Home > 105th Congressional Bills > S. 2358 (rs) To provide for the establishment of a service-connection for illnesses associated with service in the Persian Gulf War, to extend and enhance certain health care authorities relating to such service, and for other purposes. ...

S. 2358 (rs) To provide for the establishment of a service-connection for illnesses associated with service in the Persian Gulf War, to extend and enhance certain health care authorities relating to such service, and for other purposes. ...


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105th CONGRESS
  2d Session
                                S. 2358


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 9, 1998

             Referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 AN ACT


 
To provide for the establishment of a presumption of service-connection 
   for illnesses associated with service in the Persian Gulf War, to 
  extend and enhance certain health care authorities relating to such 
                    service, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Persian Gulf War 
Veterans Act of 1998''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
       TITLE I--SERVICE CONNECTION FOR PERSIAN GULF WAR ILLNESSES

Sec. 101. Presumption of service connection for illnesses associated 
                            with service in the Persian Gulf during the 
                            Persian Gulf War.
Sec. 102. Agreement with National Academy of Sciences.
Sec. 103. Monitoring of health status and health care of Persian Gulf 
                            War veterans.
Sec. 104. Reports on recommendations for additional scientific 
                            research.
Sec. 105. Outreach.
Sec. 106. Definitions.
  TITLE II--EXTENSION AND ENHANCEMENT OF PERSIAN GULF WAR HEALTH CARE 
                              AUTHORITIES

Sec. 201. Extension of authority to provide health care for Persian 
                            Gulf War veterans.
Sec. 202. Extension and improvement of evaluation of health status of 
                            spouses and children of Persian Gulf War 
                            veterans.
                        TITLE III--MISCELLANEOUS

Sec. 301. Assessment of establishment of independent entity to evaluate 
                            post-conflict illnesses among members of 
                            the Armed Forces and health care provided 
                            by DoD and VA before and after deployment 
                            of such members.

       TITLE I--SERVICE CONNECTION FOR PERSIAN GULF WAR ILLNESSES

SEC. 101. PRESUMPTION OF SERVICE CONNECTION FOR ILLNESSES ASSOCIATED 
              WITH SERVICE IN THE PERSIAN GULF DURING THE PERSIAN GULF 
              WAR.

    (a) In General.--(1) Subchapter II of chapter 11 of title 38, 
United States Code, is amended by adding at the end the following:
``Sec. 1118. Presumptions of service connection for illnesses 
              associated with service in the Persian Gulf during the 
              Persian Gulf War
    ``(a)(1) For purposes of section 1110 of this title, and subject to 
section 1113 of this title, each illness, if any, described in 
paragraph (2) shall be considered to have been incurred in or 
aggravated by service referred to in that paragraph, notwithstanding 
that there is no record of evidence of such illness during the period 
of such service.
    ``(2) An illness referred to in paragraph (1) is any diagnosed or 
undiagnosed illness that--
            ``(A) the Secretary determines in regulations prescribed 
        under this section to warrant a presumption of service 
        connection by reason of having a positive association with 
        exposure to a biological, chemical, or other toxic agent, 
        environmental or wartime hazard, or preventive medicine or 
        vaccine known or presumed to be associated with service in the 
        Armed Forces in the Southwest Asia theater of operations during 
        the Persian Gulf War; and
            ``(B) becomes manifest within the period, if any, 
        prescribed in such regulations in a veteran who served on 
        active duty in that theater of operations during that war and 
        by reason of such service was exposed to such agent, hazard, or 
        medicine or vaccine.
    ``(3) For purposes of this subsection, a veteran who served on 
active duty in the Southwest Asia theater of operations during the 
Persian Gulf War and has an illness described in paragraph (2) shall be 
presumed to have been exposed by reason of such service to the agent, 
hazard, or medicine or vaccine associated with the illness in the 
regulations prescribed under this section unless there is conclusive 
evidence to establish that the veteran was not exposed to the agent, 
hazard, or medicine or vaccine by reason of such service.
    ``(b)(1)(A) Whenever the Secretary makes a determination described 
in subparagraph (B), the Secretary shall prescribe regulations 
providing that a presumption of service connection is warranted for the 
illness covered by that determination for purposes of this section.
    ``(B) A determination referred to in subparagraph (A) is a 
determination based on sound medical and scientific evidence that a 
positive association exists between--
            ``(i) the exposure of humans or animals to a biological, 
        chemical, or other toxic agent, environmental or wartime 
        hazard, or preventive medicine or vaccine known or presumed to 
        be associated with service in the Southwest Asia theater of 
        operations during the Persian Gulf War; and
            ``(ii) the occurrence of a diagnosed or undiagnosed illness 
        in humans or animals.
    ``(2)(A) In making determinations for purposes of paragraph (1), 
the Secretary shall take into account--
            ``(i) the reports submitted to the Secretary by the 
        National Academy of Sciences under section 102 of the Persian 
        Gulf War Veterans Act of 1998; and
            ``(ii) all other sound medical and scientific information 
        and analyses available to the Secretary.
    ``(B) In evaluating any report, information, or analysis for 
purposes of making such determinations, the Secretary shall take into 
consideration whether the results are statistically significant, are 
capable of replication, and withstand peer review.
    ``(3) An association between the occurrence of an illness in humans 
or animals and exposure to an agent, hazard, or medicine or vaccine 
shall be considered to be positive for purposes of this subsection if 
the credible evidence for the association is equal to or outweighs the 
credible evidence against the association.
    ``(c)(1) Not later than 60 days after the date on which the 
Secretary receives a report from the National Academy of Sciences under 
section 102 of the Persian Gulf War Veterans Act of 1998, the Secretary 
shall determine whether or not a presumption of service connection is 
warranted for each illness, if any, covered by the report.
    ``(2) If the Secretary determines under this subsection that a 
presumption of service connection is warranted, the Secretary shall, 
not later than 60 days after making the determination, issue proposed 
regulations setting forth the Secretary's determination.
    ``(3)(A) If the Secretary determines under this subsection that a 
presumption of service connection is not warranted, the Secretary 
shall, not later than 60 days after making the determination, publish 
in the Federal Register a notice of the determination. The notice shall 
include an explanation of the scientific basis for the determination.
    ``(B) If an illness already presumed to be service connected under 
this section is subject to a determination under subparagraph (A), the 
Secretary shall, not later than 60 days after publication of the notice 
under that subparagraph, issue proposed regulations removing the 
presumption of service connection for the illness.
    ``(4) Not later than 90 days after the date on which the Secretary 
issues any proposed regulations under this subsection, the Secretary 
shall issue final regulations. Such regulations shall be effective on 
the date of issuance.
    ``(d) Whenever the presumption of service connection for an illness 
under this section is removed under subsection (c)--
            ``(1) a veteran who was awarded compensation for the 
        illness on the basis of the presumption before the effective 
        date of the removal of the presumption shall continue to be 
        entitled to receive compensation on that basis; and
            ``(2) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from the illness on the basis of the presumption before that 
        date shall continue to be entitled to receive dependency and 
        indemnity compensation on that basis.
    ``(e) Subsections (b) through (d) shall cease to be effective 10 
years after the first day of the fiscal year in which the National 
Academy of Sciences submits to the Secretary the first report under 
section 102 of the Persian Gulf War Veterans Act of 1998.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating 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.''.
    (b) Conforming Amendments.--Section 1113 of title 38, United States 
Code, is amended--
            (1) by striking out ``or 1117'' each place it appears and 
        inserting in lieu thereof ``1117, or 1118''; and
            (2) in subsection (a), by striking out ``or 1116'' and 
        inserting in lieu thereof ``, 1116, or 1118''.
    (c) Compensation for Undiagnosed Gulf War Illnesses.--Section 1117 
of title 38, United States Code, is amended--
            (1) by redesignating subsections (c), (d), and (e) as 
        subsections (d), (e), and (f), respectively; and
            (2) by inserting after subsection (b) the following new 
        subsection (c):
    ``(c)(1) Whenever the Secretary determines under section 1118(c) of 
this title that a presumption of service connection for an undiagnosed 
illness (or combination of undiagnosed illnesses) previously 
established under this section is no longer warranted--
            ``(A) a veteran who was awarded compensation under this 
        section for such illness (or combination of illnesses) on the 
        basis of the presumption shall continue to be entitled to 
        receive compensation under this section on that basis; and
            ``(B) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from the disease on the basis of the presumption before that 
        date shall continue to be entitled to receive dependency and 
        indemnity compensation on that basis.
    ``(2) This subsection shall cease to be effective 10 years after 
the first day of the fiscal year in which the National Academy of 
Sciences submits to the Secretary the first report under section 102 of 
the Persian Gulf War Veterans Act of 1998.''.

SEC. 102. AGREEMENT WITH NATIONAL ACADEMY OF SCIENCES.

    (a) Purpose.--The purpose of this section is to provide for the 
National Academy of Sciences, an independent nonprofit scientific 
organization with appropriate expertise, to review and evaluate the 
available scientific evidence regarding associations between illnesses 
and exposure to toxic agents, environmental or wartime hazards, or 
preventive medicines or vaccines associated with Gulf War service.
    (b) Agreement.--The Secretary of Veterans Affairs shall seek to 
enter into an agreement with the National Academy of Sciences for the 
Academy to perform the activities covered by this section and section 
103(a)(6). The Secretary shall seek to enter into the agreement not 
later than two months after the date of enactment of this Act.
    (c) Identification of Agents and Illnesses.--(1) Under the 
agreement under subsection (b), the National Academy of Sciences 
shall--
            (A) identify the biological, chemical, or other toxic 
        agents, environmental or wartime hazards, or preventive 
        medicines or vaccines to which members of the Armed Forces who 
        served in the Southwest Asia theater of operations during the 
        Persian Gulf War may have been exposed by reason of such 
        service; and
            (B) identify the illnesses (including diagnosed illnesses 
        and undiagnosed illnesses) that are manifest in such members.
    (2) In identifying illnesses under paragraph (1)(B), the Academy 
shall review and summarize the relevant scientific evidence regarding 
chronic illnesses among the members described in paragraph (1)(A) and 
among other appropriate populations of individuals, including 
mortality, symptoms, and adverse reproductive health outcomes among 
such members and individuals.
    (d) Initial Consideration of Specific Agents.--(1) In identifying 
under subsection (c) the agents, hazards, or preventive medicines or 
vaccines to which members of the Armed Forces may have been exposed for 
purposes of the first report under subsection (i), the National Academy 
of Sciences shall consider, within the first six months after the date 
of enactment of this Act, the following:
            (A) The following organophosphorous pesticides:
                    (i) Chlorpyrifos.
                    (ii) Diazinon.
                    (iii) Dichlorvos.
                    (iv) Malathion.
            (B) The following carbamate pesticides:
                    (i) Proxpur.
                    (ii) Carbaryl.
                    (iii) Methomyl.
            (C) The carbamate pyridostigmine bromide used as nerve 
        agent prophylaxis.
            (D) The following chlorinated dydrocarbon and other 
        pesticides and repellents:
                    (i) Lindane.
                    (ii) Pyrethrins.
                    (iii) Permethrins.
                    (iv) Rodenticides (bait).
                    (v) Repellent (DEET).
            (E) The following low-level nerve agents and precursor 
        compounds at exposure levels below those which produce 
        immediately apparent incapacitating symptoms:
                    (i) Sarin.
                    (ii) Tabun.
            (F) The following synthetic chemical compounds:
                    (i) Mustard agents at levels below those which 
                cause immediate blistering.
                    (ii) Volatile organic compounds.
                    (iii) Hydrazine.
                    (iv) Red fuming nitric acid.
                    (v) Solvents.
            (G) The following sources of radiation:
                    (i) Depleted uranium.
                    (ii) Microwave radiation.
                    (iii) Radio frequency radiation.
            (H) The following environmental particulates and 
        pollutants:
                    (i) Hydrogen sulfide.
                    (ii) Oil fire byproducts.
                    (iii) Diesel heater fumes.
                    (iv) Sand micro-particles.
            (I) Diseases endemic to the region (including the 
        following):
                    (i) Leishmaniasis.
                    (ii) Sandfly fever.
                    (iii) Pathogenic escherechia coli.
                    (iv) Shigellosis.
            (J) Time compressed administration of multiple live, 
        ``attenuated'', and toxoid vaccines.
    (2) The consideration of agents, hazards, and medicines and 
vaccines under paragraph (1) shall not preclude the Academy from 
identifying other agents, hazards, or medicines or vaccines to which 
members of the Armed Forces may have been exposed for purposes of any 
report under subsection (i).
    (3) Not later than six months after the date of enactment of this 

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