Text: H.R.556 — 102nd Congress (1991-1992)All Information (Except Text)

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--H.R.556--
H.R.556
One Hundred Second Congress of the United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Thursday, the third day of January,
one thousand nine hundred and ninety-one
An Act
To provide for the Secretary of Veterans Affairs to obtain independent
scientific review of the available scientific evidence regarding associations
between diseases and exposure to dioxin and other chemical compounds in
herbicides, 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.
 This Act may be cited as the `Agent Orange Act of 1991'.
SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR DISEASES ASSOCIATED WITH
EXPOSURE TO CERTAIN HERBICIDE AGENTS.
 (a) IN GENERAL- (1) Chapter 11 of title 38, United States Code, is amended
 by adding at the end of subchapter II the following new section:
-`Sec. 316. Presumptions of service connection for diseases associated with
exposure to certain herbicide agents
 `(a)(1) For the purposes of section 310 of this title, and subject to
 section 313 of this title--
 `(A) a disease specified in paragraph (2) of this subsection becoming
 manifest as specified in that paragraph in a veteran who, during active
 military, naval, or air service, served in the Republic of Vietnam during
 the Vietnam era; and
 `(B) each additional disease (if any) that (1) the Secretary determines
 in regulations prescribed under this section warrants a presumption of
 service-connection by reason of having positive association with exposure
 to an herbicide agent, and (2) becomes manifest within the period (if any)
 prescribed in such regulations in a veteran who, during active military,
 naval, or air service, served in the Republic of Vietnam during the Vietnam
 era and while so serving was exposed to that herbicide agent,
shall be considered to have been incurred in or aggravated by such service,
notwithstanding that there is no record of evidence of such disease during
the period of such service.
 `(2) The diseases referred to in paragraph (1)(A) of this subsection are
 the following:
 `(A) Non-Hodgkin's lymphoma becoming manifest to a degree of disability of
 10 percent or more.
 `(B) Each soft-tissue sarcoma becoming manifest to a degree of disability
 of 10 percent or more other than osteosarcoma, chondrosarcoma, Kaposi's
 sarcoma, or mesothelioma.
 `(C) Chloracne or another acneform disease consistent with chloracne becoming
 manifest to a degree of disability of 10 percent or more within one year
 after the last date on which the veteran performed active military, naval,
 or air service in the Republic of Vietnam during the Vietnam era.
 `(3) For the purposes of this subsection, a veteran who, during active
 military, naval, or air service, served in the Republic of Vietnam during
 the Vietnam era and has a disease referred to in paragraph (1)(B) of this
 subsection shall be presumed to have been exposed during such service to
 an herbicide agent containing dioxin or 2,4-dichlorophenoxyacetic acid,
 and may be presumed to have been exposed during such service to any other
 chemical compound in an herbicide agent, unless there is affirmative
 evidence to establish that the veteran was not exposed to any such agent
 during that service.
 `(4) For purposes of this section, the term `herbicide agent' means a
 chemical in an herbicide used in support of the United States and allied
 military operations in the Republic of Vietnam during the Vietnam era.
 `(b)(1) Whenever the Secretary determines, on the basis of sound medical
 and scientific evidence, that a positive association exists between (A)
 the exposure of humans to an herbicide agent, and (B) the occurrence of a
 disease in humans, the Secretary shall prescribe regulations providing that
 a presumption of service connection is warranted for that disease for the
 purposes of this section.
 `(2) In making determinations for the purpose of this subsection, the
 Secretary shall take into account (A) reports received by the Secretary
 from the National Academy of Sciences under section 3 of the Agent Orange
 Act of 1991, and (B) all other sound medical and scientific information and
 analyses available to the Secretary. In evaluating any study for the purpose
 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 a disease in humans and
 exposure to an herbicide agent  shall be considered to be positive for the
 purposes of this section if the credible evidence for the association is
 equal to or outweighs the credible evidence against the association.
 `(c)(1)(A) Not later than 60 days after the date on which the Secretary
 receives a report from the National Academy of Sciences under section 3
 of the Agent Orange Act of 1991,  the Secretary shall determine whether a
 presumption of service connection is warranted for each disease covered by the
 report. If the Secretary determines that such a presumption is warranted,
 the Secretary, not later than 60 days after making the determination,
 shall issue proposed regulations setting forth the Secretary's determination.
 `(B) If the Secretary determines that a presumption of service connection
 is not warranted, the Secretary, not later than 60 days after making
 the determination, shall publish in the Federal Register a notice of that
 determination. The notice shall include an explanation of the scientific basis
 for that determination. If the disease already is included in regulations
 providing for a presumption of service connection, the Secretary, not later
 than 60 days after publication of the notice of a determination that the
 presumption is not warranted, shall issue proposed regulations removing
 the presumption for the disease.
 `(2) 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 a disease is removed from regulations prescribed under this
 section--
 `(1) a veteran who was awarded compensation for such disease on the basis
 of the presumption provided in subsection (a) before the effective date of
 the removal 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 such disease on
 the basis of such presumption shall continue to be entitled to receive
 dependency and indemnity compensation on such 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
 transmits to the Secretary the first report under section 3 of the Agent
 Orange Act of 1991.'.
 (2) The table of sections at the beginning of such chapter is amended by
 inserting after the item relating to section 315 the following new item:
`316. Presumptions of service connection for diseases associated with
exposure to certain herbicide agents.'.
 (b) CONFORMING AMENDMENT- Section 313 of title 38, United States Code,
 is amended by inserting `or 316' after `section 312' each place it appears.
SEC. 3. 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 which is not part of the Federal Government, to review
 and evaluate the available scientific evidence regarding associations between
 diseases and exposure to dioxin and other chemical compounds in herbicides.
 (b) AGREEMENT- The Secretary shall seek to enter into an agreement with the
 National Academy of Sciences for the Academy to perform the services covered
 by this section. The Secretary shall seek to enter into such agreement not
 later than two months after the date of the enactment of this Act.
 (c) REVIEW OF SCIENTIFIC EVIDENCE- Under an agreement between the Secretary
 and the National Academy of Sciences under this section, the Academy shall
 review and summarize the scientific evidence, and assess the strength thereof,
 concerning the association between exposure to an herbicide used in support
 of the United States and allied military operations in the Republic of
 Vietnam during the Vietnam era and each disease suspected to be associated
 with such exposure.
 (d) SCIENTIFIC DETERMINATIONS CONCERNING DISEASES- (1) For each disease
 reviewed, the Academy shall determine (to the extent that available scientific
 data permit meaningful determinations)--
 (A) whether a statistical association with herbicide exposure exists, taking
 into account the strength of the scientific evidence and the appropriateness
 of the statistical and epidemiological methods used to detect the association;
 (B) the increased risk of the disease among those exposed to herbicides
 during service in the Republic of Vietnam during the Vietnam era; and
 (C) whether there exists a plausible biological mechanism or other evidence
 of a causal relationship between herbicide exposure and the disease.
 (2) The Academy shall include in its reports under subsection (g) a
 full discussion of the scientific evidence and reasoning that led to its
 conclusions under this subsection.
 (e) RECOMMENDATIONS FOR ADDITIONAL SCIENTIFIC STUDIES- The Academy shall
 make any recommendations it has for additional scientific studies to
 resolve areas of continuing scientific uncertainty relating to herbicide
 exposure. In making recommendations for further study, the Academy shall
 consider the scientific information that is currently available, the value
 and relevance of the information that could result from additional studies,
 and the cost and feasibility of carrying out such additional studies.
 (f) SUBSEQUENT REVIEWS- An agreement under subsection (b) shall require
 the National Academy of Sciences--
 (1) to conduct as comprehensive a review as is practicable of the evidence
 referred to in subsection (c) that became available since the last review
 of such evidence under this section; and
 (2) to make its determinations and estimates on the basis of the results of
 such review and all other reviews conducted for the purposes of this section.
 (g) REPORTS- (1) The agreement between the Secretary and the National Academy
 of Sciences shall require the Academy to transmit to the Secretary and the
 Committees on Veterans' Affairs of the Senate and House of Representatives
 periodic written reports regarding the Academy's activities under the
 agreement. Such reports shall be submitted at least once every two years
 (as measured from the date of the first report).
 (2) The first report under this subsection shall be transmitted not later than
 the end of the 18-month period beginning on the date of the enactment of this
 Act. That report shall include (A) the determinations and discussion referred
 to in subsection (d), (B) any recommendations of the Academy under subsection
 (e), and (C) the recommendation of the Academy as to whether the provisions
 of each of sections 6 through 9 should be implemented by the Secretary. In
 making its recommendation with respect to each such section, the Academy shall
 consider the scientific information that is currently available, the value
 and relevance of the information that could result from implementing that
 section, and the cost and feasibility of implementing that section. If the
 Academy recommends that the provisions of section 6 should be implemented,
 the Academy shall also recommend the means by which clinical data referred
 to in that section could be maintained in the most scientifically useful way.
 (h) LIMITATION ON AUTHORITY- The authority to enter into agreements under
 this section shall be effective for a fiscal year to the extent that
 appropriations are available.
 (i) SUNSET- This section shall cease to be effective 10 years after the last
 day of the fiscal year in which the National Academy of Sciences transmits
 to the Secretary the first report under subsection (g).
 (j) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZATION- If the Secretary is unable
 within the time period prescribed in subsection (b) to enter into an agreement
 with the National Academy of Sciences for the purposes of this section on
 terms acceptable to the Secretary, the Secretary shall seek to enter into
 an agreement for the purposes of this section with another appropriate
 scientific organization that is not part of the Government and operates as
 a not-for-profit entity and that has expertise and objectivity comparable to
 that of the National Academy of Sciences. If the Secretary enters into such
 an agreement with another organization, then any reference in this section
 and in section 316 of title 38, United States Code (as added by section 2),
 to the National Academy of Sciences shall be treated as a reference to the
 other organization.
SEC. 4. OUTREACH SERVICES.
 Section 1204(a) of the Veterans' Benefits Improvement Act of 1988 (division
 B of Public Law 100-687; 102 Stat. 4125) is amended--
 (1) in clause (1), by striking out `, as such information on health risks
 becomes known';
 (2) by redesignating clauses (1) and (2) as clauses (A) and (B), respectively;
 (3) by inserting `(1)' after `PROGRAM- '; and
 (4) by adding at the end the following new paragraph:
 `(2) The Secretary of Veterans Affairs shall annually furnish updated
 information on health risks described in paragraph (1)(A) to veterans
 referred to in paragraph (1).'.
SEC. 5. EXTENSION OF HEALTH-CARE ELIGIBILITY BASED ON EXPOSURE TO AGENT
ORANGE OR IONIZING RADIATION.
 Section 610(e)(3) of title 38, United States Code, is amended by striking
 out `December 31, 1990' and inserting in lieu thereof `December 31, 1993'.
SEC. 6. RESULTS OF EXAMINATIONS AND TREATMENT OF VETERANS FOR DISABILITIES
RELATED TO EXPOSURE TO CERTAIN HERBICIDES OR TO SERVICE IN VIETNAM.
 (a) IN GENERAL- Subject to subsections (d) and (e), the Secretary of
 Veterans Affairs shall compile and analyze, on a continuing basis, all
 clinical data that (1) is obtained by the Department of Veterans Affairs
 in connection with examinations and treatment furnished to veterans by the
 Department after November 3, 1981, by reason of eligibility provided in
 section 610(e)(1)(A) of title 38, United States Code, and (2) is likely to
 be scientifically useful in determining the association, if any, between
 the disabilities of veterans referred to in such section and exposure to
 dioxin or any other toxic substance referred to in such section or between
 such disabilities and active military, naval, or air service in the Republic
 of Vietnam during the Vietnam era.
 (b) ANNUAL REPORT- The Secretary shall submit to the Committees on Veterans'
 Affairs of the Senate and the House of Representatives an annual report
 containing--
 (1) the information compiled in accordance with subsection (a);
 (2) the Secretary's analysis of such information;
 (3) a discussion of the types and incidences of disabilities identified by
 the Department of Veterans Affairs in the case of veterans referred to in
 subsection (a);
 (4) the Secretary's explanation for the incidence of such disabilities;
 (5) other explanations for the incidence of such disabilities considered
 reasonable by the Secretary; and
 (6) the Secretary's views on the scientific validity of drawing conclusions
 from the incidence of such disabilities, as evidenced by the data compiled
 under subsection (a), about any association between such disabilities and
 exposure to dioxin or any other toxic substance referred to in section
 610(e)(1)(A) of title 38, United States Code, or between such disabilities
 and active military, naval, or air service, in the Republic of Vietnam
 during the Vietnam era.
 (c) FIRST REPORT- The first report under subsection (b) shall be submitted
 not later than one year after the effective date of this section.
 (d) FUNDING- The authority of the Secretary to carry out this section is
 effective in any fiscal year only to the extent or in the amount specifically
 provided in statutory language in appropriations Acts.
 (e) EFFECTIVE DATE- (1) This section shall take effect at the end of the
 90-day period beginning on the date on which the first report of the National
 Academy of Sciences under section 3(g) is received by the Secretary, except
 that this section shall not take effect if the Secretary, after receiving
 that report and before the end of that 90-day period--
 (A) determines that it is not feasible or cost-effective to carry out
 this section or that carrying out this section would not make a material
 contribution to the body of scientific knowledge concerning the health
 effects in humans of herbicide exposure; and
 (B) notifies the Committees on Veterans' Affairs of the Senate and House
 of Representatives of the Secretary's determination and the reasons therefor.
 (2) In making a determination under this subsection, the Secretary shall
 give great weight to the views and recommendations of the Academy expressed
 in that report with respect to the implementation of this section.
SEC. 7. TISSUE ARCHIVING SYSTEM.
 (a) ESTABLISHMENT OF SYSTEM- Subject to subsections (e) and (f), for the
 purpose of facilitating future scientific research on the effects of exposure
 of veterans to dioxin and other toxic agents in herbicides used in support
 of United States and allied military operations in the Republic of Vietnam
 during the Vietnam era, the Secretary of Veterans Affairs shall establish and
 maintain a system for the collection and storage of voluntarily contributed
 samples of blood and tissue of veterans who performed active military,
 naval, or air service in the Republic of Vietnam during the Vietnam era.
 (b) SECURITY OF SPECIMENS- The Secretary shall ensure that the tissue is
 collected and stored under physically secure conditions and that the tissue
 is maintained in a condition that is useful for research referred to in
 subsection (a).
 (c) AUTHORIZED USE OF SPECIMENS- The Secretary may make blood and tissue
 available from the system for research referred to in subsection (a). The
 Secretary shall carry out this section in a manner consistent with the
 privacy rights and interests of the blood and tissue donors.
 (d) LIMITATIONS ON ACCEPTANCE OF SAMPLES- The Secretary may prescribe such
 limitations on the acceptance and storage of blood and tissue samples as
 the Secretary considers appropriate consistent with the purpose specified
 in  subsection (a).
 (e) FUNDING- The authority of the Secretary to carry out this section is
 effective in any fiscal year only to the extent or in the amount specifically
 provided in statutory language in appropriations Acts.
 (f) EFFECTIVE DATE- (1) This section shall take effect at the end of the
 90-day period beginning on the date on which the first report of the National
 Academy of Sciences under section 3(g) is received by the Secretary, except
 that this section shall not take effect if the Secretary, after receiving
 that report and before the end of that 90-day period--
 (A) determines that it is not feasible or cost-effective to carry out
 this section or that carrying out this section would not make a material
 contribution to the body of scientific knowledge concerning the health
 effects in humans of herbicide exposure; and
 (B) notifies the Committees on Veterans' Affairs of the Senate and House
 of Representatives of the Secretary's determination and the reasons therefor.
 (2) In making a determination under this subsection, the Secretary shall
 give great weight to the views and recommendations of the Academy expressed
 in that report with respect to the implementation of this section.
SEC. 8. SCIENTIFIC RESEARCH FEASIBILITY STUDIES PROGRAM.
 (a) ESTABLISHMENT OF PROGRAM- Subject to subsections (e) and (f), the
 Secretary of Veterans Affairs shall establish a program to provide for the
 conduct of studies of the feasibility of conducting additional scientific
 research on--
 (1) health hazards resulting from exposure to dioxin;
 (2) health hazards resulting from exposure to other toxic agents in
 herbicides used in support of United States and allied military operations
 in the Republic of Vietnam during the Vietnam era; and
 (3) health hazards resulting from active military, naval, or air service
 in the Republic of Vietnam during the Vietnam era.
 (b) PROGRAM REQUIREMENTS- (1) Under the program established pursuant
 to subsection (a), the Secretary shall, pursuant to criteria prescribed
 pursuant to paragraph (2), award contracts or furnish financial assistance to
 non-Government entities for the conduct of studies referred to in subsection
 (a).
 (2) The Secretary shall prescribe criteria for (A) the selection of entities
 to be awarded contracts or to receive financial assistance under the program,
 and (B) the approval of studies to be conducted under such contracts or
 with such financial assistance.
 (c) REPORT- The Secretary shall promptly report the results of studies
 conducted under the program to the Committees on Veterans' Affairs of the
 Senate and the House of Representatives.
 (d) CONSULTATION WITH THE NATIONAL ACADEMY OF SCIENCES- (1) To the extent
 provided under any agreement entered into by the Secretary and the National
 Academy of Sciences under this Act--
 (A) the Secretary shall consult with the Academy regarding the establishment
 and administration of the program under subsection (a); and
 (B) the Academy shall review the studies conducted under contracts awarded
 pursuant to the program and the studies conducted with financial assistance
 furnished pursuant to the program.
 (2) The agreement shall require the Academy to submit to the Secretary
 and the Committees on Veterans' Affairs of the Senate and the House of
 Representatives any recommendations that the Academy considers appropriate
 regarding any studies reviewed under the agreement.
 (e) FUNDING- The authority of the Secretary to carry out this section is
 effective in any fiscal year only to the extent or in the amount specifically
 provided in statutory language in appropriations Acts.
 (f) EFFECTIVE DATE- (1) This section shall take effect at the end of the
 90-day period beginning on the date on which the first report of the National
 Academy of Sciences under section 3(g) is received by the Secretary, except
 that this section shall not take effect if the Secretary, after receiving
 that report and before the end of that 90-day period--
 (A) determines that it is not feasible or cost-effective to carry out
 this section or that carrying out this section would not make a material
 contribution to the body of scientific knowledge concerning the health
 effects in humans of herbicide exposure; and
 (B) notifies the Committees on Veterans' Affairs of the Senate and House
 of Representatives of the Secretary's determination and the reasons therefor.
 (2) In making a determination under this subsection, the Secretary shall
 give great weight to the views and recommendations of the Academy expressed
 in that report with respect to the implementation of this section.
SEC. 9. BLOOD TESTING OF CERTAIN VIETNAM-ERA VETERANS.
 (a) BLOOD TESTING- Subject to subsections (d) and (e), in the case of
 a veteran described in section 610(e)(1)(A) of title 38, United States
 Code, who--
 (1) has applied for medical care from the Department of Veterans Affairs; or
 (2) has filed a claim for, or is in receipt of disability compensation
 under chapter 11 of title 38, United States Code,
the Secretary of Veterans Affairs shall, upon the veteran's request,
obtain a sufficient amount of blood serum from the veteran to enable
the Secretary to conduct a test of the serum to ascertain the level of
2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) which may be present in the
veteran's body.
 (b) NOTIFICATION OF TEST RESULTS- Upon completion of such test, the
 Secretary shall notify the veteran of the test results and provide the
 veteran a complete explanation as to what, if anything, the results of the
 test indicate regarding the likelihood of the veteran's exposure to TCDD
 while serving in the Republic of Vietnam.
 (c) INCORPORATION IN SYSTEM- The Secretary shall maintain the veteran's
 blood sample and the results of the test as part of the system required by
 section 7.
 (d) FUNDING- The authority of the Secretary to carry out this section is
 effective in any fiscal year only to the extent or in the amount specifically
 provided in statutory language in appropriations Acts, but such amount
 shall not exceed $4,000,000 in any fiscal year.
 (e) EFFECTIVE DATE- (1) This section shall take effect at the end of the
 90-day period beginning on the date on which the first report of the National
 Academy of Sciences under section 3(g) is received by the Secretary, except
 that this section shall not take effect if the Secretary, after receiving
 that report and before the end of that 90-day period--
 (A) determines that it is not feasible or cost-effective to carry out
 this section or that carrying out this section would not make a material
 contribution to the body of scientific knowledge concerning the health
 effects in humans of herbicide exposure; and
 (B) notifies the Committees on Veterans' Affairs of the Senate and House
 of Representatives of the Secretary's determination and the reasons therefor.
 (2) In making a determination under this subsection, the Secretary shall
 give great weight to the views and recommendations of the Academy expressed
 in that report with respect to the implementation of this section.
SEC. 10. CONFORMING AMENDMENTS TO PUBLIC LAW 98-542.
 (a) AMENDMENTS TO SECTION 2- Section 2 of Public Law 98-542 (38 U.S.C. 354
 note) is amended by striking out `that chloracne,' in paragraph (5) and
 all that follows through `herbicides and'.
 (b) AMENDMENTS TO SECTION 3- Section 3 of such Public Law is amended by
 striking out `during service in the Armed Forces in the Republic of Vietnam
 to a herbicide containing dioxin or'.
 (c) AMENDMENTS TO SECTION 5- Section 5 of such Public Law is amended
 as follows:
 (1) Subsection (a)(1) is amended by striking out `during service--' and
 all that follows through `in connection with' and inserting in lieu thereof
 `during service in connection with'.
 (2) Subsection (b) is amended--
 (A) by striking out `of exposure to herbicides containing dioxin or' in
 the first sentence of paragraph (1)(A);
 (B) by striking out `evidence indicating--' in paragraph (2)(B) and all
 that follows through `(ii) a connection to' and inserting in lieu thereof
 `evidence indicating a connection to';
 (C) in paragraph (3)--
 (i) by striking out `herbicide or' in subparagraph (A); and
 (ii) by striking out `to a herbicide containing dioxin or' in subparagraph
 (B); and
 (D) by striking out `of the appropriate panel' in the first sentence of
 paragraph (1)(B), in the first sentence of paragraph (2)(A)(i), and in
 paragraph (2)(B).
 (d) AMENDMENTS TO SECTION 6- Section 6 of such Public Law is amended
 as follows:
 (1) Subsection (a) is amended--
 (A) in the matter preceding paragraph (1), by striking out `fifteen members'
 and inserting in lieu thereof `nine members';
 (B) in paragraph (1)--
 (i) by striking out `eleven individuals' and inserting in lieu thereof
 `six individuals';
 (ii) by striking out subparagraph (A);
 (iii) by redesignating subparagraph (B) as subparagraph (A); and
 (iv) by redesignating subparagraph (C) as subparagraph (B) and in that
 subparagraph--
 (I) by striking out `five individuals'  and inserting in lieu thereof
 `three individuals'; and
 (II) by striking out `dioxin or'; and
 (C) in paragraph (2)--
 (i) by striking out `four individuals' and inserting in lieu thereof `three
 individuals'; and
 (ii) by striking out `dioxin or'.
 (2) Subsection (d) is amended--
 (A) by striking out `eleven' in paragraph (1) and inserting in lieu thereof
 `six'; and
 (B) by striking out `be divided into' in paragraph (2) and all that follows
 through `(B) an eight-member panel with' and inserting in lieu thereof `have'.
 (e) EFFECTIVE DATE- (1) Except as provided in paragraph (2), the amendments
 made by this section shall take effect at the end of the six-month period
 beginning on the date of the enactment of this Act.
 (2)(A) If the Secretary of Veterans Affairs determines before the end of
 such six-month period that the Environmental Hazards Advisory Committee
 established under section 6 of Public Law 98-542 (38 U.S.C. 354 note)
 has completed its responsibilities under that section and the directives
 of the Secretary pursuant to the Nehmer case court order, the amendments
 made by this section shall take effect as of the date of such determination.
 (B) For purposes of this paragraph, the term `Nehmer case court order'
 means the court order dated May 2, 1989, in the case of Nehmer v. Department
 of Veterans Affairs, in the United States district court for the northern
 district of California (civil action docket number C-86-6160 TEH).
 (3) If the Secretary makes a determination under paragraph (2), the
 Secretary shall promptly publish in the Federal Register a notice that such
 determination has been made and that such amendments have thereby taken
 effect as of the date of such determination.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.