vcs ppt - baldwin gulf war provisos in senate fy17 milconva

7/26/2019 VCS PPT - Baldwin Gulf War Provisos in Senate FY17 MilConVA

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

New Congressional Guidance onGulf War Health & BenefitsMay 2016

Baldwin Gulf War Provisos -- Adopted April 18, 2016


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Congress has provided VA with substantial added guidanceon 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.SDepartment of Veterans Affairs (VA) (FY17 MilConVA).

Report & Bill Name/Number:S. Rpt. 114-237

, Military Construction, VeteransAffairs, and Related Agencies Appropriation Bill, 2017, (April 18, 2016)accompanyingS. 2806(114thCongress), the Military Construction, Veterans

Affairs, and Related Agencies Act, 2017.

New Gulf War Guidance from Congress
https://www.congress.gov/congressional-report/114th-congress/senate-report/237/1https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/congressional-report/114th-congress/senate-report/237/1


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Reports accompany bills and give additionaldirectives

Report language explains the provisions of a

measure to the chamber or chambers that willsubsequently consider it.1

Report language may also communicatelegislative intent to the agencies that will carry out

the measure once it becomes law.1 Not law, but agencies usually seek to complywith any directives contained therein.1

What is Report Language

1Congressional 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
https://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdfhttps://www.fas.org/sgp/crs/misc/R44124.pdf


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As noted in a relevant Congressional ResearchService Report, the criticisms and suggestions

carried in the reports accompanying each bill areexpected to influence the subsequent behavior ofthe agency. Committee reports are not the law,

but it is expected that they be regarded almost asseriously.2

Effect of Report Language

2Richard Fenno, The Power of the Purse: Appropriations Politics in Congress (Boston: Little, Brown and

Company, 1966), p. 18. Quoted in CRS R44124, p. 1)


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March 2016: Provisos requested by U.S. Senator TammyBaldwin (D-WI), a member of the Senate AppropriationsCommittee and the Subcommittee on Military Constructionand Veterans Affairs (MilConVA)

March-April 2016: Provisos reviewed, edited by SenateAppropriations Committee/Subcommittee professional staff,incorporated into final Report

April 2016: Committee Report, with the Baldwin Gulf Warprovisos included, approved by the Senate Defense

Appropriations Subcommittee April 18, 2016: FY17 MilConVA appropriations bill voted outfull Senate Appropriations Committee on with accompanyingReport, S.Rpt. 114-237.3


Timeline

3S. Rpt. 114-237

,Military Construction, Veterans Affairs, and Related Agencies Appropriation Bill, 2017

(April 18, 2016), accompanyingS. 2806(114th

Congress), the Military Construction, Veterans Affairs, andRelated Agencies Act, 2017. (pp. 34-35)
https://www.congress.gov/congressional-report/114th-congress/senate-report/237/1https://www.congress.gov/congressional-report/114th-congress/senate-report/237/1https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/congressional-report/114th-congress/senate-report/237/1


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The Senate Appropriations Committee hasconcluded its work on the bill and its accompanyingreport is final.

The appropriations bills are required to be completedby September 30 (2016); they are frequentlycompleted later than that.

The provisos contained in the Report are highly

unlikely to be modified while FY17 MilConVAappropriations proceed through the legislativeprocess to enactment.


Status

3S. Rpt. 114-237

,Military Construction, Veterans Affairs, and Related Agencies Appropriation Bill, 2017




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Gulf War-related provisos included at the

request of U.S. Senator Tammy Baldwin

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

Baldwin Gulf WarProvisos (2016)


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Gulf War Veterans Claims for Service-ConnectedDisability Compensation, currently denied at a greater

than 80% rate:1. The Committee is concerned by theDepartments [of Veterans Affairs] rates ofdenial of Gulf War veterans claims for

undiagnosed illnesses and chronic multi-symptom illnesses.3

Baldwin Gulf War Provisos (FY17 MilConVA):

Gulf War Disability Claims

3S. Rpt. 114-237,Military Construction, Veterans Affairs, and Related Agencies Appropriation Bill, 2017




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2.Helping Standardize Gulf War veterans disabiltyclaims, currently denied at a greater than 80% rate:The Department [of Veterans Affairs] is

directed to provide the Committees onAppropriations of both Houses of Congresswith a finalized Disability BenefitsQuestionnaire (DBQ) within 180 days of the

enactment of this act for each of these types ofclaims for which a DBQ does not currentlyexist.3







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3.Making claims filing period permanent (currently

set to expire December 31, 2016 unless VA takesrulemaking action):The Committee urges theDepartment [of Veterans Affairs] to makepermanent the period for filing Gulf War

presumptive claims under 38 CFR 3.317.3







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4. Calling on VA to remedy its claims adjudicationprocess:While the Committee commends VA

on its efforts to revise the Compensation andPension manual for Service Connection forCertain Disabilities Associated with Gulf WarService, concern remains that VA claims

adjudicators are not consistently following thesechanges.3







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5. Epidemiological studies with disease-specific healthand mortality outcomes:The Committeerecommends the Department [of Veterans

Affairs] continue to conduct and publishepidemiological studies regarding theprevalence of Gulf War illness and disease-specific morbidity and mortality in Gulf Warveterans and the development of effectivetreatments, preventions, and cures.4


Gulf War Health Research



Congress), the Military Construction, Veterans Affairs, andRelated Agencies Act, 2017. (p.58)


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6. New mandated on Gulf War study statutorily mandatedin 2008 but never completed by VA as directed:TheDepartment [of Veterans Affairs] is directed, within60 days of the enactment of this act, to contract with

the National Academy of Sciences (NAS) for a studywith the NAS collecting new data to determine theprevalence of diagnosed neurological diseases,including multiple sclerosis, Parkinsons disease,

and brain cancers, in Gulf War veterans, as directedby P.L. 110-389, Section 804 and advised in theIOMs 2015 report on the studys design.4


Gulf War Health Research





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7. Gulf War Illness Nomenclature:The Committeeis concerned by VAs ever-evolving terminology

for the signature adverse health outcome of thePersian Gulf War as recognized by the Instituteof Medicine (IOM) Gulf War illness andencourages the Department [of Veterans

Affairs] to utilize the term, Gulf War illness, asIOM has recommended.4


Gulf War Illness Nomenclature





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8. Gulf War Illness Clinical Guideline Revision:The Committeeurges the Secretary to consider revising and updating theClinical Practice Guideline for Chronic Multisymptom Illness(CMI) consistent with the July 2011 Veterans Health Initiative,Caring for Gulf War Veterans, that it, cannot be reliablyascribed to any known psychiatric disorder, and to focus onrecent Gulf War illness treatment research findings andongoing Gulf War illness treatment research direction.4

9. Training of clinicians on GWI:Furthermore, the Committee

encourages the Department [of Veterans Affairs] tostrengthen the training of primary, specialty, and mentalhealthcare providers on the Gulf War illness case definitionsrecommended by the IOM. 4


Gulf War Clinician Guide Revision

4S. Rpt. 114-237, Military Construction, Veterans Affairs, and Related Agencies Appropriation Bill, 2017


https://www.congress.gov/congressional-report/114th-congress/senate-report/237/1https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/bill/114th-congress/senate-bill/2806https://www.congress.gov/congressional-report/114th-congress/senate-report/237/1


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10. Role of the Research Advisory Committee on Gulf WarVeterans Illnesses (RAC):The role of the ResearchAdvisory Committee on Gulf War Veterans Illnesses(RAC) was intended to provide a meaningful

consultative role in helping shape the Persian Gulf Warresearch agenda, strengthen the process by which thegovernment sets its Persian Gulf War research agenda,and lend credibility to future research activities.

11. Concerns regarding VAs fulfillment of that role:However, concern has been raised that this role hasbeen degraded and compromised.4


Gulf War RAC





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12.RAC Charter Concerns:The RAC charter nolonger requires it to assess the effectiveness of

Federal Gulf War research, no longer contains arequirement for its own staff, and its purview ispresently limited solely to research conducted

by the Department [of Veterans Affairs].4


Gulf WarRAC Charter





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13.RAC Membership Concerns:Determinations bythe RAC and the IOM that Gulf War illness is

physiological and not psychological orpsychiatric in nature should be the basis indetermining the type of medical practitionersand scientific researchers needed to create awell-qualified membership.4


Gulf War RAC Members





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14.RAC Activity Concerns:The Committee notes

the RAC has provided no newrecommendations since September 2014 andencourages the RAC renew its efforts instudying Gulf War Illness.4


Gulf War RAC Activity





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15.VA Health/Benefits Utilization Data ReportingConcerns:Finally, the Committee urges theDepartment [of Veterans Affairs] to restore

regular reporting throughout the year ofhealthcare and benefits utilization by Gulf Warand post-9/11 veterans, to publish these reportson the Departments Web site, and to consider

for adoption the Recommendations for NewVA Gulf War-Era Data Report, adopted by theRAC on February 1, 2012.4


VA Gulf War Data Reporting


(April 18, 2016), accompanyingS. 2806(114

th



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16.Sleep Disorders:The Committee recommends

the Department [of Veterans Affairs] assign aprogram manager for sleep disorders, includingsleep apnea, that affect at least 200,000 veteransof the Persian Gulf War and Operations Iraqi

Freedom and Enduring Freedom.5


Gulf War/OIF/OEF Sleep Disorders


(April 18, 2016), accompanyingS. 2806(114

th



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

AdditionalProvisos of Interest


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Functional Gastrointestinal Disorders and Gulf WarIllness. The Committee continues to monitor the

Departments [of Veterans Affairs] plan toaddress Gulf War Illness and encourages theDepartment [of Veterans Affairs] to includeresearch on early intervention for functional

gastrointestinal disorders related to Gulf WarIllness in veterans and military personnel.6


Functional Gastrointestinal Disorders


(April 18, 2016), accompanyingS. 2806(114thCongress), the Military Construction, Veterans Affairs, and

Related Agencies Act, 2017. (p.45)


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Toxic Exposures.The Committee wants to ensureVA is actively researching the residual impact toveterans 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 tothe Committees on Appropriations of both Houses ofCongress no later than 180 days after enactment of

this act detailing ongoing activities and future plansfor research into residual exposure to Agent Orangeand other toxins.7


Toxic Exposures





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National Academy of Medicine Study on Toxic Exposures.Veterans have expressed growing concern that toxic exposureduring their military service is related to adverse healthconditions in their children and grandchildren. According tothe National Academy of Medicine [NAM], scientific data andresearch is extremely limited to determine what exposures maycause harm to future generations. The report, Veterans andAgent Orange: Update 2014, recommended VA pursue furtherlaboratory research to identify toxins and dioxins that may

cause epigenetic modifications and invest in epidemiologicprotocols that address the challenges of connecting adverseconditions in the children of members of the military with toxicexposure. [ctd]


NAM Toxic Exposures Study



Related Agencies Act, 2017. (pp.57-58)


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[ctd.]The Committee directs the Department [of Veterans Affairs] tocontract with NAM on an assessment that will include a review of thescientific literature regarding toxicological and epidemiologicalresearch on descendants of individuals with toxic exposure; anassessment of areas requiring further scientific study relating to thedescendants of veterans with toxic exposure; an assessment of the scopeand methodology required to conduct adequate scientific researchrelating to the descendants of individuals with toxic exposure; willestablish categories and provide definitions for categories that assessthe evidence that a particular health condition is related to toxicexposure; an analysis of the feasibility, value and relevance, and need

for access to additional information held by a Federal agency ofconducting further scientific research; and identification of a researchentity or entities with expertise and ability to conduct the relevantscientific research.8


NAM Toxic Exposures Study, ctd.





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Research Reports.The Committee is aware VA publiclyreports all of its completed and ongoing VA funded researchprojects through the NIH Research Portfolio OnlineReporting Tools [RePORT]. However, funding informationfor each project is not provided on the site by VA. The

Committee directs VA to report the total cost of eachongoing project and going forward, provide fundinginformation for any new projects, in addition to theinformation which is already publicly reported.

Additionally, the Committee directs VA to prominentlyplace a description and a link to the NIH RePORT Web siteon the VA Office Research and Development main Web pageso that any veteran may access this information easily.9


VA Research Reports





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Burn Pits.The Committee recommends VAcontinue conducting medical trials, using availabletreatments for pulmonary, cardiovascular, and other

diseases and conditions related to the exposure toopen air burn pits. The Department [of Veterans Affairs] is directed toprovide an update to the Committees on

Appropriations of both Houses of Congress no laterthan 180 days after enactment of this act on the statusand progress of such medical trials.10


Burn Pits





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Furthermore, where appropriate, VA is encouraged towork with private and public institutions which havealready begun to research the chronic impacts ofexposure to burn pits in order to develop treatments forveterans exposed to burn pits.

The Department [of Veterans Affairs] is directed tosubmit a report to the Committees on Appropriations ofboth Houses of Congress no later than 90 days afterenactment of this act regarding the feasibility of entering

into cooperative agreements with institutions engaged inthe aforementioned research and whether additionalauthorities and funding are needed to pursue suchresearch.10


Burn Pits





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Promotion of Federal Burn Pits Registry.The Committeedirects the Department to work with State Governors andState veterans affairs agencies to promote and educate Stateofficials about the Federal Airborne Hazards and Open Burn

Pit Registry. The Committee is concerned that efforts by the States haveled to confusion among veterans about which registry is theofficial 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 tocommunicate the existence and purpose of the AirborneHazards and Open Burn Pit Registry.11


Airborne Hazards & Open Burn Pit Registry



Related Agencies Act, 2017. (pp. 37-38)


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Conclusion

vcs ppt - baldwin gulf war provisos in senate fy17 milconva

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