38 U.S.C. § 1117 — Compensation for disabilities occurring in

Page 171 TITLE 38—VETERANS’ BENEFITS § 1117 1 See References in Text note below. the Committees on Veterans’ Affairs of the House of Representatives and the Senate updates on the status of such regulations. ‘‘(3) PENDING CASES.— ‘‘(A) AUTHORITY TO STAY.—The Secretary may stay a claim described in subparagraph (B) until the date on which the Secretary commences the implementa- tion of section 1116B of title 38, United States Code, as added by subsection (a). ‘‘(B) CLAIMS DESCRIBED.—A claim described in this subparagraph is a claim for disability compensation— ‘‘(i) relating to the service and diseases covered by such section 1116B; and ‘‘(ii) that is pending at the Veterans Benefits Ad- ministration or the Board of Veterans’ Appeals on or after the date of the enactment of this Act and before the date on which the Secretary commences the implementation of such section 1116B.’’ § 1117. Compensation for disabilities occurring in Persian Gulf War veterans (a)(1) The Secretary may pay compensation under this subchapter to a Persian Gulf veteran with a qualifying chronic disability that became manifest to any degree at any time. (2) For purposes of this subsection, the term ‘‘qualifying chronic disability’’ means a chronic disability resulting from any of the following (or any combination of any of the following): (A) An undiagnosed illness. (B) A medically unexplained chronic multi- symptom illness (such as chronic fatigue syn- drome, fibromyalgia, and irritable bowel syn- drome) that is defined by a cluster of signs or symptoms. (C) Any diagnosed illness that the Secretary determines in regulations prescribed under subsection (c) warrants a presumption of serv- ice-connection. (b)(1) Whenever the Secretary determines under section 1118(c) 1 of this title that a pre- sumption of service connection previously estab- lished under this section is no longer war- ranted— (A) a veteran who was awarded compensa- tion under this section on the basis of the pre- sumption shall continue to be entitled to re- ceive 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 dis- ease on the basis of the presumption before that date shall continue to be entitled to re- ceive dependency and indemnity compensation on that basis. (2) This subsection shall cease to be effective on September 30, 2011. (c)(1) The Secretary shall prescribe regula- tions to carry out this section. (2) Those regulations shall include the fol- lowing: (A) A description of the period and geo- graphical area or areas of military service in connection with which compensation under this section may be paid. (B) A description of the illnesses for which compensation under this section may be paid. (C) A description of any relevant medical characteristic (such as a latency period) asso- ciated with each such illness. (d) If a Persian Gulf veteran at a medical facil- ity of the Department presents with any one symptom associated with Gulf War Illness, the Secretary shall ensure that health care per- sonnel of the Department use a disability bene- fits questionnaire, or successor questionnaire, designed to identify Gulf War Illness, in addition to any other diagnostic actions the personnel determine appropriate. (e) A disability for which compensation under this subchapter is payable shall be considered to be service connected for purposes of all other laws of the United States. (f) For purposes of this section, the term ‘‘Per- sian Gulf veteran’’ means a veteran who served on active duty in the Armed Forces in the Southwest Asia theater of operations, Afghani- stan, Israel, Egypt, Turkey, Syria, or Jordan, during the Persian Gulf War. (g) For purposes of this section, signs or symp- toms that may be a manifestation of an undiagnosed illness or a chronic multisymptom illness include the following: (1) Fatigue. (2) Unexplained rashes or other dermato- logical signs or symptoms. (3) Headache. (4) Muscle pain. (5) Joint pain. (6) Neurological signs and symptoms. (7) Neuropsychological signs or symptoms. (8) Signs or symptoms involving the upper or lower respiratory system. (9) Sleep disturbances. (10) Gastrointestinal signs or symptoms. (11) Cardiovascular signs or symptoms. (12) Abnormal weight loss. (13) Menstrual disorders. (h)(1) If the Secretary determines with respect to a medical research project sponsored by the Department that it is necessary for the conduct of the project that Persian Gulf veterans in re- ceipt of compensation under this section or sec- tion 1118 of this title participate in the project without the possibility of loss of service connec- tion under either such section, the Secretary shall provide that service connection granted under either such section for disability of a vet- eran who participated in the research project may not be terminated. Except as provided in paragraph (2), notwithstanding any other provi- sion of law any grant of service-connection pro- tected under this subsection shall remain serv- ice-connected for purposes of all provisions of law under this title. (2) Paragraph (1) does not apply in a case in which— (A) the original award of compensation or service connection was based on fraud; or (B) it is clearly shown from military records that the person concerned did not have the requisite service or character of discharge. (3) The Secretary shall publish in the Federal Register a list of medical research projects spon- sored by the Department for which service con- nection granted under this section or section 1118 of this title may not be terminated pursu- ant to paragraph (1). (i)(1) The Secretary shall take such actions as may be necessary to ensure that health care per- Page 172 TITLE 38—VETERANS’ BENEFITS § 1117 sonnel of the Department are appropriately trained to effectively carry out this section. (2) Not less frequently than once each year, the Secretary shall submit to Congress a report on the actions taken by the Secretary to carry out paragraph (1). (Added Pub. L. 103–446, title I, § 106(a)(1), Nov. 2, 1994, 108 Stat. 4650; amended Pub. L. 105–277, div. C, title XVI, § 1602(c), Oct. 21, 1998, 112 Stat. 2681–744; Pub. L. 107–103, title II, §§ 202(a), (b)(1), (d)(1), 203(a), Dec. 27, 2001, 115 Stat. 988, 989; Pub. L. 109–233, title V, § 503(1), June 15, 2006, 120 Stat. 415; Pub. L. 117–168, title IV, § 405, Aug. 10, 2022, 136 Stat. 1783.) Editorial Notes REFERENCES IN TEXT Section 1118(c) of this title, referred to in subsec. (b)(1), was repealed by Pub. L. 117–168, title II, § 202(d)(3)(A), Aug. 10, 2022, 136 Stat. 1775. AMENDMENTS 2022—Subsec. (a)(1). Pub. L. 117–168, § 405(a), sub- stituted ‘‘became manifest to any degree at any time.’’ for ‘‘became manifest— ‘‘(A) during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War; or ‘‘(B) to a degree of 10 percent or more during the presumptive period prescribed under subsection (b).’’ Subsec. (a)(2)(C). Pub. L. 117–168, § 405(b)(3), sub- stituted ‘‘under subsection (c)’’ for ‘‘under subsection (d)’’. Subsecs. (b), (c). Pub. L. 117–168, § 405(b)(1), (2), redes- ignated subsecs. (c) and (d) as (b) and (c), respectively, and struck out former subsec. (b) which read as follows: ‘‘The Secretary shall prescribe by regulation the period of time following service in the Southwest Asia theater of operations during the Persian Gulf War that the Sec- retary determines is appropriate for presumption of service connection for purposes of this section. The Secretary’s determination of such period of time shall be made following a review of any available credible medical or scientific evidence and the historical treat- ment afforded disabilities for which manifestation peri- ods have been established and shall take into account other pertinent circumstances regarding the experi- ences of veterans of the Persian Gulf War.’’ Subsec. (d). Pub. L. 117–168, § 405(b)(2), (c), added sub- sec. (d) and redesignated former subsec. (d) as (c). Subsec. (f). Pub. L. 117–168, § 405(d), inserted ‘‘, Afghanistan, Israel, Egypt, Turkey, Syria, or Jor- dan,’’ after ‘‘operations’’. Subsec. (i). Pub. L. 117–168, § 405(e), added subsec. (i). 2006—Subsec. (h)(1). Pub. L. 109–233 substituted ‘‘not- withstanding’’ for ‘‘nothwithstanding’’. 2001—Subsec. (a). Pub. L. 107–103, § 202(a)(1), amended subsec. (a) generally. Prior to amendment, subsec. (a) read as follows: ‘‘The Secretary may pay compensation under this subchapter to any Persian Gulf veteran suf- fering from a chronic disability resulting from an undiagnosed illness (or combination of undiagnosed ill- nesses) that— ‘‘(1) became manifest during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War; or ‘‘(2) became manifest to a degree of 10 percent or more within the presumptive period prescribed under subsection (b).’’ Subsec. (c)(1). Pub. L. 107–103, § 202(a)(2)(A), struck out ‘‘for an undiagnosed illness (or combination of undiagnosed illnesses)’’ after ‘‘service connection’’ in introductory provisions. Subsec. (c)(1)(A). Pub. L. 107–103, § 202(a)(2)(B), struck out ‘‘for such illness (or combination of illnesses)’’ after ‘‘awarded compensation under this section’’. Subsec. (c)(2). Pub. L. 107–103, § 202(d)(1), substituted ‘‘on September 30, 2011’’ for ‘‘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 1603 of the Persian Gulf War Veterans Act of 1998’’. Subsec. (g). Pub. L. 107–103, § 202(b)(1), added subsec. (g). Subsec. (h). Pub. L. 107–103, § 203(a), added subsec. (h). 1998—Subsecs. (c) to (f). Pub. L. 105–277 added subsec. (c) and redesignated former subsecs. (c) to (e) as (d) to (f), respectively. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2001 AMENDMENT Pub. L. 107–103, title II, § 202(c), Dec. 27, 2001, 115 Stat. 989, provided that: ‘‘The amendments made by sub- sections (a) and (b) [amending this section and section 1118 of this title] shall take effect on March 1, 2002.’’ Pub. L. 107–103, title II, § 203(b), Dec. 27, 2001, 115 Stat. 990, provided that: ‘‘The authority provided by sub- section (h) of section 1117 of title 38, United States Code, as added by subsection (a), may be used by the Secretary of Veterans Affairs with respect to any med- ical research project of the Department of Veterans Af- fairs, whether commenced before, on, or after the date of the enactment of this Act [Dec. 27, 2001].’’ REGULATIONS Pub. L. 103–446, title I, § 106(d), Nov. 2, 1994, 108 Stat. 4651, provided that: ‘‘If the Secretary states in the re- port under subsection (c) [set out below] that the Sec- retary intends to pay compensation as provided in sec- tion 1117 of title 38, United States Code, as added by subsection (a), the Secretary shall, not later than 30 days after the date on which such report is submitted, publish in the Federal Register proposed regulations under subsections (b) and (c) of that section.’’ AGREEMENT WITH NATIONAL ACADEMY OF SCIENCES RE- GARDING EVALUATION OF HEALTH CONSEQUENCES OF SERVICE IN SOUTHWEST ASIA DURING THE PERSIAN GULF WAR Pub. L. 105–368, title I, § 101, Nov. 11, 1998, 112 Stat. 3317, as amended by Pub. L. 111–275, title VIII, § 806(b)(1), (2), Oct. 13, 2010, 124 Stat. 2891, provided that the Secretary of Veterans Affairs was to enter into an agreement with the National Academy of Sciences to review and evaluate the available scientific evidence regarding associations between illness and service in the Southwest Asia theater of operations during the Persian Gulf War, and that the section would cease to be effective on Oct. 1, 2018. IMPROVING EFFECTIVENESS OF CARE OF PERSIAN GULF WAR VETERANS Pub. L. 105–368, title I, § 105, Nov. 11, 1998, 112 Stat. 3324, provided that: ‘‘(a) ASSESSMENT BY NATIONAL ACADEMY OF SCIENCES.—Not later than April 1, 1999, the Secretary of Veterans Affairs shall enter into a contract with the National Academy of Sciences to review the available scientific data in order to— ‘‘(1) assess whether a methodology could be used by the Department of Veterans Affairs for determining the efficacy of treatments furnished to, and health outcomes (including functional status) of, Persian Gulf War veterans who have been treated for illnesses which may be associated with their service in the Persian Gulf War; and ‘‘(2) identify, to the extent feasible, with respect to each undiagnosed illness prevalent among such vet- erans and for any other chronic illness that the Acad- emy determines to warrant such review, empirically valid models of treatment for such illness which em- ploy successful treatment modalities for populations with similar symptoms. ‘‘(b) ACTION ON REPORT.—(1) After receiving the final report of the National Academy of Sciences under sub- Page 173 TITLE 38—VETERANS’ BENEFITS § 1117 section (a), the Secretary shall, if a reasonable and sci- entifically feasible methodology is identified by the Academy, develop an appropriate mechanism to mon- itor and study the effectiveness of treatments furnished to, and health outcomes of, Persian Gulf War veterans who suffer from diagnosed and undiagnosed illnesses which may be associated with their service in the Per- sian Gulf War. ‘‘(2) The Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Represent- atives a report on the implementation of paragraph (1). ‘‘(3) The Secretary shall carry out paragraphs (1) and (2) not later than 180 days after receiving the final re- port of the National Academy of Sciences under sub- section (a).’’ AGREEMENT WITH NATIONAL ACADEMY OF SCIENCES RE- GARDING TOXIC DRUGS AND ILLNESSES ASSOCIATED WITH GULF WAR Pub. L. 105–277, div. C, title XVI, §§ 1603–1605, Oct. 21, 1998, 112 Stat. 2681–745 to 2681–748, as amended by Pub. L. 107–103, title II, § 202(d)(2), Dec. 27, 2001, 115 Stat. 989; Pub. L. 111–275, title VIII, § 806(a), (b)(3), Oct. 13, 2010, 124 Stat. 2890, 2893, provided that: ‘‘SEC. 1603. AGREEMENT WITH NATIONAL ACAD- EMY OF SCIENCES. ‘‘(a) PURPOSE.—The purpose of this section is to pro- vide for the National Academy of Sciences, an inde- pendent nonprofit scientific organization with appro- priate expertise, to review and evaluate the available scientific evidence regarding associations between ill- nesses 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 Na- tional Academy of Sciences for the Academy to per- form the activities covered by this section. The Sec- retary shall seek to enter into the agreement not later than two months after the date of enactment of this Act [Oct. 21, 1998]. ‘‘(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 may have been exposed by reason of service in the Southwest Asia theater of op- erations during the Persian Gulf War or, after Sep- tember 11, 2001, in another Post-9/11 Global Theater of Operations; and ‘‘(B) identify the illnesses (including diagnosed ill- nesses 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 illnesses among the mem- bers described in paragraph (1)(A) and among other ap- propriate populations of individuals, including mor- tality, symptoms, and adverse reproductive health out- comes 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 pur- poses of the first report under subsection (i), the Na- tional Academy of Sciences shall consider, within the first six months after the date of enactment of this Act [Oct. 21, 1998], 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 hydrocarbon 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 pre- cursor 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. ‘‘(vi) Uranium. ‘‘(G) The following ionizing 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 medi- cines and vaccines under paragraph (1) shall not pre- clude the Academy from identifying other agents, haz- ards, 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 en- actment of this Act [Oct. 21, 1998], the Academy shall submit to the designated congressional committees a report specifying the agents, hazards, and medicines and vaccines considered under paragraph (1). ‘‘(e) DETERMINATIONS OF ASSOCIATIONS BETWEEN AGENTS AND ILLNESSES.—(1) For each agent, hazard, or medicine or vaccine and illness identified under sub- section (c), the National Academy of Sciences shall de- termine, to the extent that available scientific data permit meaningful determinations— ‘‘(A) whether a statistical association exists be- tween exposure to the agent, hazard, or medicine or vaccine and the illness, taking into account the strength of the scientific evidence and the appro- priateness of the scientific methodology used to de- tect the association; ‘‘(B) the increased risk of the illness among human or animal populations exposed to the agent, hazard, or medicine or vaccine; and ‘‘(C) whether a plausible biological mechanism or other evidence of a causal relationship exists between exposure to the agent, hazard, or medicine or vaccine and the illness. ‘‘(2) The Academy shall include in its reports under subsection (i) a full discussion of the scientific evidence and reasoning that led to its conclusions under this subsection. ‘‘(f) REVIEW OF POTENTIAL TREATMENT MODELS FOR CERTAIN ILLNESSES.—Under the agreement under sub- section (b), the National Academy of Sciences shall separately review, for each chronic undiagnosed illness identified under subsection (c)(1)(B) and for any other Page 174 TITLE 38—VETERANS’ BENEFITS § 1117 chronic illness that the Academy determines to war- rant such review, the available scientific data in order to identify empirically valid models of treatment for such illnesses which employ successful treatment mo- dalities for populations with similar symptoms. ‘‘(g) RECOMMENDATIONS FOR ADDITIONAL SCIENTIFIC STUDIES.—(1) Under the agreement under subsection (b), the National Academy of Sciences shall make any recommendations that it considers appropriate for ad- ditional scientific studies (including studies relating to treatment models) to resolve areas of continuing sci- entific uncertainty relating to the health consequences of exposure to toxic agents, environmental or wartime hazards, or preventive medicines or vaccines associated with service described in subsection (c)(1)(A). ‘‘(2) In making recommendations for additional stud- ies, the Academy shall consider the available scientific data, the value and relevance of the information that could result from such studies, and the cost and feasi- bility of carrying out such studies. ‘‘(h) SUBSEQUENT REVIEWS.—(1) Under the agreement under subsection (b), the National Academy of Sciences shall conduct on a periodic and ongoing basis addi- tional reviews of the evidence and data relating to its activities under this section. ‘‘(2) As part of each review under this subsection, the Academy shall— ‘‘(A) conduct as comprehensive a review as is prac- ticable of the evidence referred to in subsection (c) and the data referred to in subsections (e), (f), and (g) that became available since the last review of such evidence and data under this section; and ‘‘(B) make determinations under the subsections re- ferred to in subparagraph (A) on the basis of the re- sults of such review and all other reviews previously conducted for purposes of this section. ‘‘(i) REPORTS.—(1) Under the agreement under sub- section (b), the National Academy of Sciences shall submit to the committees and officials referred to in paragraph (6) periodic written reports regarding the Academy’s activities under the agreement. ‘‘(2) The first report under paragraph (1) shall be sub- mitted not later than 18 months after the date of enact- ment of this Act [Oct. 21, 1998]. That report shall in- clude— ‘‘(A) the determinations and discussion referred to in subsection (e); ‘‘(B) the results of the review of models of treat- ment under subsection (f); and ‘‘(C) any recommendations of the Academy under subsection (g). ‘‘(3) Reports shall be submitted under this subsection at least once every two years, as measured from the date of the report under paragraph (2). ‘‘(4) In any report under this subsection (other than the report under paragraph (2)), the Academy may specify an absence of meaningful developments in the scientific or medical community with respect to the ac- tivities of the Academy under this section during the 2- year period ending on the date of such report. ‘‘(5) In each report under this subsection submitted after the date of the enactment of this paragraph [Oct. 13, 2010], any determinations, results, and recommenda- tions as described in paragraph (2) shall be submitted separately as follows: ‘‘(A) For the Southwest Asia theater of operations for the period of the Persian Gulf War ending on Sep- tember 11, 2001. ‘‘(B) For the Post-9/11 Global Theaters of Oper- ations for the period of the Persian Gulf War begin- ning on September 11, 2001. ‘‘(6) Reports under this subsection shall be submitted to the following: ‘‘(A) The designated congressional committees. ‘‘(B) The Secretary of Veterans Affairs. ‘‘(C) The Secretary of Defense. ‘‘(j) SUNSET.—This section shall cease to be effective on October 1, 2015. ‘‘(k) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA- TION.—(1) If the Secretary is unable within the time pe- riod set forth in subsection (b) to enter into an agree- ment with the National Academy of Sciences for the purposes of this section on terms acceptable to the Sec- retary, the Secretary shall seek to enter into an agree- ment for purposes of this section with another appro- priate scientific organization that is not part of the Government, operates as a not-for-profit entity, and has expertise and objectivity comparable to that of the National Academy of Sciences. ‘‘(2) If the Secretary enters into an agreement with another organization under this subsection, any ref- erence in this section and section 1118 of title 38, United States Code (as added by section 1602(a)), to the National Academy of Sciences shall be treated as a ref- erence to such other organization. ‘‘(l) DEFINITIONS.—In this section: ‘‘(1) The term ‘Persian Gulf War’ has the meaning given that term in section 101(33) of title 38, United States Code. ‘‘(2) The term ‘Post-9/11 Global Theater of Oper- ations’ means Afghanistan, Iraq, and any other the- ater of operations for which the Global War on Ter- rorism Expeditionary Medal is awarded for service. ‘‘[SEC. 1604. Repealed. Pub. L. 111–275, title VIII, § 806(b)(3), Oct. 13, 2010, 124 Stat. 2893.] ‘‘SEC. 1605. DEFINITIONS. ‘‘In this title [enacting section 1118 of this title, amending this section and section 1113 of this title, and enacting this note and provisions set out as a note under section 101 of this title]: ‘‘(1) The term ‘toxic agent, environmental or war- time hazard, or preventive medicine or vaccine asso- ciated with Gulf War service’ means a biological, chemical, or other toxic agent, environmental or war- time hazard, or preventive medicine or vaccine that is known or presumed to be associated with service in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, whether such association arises as a result of single, repeated, or sustained exposure and whether such association arises through exposure singularly or in combination. ‘‘(2) The term ‘designated congressional commit- tees’ means the following: ‘‘(A) The Committees on Veterans’ Affairs and Armed Services of the Senate. ‘‘(B) The Committees on Veterans’ Affairs and National Security [now Armed Services] of the House of Representatives. ‘‘(3) The term ‘Persian Gulf War’ has the meaning given that term in section 101(33) of title 38, United States Code.’’ PERSIAN GULF WAR VETERANS’ BENEFITS Pub. L. 103–446, title I, §§ 102–105, 107, 109, 110, Nov. 2, 1994, 108 Stat. 4647–4650, 4652–4654, as amended by Pub. L. 104–262, title III, § 352(a), Oct. 9, 1996, 110 Stat. 3210; Pub. L. 105–368, title I, § 107, Nov. 11, 1998, 112 Stat. 3325; Pub. L. 106–117, title II, § 205(b), (c), Nov. 30, 1999, 113 Stat. 1563; Pub. L. 115–182, title I, § 144(a)(3), June 6, 2018, 132 Stat. 1430, provided that: ‘‘SEC. 102. FINDINGS. ‘‘The Congress makes the following findings: ‘‘(1) During the Persian Gulf War, members of the Armed Forces were exposed to numerous potentially toxic substances, including fumes and smoke from military operations, oil well fires, diesel exhaust, paints, pesticides, depleted uranium, infectious agents, investigational drugs and vaccines, and indig- enous diseases, and were also given multiple immuni- zations. It is not known whether these servicemembers were exposed to chemical or biologi- cal warfare agents. However, threats of enemy use of chemical and biological warfare heightened the psy- chological stress associated with the military oper- ation. ‘‘(2) Significant numbers of veterans of the Persian Gulf War are suffering from illnesses, or are exhib- iting symptoms of illness, that cannot now be diag- Page 175 TITLE 38—VETERANS’ BENEFITS § 1117 nosed or clearly defined. As a result, many of these conditions or illnesses are not considered to be serv- ice connected under current law for purposes of bene- fits administered by the Department of Veterans Af- fairs. ‘‘(3) The National Institutes of Health Technology Assessment Workshop on the Persian Gulf Experience and Health, held in April 1994, concluded that the complex biological, chemical, physical, and psycho- logical environment of the Southwest Asia theater of operations produced complex adverse health effects in Persian Gulf War veterans and that no single dis- ease entity or syndrome is apparent. Rather, it may be that the illnesses suffered by those veterans result from multiple illnesses with overlapping symptoms and causes that have yet to be defined. ‘‘(4) That workshop concluded that the information concerning the range and intensity of exposure to toxic substances by military personnel in the South- west Asia theater of operations is very limited and that such information was collected only after a con- siderable delay. ‘‘(5) In response to concerns regarding the health- care needs of Persian Gulf War veterans, particularly those who suffer from illnesses or conditions for which no diagnosis has been made, the Congress, in Public Law 102–585 [see Short Title of 1992 Amend- ments note under section 101 of this title], directed the establishment of a Persian Gulf War Veterans Health Registry, authorized health examinations for veterans of the Persian Gulf War, and provided for the National Academy of Sciences to conduct a com- prehensive review and assessment of information re- garding the health consequences of military service in the Persian Gulf theater of operations and to de- velop recommendations on avenues for research re- garding such health consequences. In Public Law 103–210 [see Tables for classification], the Congress authorized the Department of Veterans Affairs to provide health care services on a priority basis to Persian Gulf War veterans. The Congress also pro- vided in Public Law 103–160 (the National Defense Au- thorization Act for Fiscal Year 1994) [see Tables for classification] for the establishment of a specialized environmental medical facility for the conduct of re- search into the possible health effects of exposure to low levels of hazardous chemicals, especially among Persian Gulf veterans, and for research into the pos- sible health effects of battlefield exposure in such veterans to depleted uranium. ‘‘(6) In response to concerns about the lack of objec- tive research on Gulf War illnesses, Congress included research provisions in the National Defense Author- ization Act for Fiscal Year 1995 [Pub. L. 103–337, see Tables for classification], which was passed by the House and Senate in September 1994. This legislation requires the Secretary of Defense to provide research grants to non-Federal researchers to support three types of studies of the Gulf War syndrome. The first type of study will be an epidemiological study or studies of the incidence, prevalence, and nature of the illness and symptoms and the risk factors associated with symptoms or illnesses. This will include ill- nesses among spouses and birth defects and illnesses among offspring born before and after the Gulf War. The second group of studies shall be conducted to de- termine the health consequences of the use of pyridostigmine bromide as a pretreatment antidote enhancer during the Persian Gulf War, alone or in combination with exposure to pesticides, environ- mental toxins, and other hazardous substances. The final group of studies shall include clinical research and other studies on the causes, possible trans- mission, and treatment of Gulf War syndrome, and will include studies of veterans and their spouses and children. ‘‘(7) Further research and studies must be under- taken to determine the underlying causes of the ill- nesses suffered by Persian Gulf War veterans and, pending the outcome of such research, veterans who are seriously ill as the result of such illnesses should be given the benefit of the doubt and be provided compensation benefits to offset the impairment in earnings capacities they may be experiencing. ‘‘SEC. 103. PURPOSES. ‘‘The purposes of this title [see Short Title of 1994 Amendments note under section 101 of this title] are— ‘‘(1) to provide compensation to Persian Gulf War veterans who suffer disabilities resulting from ill- nesses that cannot now be diagnosed or defined, and for which other causes cannot be identified; ‘‘(2) to require the Secretary of Veterans Affairs to develop at the earliest possible date case assessment strategies and definitions or diagnoses of such ill- nesses; ‘‘(3) to promote greater outreach to Persian Gulf War veterans and their families to inform them of on- going research activities, as well as the services and benefits to which they are currently entitled; and ‘‘(4) to ensure that research activities and accom- panying surveys of Persian Gulf War veterans are ap- propriately funded and undertaken by the Depart- ment of Veterans Affairs. ‘‘SEC. 104. DEVELOPMENT OF MEDICAL EVALUA- TION PROTOCOL. ‘‘(a) UNIFORM MEDICAL EVALUATION PROTOCOL.—(1) The Secretary of Veterans Affairs shall develop and im- plement a uniform and comprehensive medical evalua- tion protocol that will ensure appropriate medical as- sessment, diagnosis, and treatment of Persian Gulf War veterans who are suffering from illnesses the origins of which are (as of the date of the enactment of this Act [Nov. 2, 1994]) unknown and that may be attributable to service in the Southwest Asia theater of operations during the Persian Gulf War. The protocol shall include an evaluation of complaints relating to illnesses in- volving the reproductive system. ‘‘(2) If such a protocol is not implemented before the end of the 120-day period beginning on the date of the enactment of this Act [Nov. 2, 1994], the Secretary shall, before the end of such period, submit to the Com- mittees on Veterans’ Affairs of the Senate and House of Representatives a report as to why such a protocol has not yet been developed. ‘‘(3)(A) The Secretary shall ensure that the evalua- tion under the protocol developed under this section is available at all Department medical centers that have the capability of providing the medical assessment, di- agnosis, and treatment required under the protocol. ‘‘(B) The Secretary may enter into contracts with non-Department medical facilities for the provision of the evaluation under the protocol. ‘‘(C) In the case of a veteran whose residence is dis- tant from a medical center described in subparagraph (A), the Secretary may provide the evaluation through a Department medical center described in that sub- paragraph and, in such a case, may provide the veteran the travel and incidental expenses therefor pursuant to the provisions of section 111 of title 38, United States Code. ‘‘(4)(A) If the Secretary is unable to diagnose the symptoms or illness of a veteran provided an evalua- tion, or if the symptoms or illness of a veteran do not respond to treatment provided by the Secretary, the Secretary may use the authority in sections 1703A, 8111, and 8153 of title 38, United States Code, in order to pro- vide for the veteran to receive diagnostic tests or treat- ment at a non-Department medical facility that may have the capability of diagnosing or treating the symp- toms or illness of the veteran. The Secretary may pro- vide the veteran the travel and incidental expenses therefor pursuant to the provisions of section 111 of title 38, United States Code. ‘‘(B) The Secretary shall request from each non-De- partment medical facility that examines or treats a veteran under this paragraph such information relating to the diagnosis or treatment as the Secretary con- siders appropriate. ‘‘(5) In each year after the implementation of the pro- tocol, the Secretary shall enter into an agreement with Page 176 TITLE 38—VETERANS’ BENEFITS § 1117 the National Academy of Sciences under which agree- ment appropriate experts shall review the adequacy of the protocol and its implementation by the Depart- ment of Veterans Affairs. ‘‘(b) RELATIONSHIP TO OTHER COMPREHENSIVE CLINICAL EVALUATION PROTOCOLS.—The Secretary, in consulta- tion with the Secretary of Defense, shall ensure that the information collected through the protocol de- scribed in this section is collected and maintained in a manner that permits the effective and efficient cross- reference of that information with information col- lected and maintained through the comprehensive clin- ical protocols of the Department of Defense for Persian Gulf War veterans. ‘‘(c) CASE DEFINITIONS AND DIAGNOSES.—The Sec- retary shall develop case definitions or diagnoses for illnesses associated with the service described in sub- section (a)(1). The Secretary shall develop such defini- tions or diagnoses at the earliest possible date. ‘‘SEC. 105. OUTREACH TO PERSIAN GULF VET- ERANS. ‘‘(a) IN GENERAL.—The Secretary of Veterans Affairs shall implement a comprehensive outreach program to inform Persian Gulf War veterans and their families of the medical care and other benefits that may be pro- vided by the Department of Veterans Affairs and the Department of Defense arising from service in the Per- sian Gulf War. ‘‘(b) NEWSLETTER.—(1) The outreach program shall in- clude a newsletter which shall be updated and distrib- uted at least semi-annually and shall be distributed to the veterans listed on the Persian Gulf War Veterans Health Registry. The newsletter shall include sum- maries of the status and findings of Government spon- sored research on illnesses of Persian Gulf War vet- erans and their families, as well as on benefits avail- able to such individuals through the Department of Veterans Affairs. The newsletter shall be prepared in consultation with veterans service organizations. ‘‘(2) The requirement under this subsection for the distribution of the newsletter shall terminate on De- cember 31, 2003. ‘‘(c) TOLL-FREE NUMBER.—The outreach program shall include establishment of a toll-free telephone number to provide Persian Gulf War veterans and their families information on the Persian Gulf War Veterans Health Registry, health care and other benefits pro- vided by the Department of Veterans Affairs, and such other information as the Secretary considers appro- priate. Such toll-free telephone number shall be estab- lished not later than 90 days after the date of the enact- ment of this Act [Nov. 2, 1994]. ‘‘SEC. 107. EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN OF PERSIAN GULF WAR VETERANS. ‘‘(a) EVALUATION PROGRAM.—Subject to subsection (c), the Secretary of Veterans Affairs shall conduct a program to evaluate the health status of spouses and children of Persian Gulf War veterans. Under the pro- gram, the Secretary shall provide for the conduct of di- agnostic testing and appropriate medical examinations of any individual— ‘‘(1) who is the spouse or child of a veteran who— ‘‘(A) is listed in the Persian Gulf War Veterans Registry established under section 702 of Public Law 102–585 [set out in a note under section 527 of this title]; and ‘‘(B) is suffering from an illness or disorder; ‘‘(2) who is apparently suffering from, or may have suffered from, an illness or disorder (including a birth defect, miscarriage, or stillbirth) which cannot be disassociated from the veteran’s service in the South- west Asia theater of operations; and ‘‘(3) who, in the case of a spouse, has granted the Secretary permission to include in the Registry rel- evant medical data (including a medical history and the results of diagnostic testing and medical exami- nations) and such other information as the Secretary considers relevant and appropriate with respect to such individual. ‘‘(b) DURATION OF PROGRAM.—The program shall be carried out during the period beginning on November 1, 1994, and ending on December 31, 2003. ‘‘(c) FUNDING LIMITATION.—The amount spent for the program under subsection (a) may not exceed $2,000,000. ‘‘(d) CONTRACTING.—The Secretary may provide for the conduct of testing and examinations under sub- section (a) through appropriate contract arrangements, including fee arrangements described in section 1703 of title 38, United States Code. ‘‘(e) STANDARD PROTOCOLS AND GUIDELINES.—The Sec- retary shall seek to ensure uniform development of medical data through the development of standard pro- tocols and guidelines for such testing and examina- tions. If such protocols and guidelines have not been adopted before the end of the 120-day period beginning on the date of the enactment of this Act [Nov. 2, 1994], the Secretary shall, before the end of such period, sub- mit to the Committees on Veterans’ Affairs of the Sen- ate and House of Representatives a report as to why such protocols and guidelines have not yet been devel- oped. ‘‘(f) ENTRY OF RESULTS IN REGISTRY.—The results of diagnostic tests, medical histories, and medical exami- nations conducted under subsection (a) shall be entered into the Persian Gulf War Veterans Health Registry. ‘‘(g) OUTREACH.—The Secretary shall conduct such outreach activities as the Secretary determines nec- essary for the purposes of the program. In conducting such outreach activities, the Secretary shall advise that medical treatment is not available under the pro- gram. ‘‘(h) USE OUTSIDE DEPARTMENT OF STANDARD PROTO- COLS AND GUIDELINES.—The Secretary shall— ‘‘(1) make the standard protocols and guidelines de- veloped under this section available to any entity which requests a copy of such protocols and guide- lines; and ‘‘(2) enter into the registry the results of any exam- ination of the spouse or child of a veteran who served in the Persian Gulf theater which a licensed physi- cian certifies was conducted using those standard protocols and guidelines. ‘‘(i) REPORT TO CONGRESS.—Not later than July 31, 1999, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Represent- atives a report on activities with respect to the pro- gram, including the provision of services under sub- section (d). ‘‘(j) DEFINITIONS.—For purposes of this section, the terms ‘child’ and ‘spouse’ have the meanings given those terms in paragraphs (4) and (31), respectively, of section 101 of title 38, United States Code. ‘‘SEC. 109. SURVEY OF PERSIAN GULF VETERANS. ‘‘(a) IN GENERAL.—The Secretary of Veterans Affairs may carry out a survey of Persian Gulf veterans to gather information on the incidence and nature of health problems occurring in Persian Gulf veterans and their families. ‘‘(b) COORDINATION WITH DEPARTMENT OF DEFENSE.— Any survey under subsection (a) shall be carried out in coordination with the Secretary of Defense. ‘‘(c) PERSIAN GULF VETERAN.—For purposes of this section, a Persian Gulf veteran is an individual who served on active duty in the Armed Forces in the Southwest Asia theater of operations during the Per- sian Gulf War as defined in section 101(33) of title 38, United States Code. ‘‘SEC. 110. AUTHORIZATION FOR EPIDEMIOLOGICAL STUDIES. ‘‘(a) STUDY OF HEALTH CONSEQUENCES OF PERSIAN GULF SERVICE.—If the National Academy of Sciences includes in the report required by section 706(b) of the Veterans Health Care Act of 1992 (Public Law 102–585) [set out in a note under section 527 of this title] a find- ing that there is a sound basis for an epidemiological study or studies on the health consequences of service in the Persian Gulf theater of operations during the Persian Gulf War and recommends the conduct of such Page 177 TITLE 38—VETERANS’ BENEFITS § 1118 a study or studies, the Secretary of Veterans Affairs is authorized to carry out such study. ‘‘(b) OVERSIGHT.—(1) The Secretary shall seek to enter into an agreement with the Medical Follow-Up Agency (MFUA) of the Institute of Medicine of the Na- tional Academy of Sciences for (A) the review of pro- posals to conduct the research referred to in subsection (a), (B) oversight of such research, and (C) review of the research findings. ‘‘(2) If the Secretary is unable to enter into an agree- ment under paragraph (1) with the entity specified in that paragraph, the Secretary shall enter into an agreement described in that paragraph with another appropriate scientific organization which does not have a connection to the Department of Veterans Affairs. In such a case, the Secretary shall submit to the Commit- tees on Veterans’ Affairs of the Senate and House of Representatives, at least 90 days before the date on which the agreement is entered into, notice in writing identifying the organization with which the Secretary intends to enter into the agreement. ‘‘(c) ACCESS TO DATA.—The Secretary shall enter into agreements with the Secretary of Defense and the Sec- retary of Health and Human Services to make available for the purposes of any study described in subsection (a) all data that the Secretary, in consultation with the National Academy of Sciences and the contractor for the study, considers relevant to the study. ‘‘(d) AUTHORIZATION.—There are authorized to be ap- propriated to the Department such sums as are nec- essary for the conduct of studies described in sub- section (a).’’ [Pub. L. 104–262, title III, § 352(b), Oct. 9, 1996, 110 Stat. 3211, provided that: ‘‘Any diagnostic testing and med- ical examinations undertaken by the Secretary of Vet- erans Affairs for the purpose of the study required by subsection (a) of such section [section 107(a) of Pub. L. 103–446, set out above] during the period beginning on October 1, 1996, and ending on the date of the enact- ment of this Act [Oct. 9, 1996] is hereby ratified.’’] REPORT TO CONGRESS ON INTENTION TO PAY COMPENSATION Section 106(c) of Pub. L. 103–446 directed Secretary of Veterans Affairs, not later than 60 days after Nov. 2, 1994, to submit to Congress a report stating whether or not the Secretary intended to pay compensation as pro- vided in this section. Executive Documents EXECUTIVE ORDER NO. 12961 Ex. Ord. No. 12961, May 26, 1995, 60 F.R. 28507, which established the Presidential Advisory Committee on Gulf War Veterans’ Illnesses, was revoked by Ex. Ord. No. 13138, § 3(g), Sept. 30, 1999, 64 F.R. 53880, formerly set out as a note under section 1013 of Title 5, Government Organization and Employees. EX. ORD. NO. 13034. EXTENSION OF PRESIDENTIAL ADVI- SORY COMMITTEE ON GULF WAR VETERANS’ ILLNESSES Ex. Ord. No. 13034, Jan. 30, 1997, 62 F.R. 5137, provided: By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: SECTION 1. Extension. The Presidential Advisory Com- mittee on Gulf War Veterans’ Illnesses (the ‘‘Com- mittee’’), established pursuant to Executive Order 12961 [formerly set out above] of May 26, 1995, is hereby ex- tended for the purposes set forth herein. All provisions of that order relating to membership and administra- tion shall remain in effect. All Committee appoint- ments, as well as the President’s designation of a Chairperson, shall remain in effect. The limitations set forth in section 2(c)–(e) and section 4(a) of Executive Order 12961 shall also remain in effect. The Committee shall remain subject to the Federal Advisory Com- mittee Act, as amended, [former] 5 U.S.C. App. [see 5 U.S.C. 1001 et seq.]. SEC. 2. Functions. (a) The Committee shall report to the President through the Secretary of Defense, the Secretary of Veterans Affairs, and the Secretary of Health and Human Services. (b) The Committee shall have two principal roles: (1) Oversight of the ongoing investigation being con- ducted by the Department of Defense with the assist- ance, as appropriate, of other executive departments and agencies into possible chemical or biological war- fare agent exposures during the Gulf War; and (2) Evaluation of the Federal Government’s plan for and progress towards the implementation of the Com- mittee’s recommendations contained in its Final Re- port submitted on December 31, 1996. (c) The Committee shall provide advice and rec- ommendations related to its oversight and evaluation responsibilities. (d) The Committee may also provide additional ad- vice and recommendations prompted by any new devel- opments related to its original functions as set forth in section 2(b) of Executive Order 12961. (e) The Committee shall submit by letter a status re- port by April 30, 1997, and a final supplemental report by October 31, 1997, unless otherwise directed by the President. SEC. 3. General Provisions. (a) The Committee shall terminate 30 days after submitting its final supple- mental report. (b) This order is intended only to improve the inter- nal management of the executive branch and it is not intended to create any right, benefit or trust responsi- bility, substantive or procedural, enforceable at law or equity by a party against the United States, its agen- cies, its officers, or any person. WILLIAM J. CLINTON. § 1118. Presumptions of service connection for ill- nesses 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 ill- ness, if any, described in paragraph (2) shall be considered to have been incurred in or aggra- vated by service referred to in that paragraph, notwithstanding that there is no record of evi- dence 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 pre- sumption 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 preven- tive medicine or vaccine known or presumed to be associated with service in the Armed Forces in the Southwest Asia theater of oper- ations during the Persian Gulf War; and (B) becomes manifest within the period, if any, prescribed in such regulations in a vet- eran who served on active duty in that theater of operations during that war and by reason of such service was exposed to such agent, haz- ard, 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 rea- son of such service to the agent, hazard, or med- icine or vaccine associated with the illness in the regulations prescribed under this section un- less there is conclusive evidence to establish