not-for-profit entity and that has expertise and

3 objectivity comparable to that of the National Academy

4 of Sciences.

5 (2) If the Secretary enters into such an agreement

6 with another organization, any reference in this section

7 and in section 1118 of title 38, United States Code (as

8 added by section 2), to the National Academy of Sciences

9 shall be treated as a reference to the other organization.

10 SEC. 4. MONITORING OF HEALTH STATUS AND TREATMENT

11 OF PERSIAN GULF WAR VETERANS.

12 (a) INFORMATION DATA BASE.—(1) The Secretary

13 of Veterans Affairs shall, in consultation with the Sec14 retary of Defense, develop a plan for the establishment

15 and operation of a single computerized information data

16 base for the collection, storage, and analysis of informa17 tion on—

18 (A) the diagnosed and undiagnosed illnesses

19 suffered by current and former members of the

20 Armed Forces who served in the Southwest Asia the21 ater of operations during the Persian Gulf War; and

22 (B) the treatment provided such members for—

23 (i) any chronic undiagnosed illnesses; and

24 (ii) any chronic illnesses for which the Na25 tional Academy of Sciences has identified a
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1 valid model of treatment pursuant to its review

2 under section 3(e).

3 (2) The plan shall provide for the commencement of

4 the operation of the data base not later than 18 months

5 after the date of enactment of this Act.

6 (3) The Secretary shall ensure in the plan that the

7 data base provides the capability of monitoring and ana8 lyzing information on—

9 (A) the illnesses covered by paragraph (1)(A);

10 (B) the treatments covered by paragraph

11 (1)(B); and

12 (C) the efficacy of such treatments.

13 (4) In order to meet the requirement under para14 graph (3), the plan shall ensure that the data base in15 cludes the following:

16 (i) Information in the Persian Gulf War Veter17 ans Health Registry established under section 702 of

18 the Persian Gulf War Veterans’ Health Status Act

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

20 note).

21 (ii) Information in the Comprehensive Clinical

22 Evaluation Program for Veterans established under

23 section 734 of the National Defense Authorization

24 Act for Fiscal Years 1992 and 1993 (10 U.S.C.

25 1074 note).
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1 (iii) Information derived from other examina2 tions and treatment provided veterans who served in

3 the Southwest Asia theater of operations during the

4 Persian Gulf War.

5 (iv) Information derived from other examina6 tions and treatment provided current members of

7 the Armed Forces (including members on active

8 duty and members of the reserve components) who

9 served in that theater of operations during that war.

10 (v) Such other information as the Secretary of

11 Veterans Affairs and the Secretary of Defense con12 sider appropriate.

13 (5) Not later than one year after the date of enact14 ment of this Act, the Secretary shall submit the plan de15 veloped under paragraph (1) to the following:

16 (A) The designated congressional committees.

17 (B) The Secretary of Veterans Affairs.

18 (C) The Secretary of Defense.

19 (D) The National Academy of Sciences.

20 (6)(A) The agreement under section 3 shall require

21 the evaluation of the plan developed under paragraph (1)

22 by the National Academy of Sciences. The Academy shall

23 complete the evaluation of the plan not later than 90 days

24 after the date of its submittal to the Academy under para25 graph (5).
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1 (B) Upon completion of the evaluation, the Academy

2 shall submit a report on the evaluation to the committees

3 and individuals referred to in subparagraphs (A) through

4 (D) of paragraph (5).

5 (7) Not later than 90 days after receipt of the report

6 under paragraph (6), the Secretary shall—

7 (A) modify the plan in light of the evaluation

8 of the Academy in the report; and

9 (B) commence implementation of the plan as so

10 modified.

11 (b) COMPILATION AND ANALYSIS OF INFORMATION

12 IN DATABASE.—(1) The Secretary of Veterans Affairs

13 shall compile and analyze, on an ongoing basis, all clinical

14 data in the data base under subsection (a) that is likely

15 to be scientifically useful in determining the association,

16 if any, between the illnesses (including diagnosed illnesses

17 and undiagnosed illnesses) of veterans covered by such

18 data and exposure to toxic agents or environmental or

19 wartime hazards associated with Gulf War service.

20 (2) The Secretary of Defense shall compile and ana21 lyze, on an ongoing basis, all clinical data in the data base

22 that is likely to be scientifically useful in determining the

23 association, if any, between the illnesses (including diag24 nosed illnesses and undiagnosed illnesses) of current mem25 bers of the Armed Forces (including members on active
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1 duty and members of the reserve components) and expo2 sure to such agents or hazards.

3 (c) ANNUAL REPORT.—Not later than April 1 of each

4 year after a year in which the Secretary of Veterans Af5 fairs and the Secretary of Defense carry out activities

6 under subsection (b), the Secretaries shall jointly submit

7 to the designated congressional committees a report con8 taining—

9 (1) with respect to the data compiled in accord10 ance with subsection (b) during the preceding year—

11 (A) an analysis of the data;

12 (B) a discussion of the types, incidences,

13 and prevalence of the disabilities and illnesses

14 identified through such data;

15 (C) an explanation for the incidence and

16 prevalence of such disabilities and illnesses;

17 (D) other reasonable explanations for the

18 incidence and prevalence of such disabilities and

19 illnesses; and

20 (E) an analysis of the scientific validity of

21 drawing conclusions from the incidence and

22 prevalence of such disabilities and illnesses, as

23 evidenced by such data, about any association

24 between such disabilities and illnesses, as the

25 case may be, and exposure to a toxic agent or
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1 environmental or wartime hazard associated

2 with Gulf War service; and

3 (2) with respect to the most current informa4 tion received under section 3(h) regarding treatment

5 models reviewed under section 3(e)—

6 (A) an analysis of the information;

7 (B) the results of any consultation between

8 such Secretaries regarding the implementation

9 of such treatment models in the health care sys10 tems of the Department of Veterans Affairs

11 and the Department of Defense; and

12 (C) in the event either such Secretary de13 termines not to implement such treatment mod14 els, an explanation for such determination.

15 SEC. 5. SCIENTIFIC RESEARCH FEASIBILITY STUDIES PRO16 GRAM.

17 (a) ESTABLISHMENT OF PROGRAM.—The Secretary

18 of Veterans Affairs, the Secretary of Defense, and the Sec19 retary of Health and Human Services shall jointly carry

20 out a program to provide for the conduct of studies of

21 the feasibility of conducting additional scientific research

22 on health hazards resulting from exposure to toxic agents

23 or environmental or wartime hazards associated with Gulf

24 War service.
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1 (b) PROGRAM REQUIREMENTS.—(1) Under the pro2 gram under subsection (a), the Secretaries shall, pursuant

3 to criteria prescribed pursuant to paragraph (2), jointly

4 award contracts or furnish financial assistance to non5 Government entities for the conduct of studies referred to

6 in subsection (a).

7 (2) The Secretaries shall jointly prescribe criteria

8 for—

9 (A) the selection of entities to be awarded con10 tracts or to receive financial assistance under the

11 program; and

12 (B) the approval of studies to be conducted

13 under such contracts or with such financial assist14 ance.

15 (c) REPORT.—The Secretaries shall jointly report the

16 results of studies conducted under the program to the des17 ignated congressional committees.

18 (d) CONSULTATION WITH NATIONAL ACADEMY OF

19 SCIENCES.—(1) To the extent provided under the agree20 ment entered into by the Secretary of Veterans Affairs

21 and the National Academy of Sciences under section 3—

22 (A) the Secretary shall consult with the Acad23 emy regarding the establishment and administration

24 of the program under subsection (a); and
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1 (B) the Academy shall review the studies con2 ducted under contracts awarded pursuant to the

3 program and the studies conducted with financial

4 assistance furnished pursuant to the program.

5 (2) The agreement shall require the Academy to sub6 mit any recommendations that the Academy considers ap7 propriate regarding any studies reviewed for purposes of

8 this subsection to the following:

9 (A) The designated congressional committees.

10 (B) The Secretary of Veterans Affairs.

11 (C) The Secretary of Defense.

12 (D) The Secretary of Health and Human Serv13 ices.

14 SEC. 6. OUTREACH.

15 (a) OUTREACH BY SECRETARY OF VETERANS AF16 FAIRS.—The Secretary of Veterans Affairs shall, in con17 sultation with the Secretary of Defense and the Secretary

18 of Health and Human Services, carry out an ongoing pro19 gram to provide veterans who served in the Southwest

20 Asia theater of operations during the Persian Gulf War

21 the information described in subsection (c).

22 (b) OUTREACH BY SECRETARY OF DEFENSE.—The

23 Secretary of Defense shall, in consultation with the Sec24 retary of Veterans Affairs and the Secretary of Health and

25 Human Services, carry out an ongoing program to provide
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1 current members of the Armed Forces (including members

2 on active duty and members of the reserve components)

3 who served in that theater of operations during that war

4 the information described in subsection (c).

5 (c) COVERED INFORMATION.—Information under

6 this subsection is information relating to—

7 (1) the health risks, if any, resulting from expo8 sure to toxic agents or environmental or wartime

9 hazards associated with Gulf War service; and

10 (2) any services or benefits available with re11 spect to such health risks.

12 SEC. 7. DEFINITIONS.

13 In this Act:

14 (1) The term ‘‘toxic agent or environmental or

15 wartime hazard associated with Gulf War service’’

16 means a biological, chemical, or other toxic agent or

17 environmental or wartime hazard that is known or

18 presumed to be associated with service in the Armed

19 Forces in the Southwest Asia theater of operations

20 during the Persian Gulf War.

21 (2) The term ‘‘designated congressional com22 mittees’’ means the following:

23 (A) The Committees on Veterans’ Affairs

24 and Armed Services of the Senate.
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1 (B) The Committees on Veterans’ Affairs

2 and National Security of the House of Rep3 resentatives.

Æ