VCS PPT - Baldwin Gulf War Provisos in Senate FY17 MilConVA

FY17 MilConVA (S.Rpt.
114-237):
New Congressional Guidance on

Gulf War Health & Benefits
May 2016
Baldwin Gulf War Provisos -- Adopted April 18, 2016
New Gulf War Guidance from Congress
Congress has provided VA with substantial added guidance

on Gulf War health and benefits issues/
The Baldwin Gulf War provisos are part of the U.S. Senates
appropriations bill for Fiscal Year 2017 (FY17) for the U.S
Department of Veterans Affairs (VA) (FY17 MilConVA).
Report & Bill Name/Number: S. Rpt. 114-237, Military Construction, Veterans

Affairs, and Related Agencies Appropriation Bill, 2017, (April 18, 2016)
accompanying S. 2806 (114th Congress), the Military Construction, Veterans
Affairs, and Related Agencies Act, 2017.
2
What is Report Language
Reports accompany bills and give additional

directives
Report language explains the provisions of a
measure to the chamber or chambers that will
subsequently consider it.1
Report language may also communicate
legislative intent to the agencies that will carry out
the measure once it becomes law.1
Not law, but agencies usually seek to comply
with any directives contained therein.1
Congressional Research Service, Appropriations Report Language: Overview of Development,

Components, and Issues for Congress, (Report R44124), July 28, 2015 (p.1) https://www.fas.org/sgp/crs/
misc/R44124.pdf
3
1
Effect of Report Language
As noted in a relevant Congressional Research

Service Report, the criticisms and suggestions
carried in the reports accompanying each bill are
expected to influence the subsequent behavior of
the agency. Committee reports are not the law,
but it is expected that they be regarded almost as
seriously.2
Richard Fenno, The Power of the Purse: Appropriations Politics in Congress (Boston: Little, Brown and
Company, 1966), p. 18. Quoted in CRS R44124, p. 1)
2
FY17 MilConVA (S.Rpt.114-237):
Timeline
March 2016: Provisos requested by U.S. Senator Tammy

Baldwin (D-WI), a member of the Senate Appropriations
Committee and the Subcommittee on Military Construction
and Veterans Affairs (MilConVA)
March-April 2016: Provisos reviewed, edited by Senate
Appropriations Committee/Subcommittee professional staff,
incorporated into final Report
April 2016: Committee Report, with the Baldwin Gulf War
provisos included, approved by the Senate Defense
Appropriations Subcommittee
April 18, 2016: FY17 MilConVA appropriations bill voted out
full Senate Appropriations Committee on with accompanying
Report, S.Rpt. 114-237. 3
S. Rpt. 114-237, Military Construction, Veterans Affairs, and Related Agencies Appropriation Bill, 2017
(April 18, 2016), accompanying S. 2806 (114th Congress), the Military Construction, Veterans Affairs, and
Related Agencies Act, 2017. (pp. 34-35)
5
3
FY17 MilConVA (S.Rpt.114-237):
Status
The Senate Appropriations Committee has

concluded its work on the bill and its accompanying
report is final.
The appropriations bills are required to be completed
by September 30 (2016); they are frequently
completed later than that.
The provisos contained in the Report are highly
unlikely to be modified while FY17 MilConVA
appropriations proceed through the legislative
process to enactment.
6
3
FY17 MilConVA
(S.Rpt. 114-237):
Baldwin Gulf War

Provisos (2016)
Gulf War-related provisos included at the
request of U.S. Senator Tammy Baldwin
Baldwin Gulf War Provisos (FY17 MilConVA):
Gulf War Disability Claims
Gulf War Veterans Claims for Service-Connected

Disability Compensation, currently denied at a greater
than 80% rate:
1.
The Committee is concerned by the
Departments [of Veterans Affairs] rates of
denial of Gulf War veterans claims for
undiagnosed illnesses and chronic multisymptom illnesses.3
8
3

2.
Helping Standardize Gulf War veterans disabilty

claims, currently denied at a greater than 80% rate:
The Department [of Veterans Affairs] is
directed to provide the Committees on
Appropriations of both Houses of Congress
with a finalized Disability Benefits
Questionnaire (DBQ) within 180 days of the
enactment of this act for each of these types of
claims for which a DBQ does not currently
exist.3
9
3

3.
Making claims filing period permanent (currently

set to expire December 31, 2016 unless VA takes
rulemaking action): The Committee urges the
Department [of Veterans Affairs] to make
permanent the period for filing Gulf War
presumptive claims under 38 CFR 3.317. 3
10
3

4.
Calling on VA to remedy its claims adjudication

process: While the Committee commends VA
on its efforts to revise the Compensation and
Pension manual for Service Connection for
Certain Disabilities Associated with Gulf War
Service, concern remains that VA claims
adjudicators are not consistently following these
changes. 3
11
3
Gulf War Health Research

5.
Epidemiological studies with disease-specific health

and mortality outcomes: The Committee
recommends the Department [of Veterans
Affairs] continue to conduct and publish
epidemiological studies regarding the
prevalence of Gulf War illness and diseasespecific morbidity and mortality in Gulf War
veterans and the development of effective
treatments, preventions, and cures. 4
Related Agencies Act, 2017. (p.58)
12
4
Gulf War Health Research

6.
New mandated on Gulf War study statutorily mandated

in 2008 but never completed by VA as directed: The
Department [of Veterans Affairs] is directed,within
60 daysof the enactment of this act, to contract with
the National Academy of Sciences (NAS) for a study
with the NAS collecting new data to determine the
prevalence of diagnosed neurological diseases,
including multiple sclerosis, Parkinsons disease,
and brain cancers, in Gulf War veterans, as directed
by P.L. 110-389, Section 804 and advised in the
IOMs 2015 report on the studys design. 4
13
4
Gulf War Illness Nomenclature

7.
Gulf War Illness Nomenclature: The Committee

is concerned by VAs ever-evolving terminology
for the signature adverse health outcome of the
Persian Gulf War as recognized by the Institute
of Medicine (IOM) Gulf War illness and
encourages the Department [of Veterans
Affairs] to utilize the term, Gulf War illness, as
IOM has recommended. 4
14
4
Gulf War Clinician Guide Revision

8.
9.
Gulf War Illness Clinical Guideline Revision: The Committee

urges the Secretary to consider revising and updating the
Clinical Practice Guideline for Chronic Multisymptom Illness
(CMI) consistent with the July 2011 Veterans Health Initiative,
Caring for Gulf War Veterans, that it, cannot be reliably
ascribed to any known psychiatric disorder, and to focus on
recent Gulf War illness treatment research findings and
ongoing Gulf War illness treatment research direction. 4
Training of clinicians on GWI: Furthermore, the Committee
encourages the Department [of Veterans Affairs] to
strengthen the training of primary, specialty, and mental
healthcare providers on the Gulf War illness case definitions
recommended by the IOM. 4
4
15
Gulf War RAC

10.
11.
Role of the Research Advisory Committee on Gulf War

Veterans Illnesses (RAC): The role of the Research
Advisory Committee on Gulf War Veterans Illnesses
(RAC) was intended to provide a meaningful
consultative role in helping shape the Persian Gulf War
research agenda, strengthen the process by which the
government sets its Persian Gulf War research agenda,
and lend credibility to future research activities.
Concerns regarding VAs fulfillment of that role:
However, concern has been raised that this role has
been degraded and compromised. 4
16
4
Gulf War RAC Charter

12.
RAC Charter Concerns: The RAC charter no

longer requires it to assess the effectiveness of
Federal Gulf War research, no longer contains a
requirement for its own staff, and its purview is
presently limited solely to research conducted
by the Department [of Veterans Affairs]. 4
17
4
Gulf War RAC Members

13.
RAC Membership Concerns: Determinations by

the RAC and the IOM that Gulf War illness is
physiological and not psychological or
psychiatric in nature should be the basis in
determining the type of medical practitioners
and scientific researchers needed to create a
well-qualified membership. 4
18
4
Gulf War RAC Activity

14.
RAC Activity Concerns: The Committee notes

the RAC has provided no new
recommendations since September 2014 and
encourages the RAC renew its efforts in
studying Gulf War Illness. 4
19
4
VA Gulf War Data Reporting

15.
VA Health/Benefits Utilization Data Reporting

Concerns: Finally, the Committee urges the
Department [of Veterans Affairs] to restore
regular reporting throughout the year of
healthcare and benefits utilization by Gulf War
and post-9/11 veterans, to publish these reports
on the Departments Web site, and to consider
for adoption the Recommendations for New
VA Gulf War-Era Data Report, adopted by the
RAC on February 1, 2012. 4
20
4
Gulf War/OIF/OEF Sleep Disorders

16.
Sleep Disorders: The Committee recommends

the Department [of Veterans Affairs] assign a
program manager for sleep disorders, including
sleep apnea, that affect at least 200,000 veterans
of the Persian Gulf War and Operations Iraqi
Freedom and Enduring Freedom. 5
21
5
FY17 MilConVA (S.Rpt. 114237):
Additional
Provisos of Interest
22
FY17 MilConVA (S.Rpt. 114-237):
Functional Gastrointestinal Disorders
Functional Gastrointestinal Disorders and Gulf War

Illness. The Committee continues to monitor the
Departments [of Veterans Affairs] plan to
address Gulf War Illness and encourages the
Department [of Veterans Affairs] to include
research on early intervention for functional
gastrointestinal disorders related to Gulf War
Illness in veterans and military personnel. 6
23
6
Toxic Exposures
Toxic Exposures.The Committee wants to ensure

VA is actively researching the residual impact to
veterans of Agent Orange and other toxic exposures
such as oil well fires and burn pits. The Department
[of Veterans Affairs] is directed to submit a report to
the Committees on Appropriations of both Houses of
Congress no later than 180 days after enactment of
this act detailing ongoing activities and future plans
for research into residual exposure to Agent Orange
and other toxins. 7
24
7
NAM Toxic Exposures Study
National Academy of Medicine Study on Toxic Exposures.

Veterans have expressed growing concern that toxic exposure
during their military service is related to adverse health
conditions in their children and grandchildren. According to
the National Academy of Medicine [NAM], scientific data and
research is extremely limited to determine what exposures may
cause harm to future generations. The report, Veterans and
Agent Orange: Update 2014, recommended VA pursue further
laboratory research to identify toxins and dioxins that may
cause epigenetic modifications and invest in epidemiologic
protocols that address the challenges of connecting adverse
conditions in the children of members of the military with toxic
exposure. [ctd]
Related Agencies Act, 2017. (pp.57-58)
25
8
NAM Toxic Exposures Study, ctd.
[ctd.]The Committee directs the Department [of Veterans Affairs] to

contract with NAM on an assessment that will include a review of the
scientific literature regarding toxicological and epidemiological
research on descendants of individuals with toxic exposure; an
assessment of areas requiring further scientific study relating to the
descendants of veterans with toxic exposure; an assessment of the scope
and methodology required to conduct adequate scientific research
relating to the descendants of individuals with toxic exposure; will
establish categories and provide definitions for categories that assess
the evidence that a particular health condition is related to toxic
exposure; an analysis of the feasibility, value and relevance, and need
for access to additional information held by a Federal agency of
conducting further scientific research; and identification of a research
entity or entities with expertise and ability to conduct the relevant
scientific research. 8
26
8
VA Research Reports
Research Reports.The Committee is aware VA publicly

reports all of its completed and ongoing VA funded research
projects through the NIH Research Portfolio Online
Reporting Tools [RePORT]. However, funding information
for each project is not provided on the site by VA. The
Committee directs VA to report the total cost of each
ongoing project and going forward, provide funding
information for any new projects, in addition to the
information which is already publicly reported.
Additionally, the Committee directs VA to prominently
place a description and a link to the NIH RePORT Web site
on the VA Office Research and Development main Web page
so that any veteran may access this information easily. 9
27
9
Burn Pits
Burn Pits.The Committee recommends VA

continue conducting medical trials, using available
treatments for pulmonary, cardiovascular, and other
diseases and conditions related to the exposure to
open air burn pits.
The Department [of Veterans Affairs] is directed to
provide an update to the Committees on
Appropriations of both Houses of Congress no later
than 180 days after enactment of this act on the status
and progress of such medical trials.10
28
10
Burn Pits
Furthermore, where appropriate, VA is encouraged to

work with private and public institutions which have
already begun to research the chronic impacts of
exposure to burn pits in order to develop treatments for
veterans exposed to burn pits.
The Department [of Veterans Affairs] is directed to
submit a report to the Committees on Appropriations of
both Houses of Congress no later than 90 days after
enactment of this act regarding the feasibility of entering
into cooperative agreements with institutions engaged in
the aforementioned research and whether additional
authorities and funding are needed to pursue such
10
research.
10
29
Airborne Hazards & Open Burn Pit Registry
Promotion of Federal Burn Pits Registry.The Committee

directs the Department to work with State Governors and
State veterans affairs agencies to promote and educate State
officials about the Federal Airborne Hazards and Open Burn
Pit Registry.
The Committee is concerned that efforts by the States have
led to confusion among veterans about which registry is the
official registry of the U.S. Department of Veterans Affairs.
The Committee urges the Department[of Veterans Affairs]
to increase outreach to veterans and State governments to
communicate the existence and purpose of the Airborne
Hazards and Open Burn Pit Registry. 11
30
11
Conclusion
31

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FY17 MilConVA (S.Rpt.

New Congressional Guidance on

Baldwin Gulf War Provisos -- Adopted April 18, 2016

New Gulf War Guidance from Congress

Congress has provided VA with substantial added guidance

Report & Bill Name/Number: S. Rpt. 114-237, Military Construction, Veterans

What is Report Language

Reports accompany bills and give additional

Congressional Research Service, Appropriations Report Language: Overview of Development,

Effect of Report Language

As noted in a relevant Congressional Research

FY17 MilConVA (S.Rpt.114-237):

March 2016: Provisos requested by U.S. Senator Tammy

FY17 MilConVA (S.Rpt.114-237):

The Senate Appropriations Committee has

Baldwin Gulf War

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Disability Claims

Gulf War Veterans Claims for Service-Connected

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Disability Claims

Helping Standardize Gulf War veterans disabilty

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Disability Claims

Making claims filing period permanent (currently

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Disability Claims

Calling on VA to remedy its claims adjudication

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Health Research

Epidemiological studies with disease-specific health

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Health Research

New mandated on Gulf War study statutorily mandated

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Illness Nomenclature

Gulf War Illness Nomenclature: The Committee

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Clinician Guide Revision

Gulf War Illness Clinical Guideline Revision: The Committee

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War RAC

Role of the Research Advisory Committee on Gulf War

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War RAC Charter

RAC Charter Concerns: The RAC charter no

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War RAC Members

RAC Membership Concerns: Determinations by

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War RAC Activity

RAC Activity Concerns: The Committee notes

Baldwin Gulf War Provisos (FY17 MilConVA):

VA Gulf War Data Reporting

VA Health/Benefits Utilization Data Reporting

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War/OIF/OEF Sleep Disorders

Sleep Disorders: The Committee recommends

FY17 MilConVA (S.Rpt. 114237):

FY17 MilConVA (S.Rpt. 114-237):

Functional Gastrointestinal Disorders

Functional Gastrointestinal Disorders and Gulf War

FY17 MilConVA (S.Rpt. 114-237):

Toxic Exposures.The Committee wants to ensure