[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2368 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 2368
To amend title 38, United States Code, to establish a presumption of
service connection for illnesses associated with exposure to certain
airborne hazards, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 5, 2021
Mrs. Luria introduced the following bill; which was referred to the
Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to establish a presumption of
service connection for illnesses associated with exposure to certain
airborne hazards, 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 ``Conceding Our Veterans' Exposures
Now And Necessitating Training Act of 2021'' or the ``COVENANT Act of
2021''.
SEC. 2. PRESUMPTIONS OF SERVICE CONNECTION FOR ILLNESSES ASSOCIATED
WITH EXPOSURE TO CERTAIN AIRBORNE HAZARDS.
(a) Sense of Congress.--It is the sense of Congress that--
(1) as in past theaters of operation, Southwest Asia and
its supporting theaters of operation pose numerous natural and
manmade hazards that negatively affect the health outcomes of
individuals serving in these foreign environments;
(2) toxic exposures from burn pits, oil well fires, and
other regional airborne hazards increase the potential for
immediate and long-term illnesses to emerge among members of
the Armed Forces; and
(3) legislation is necessary--
(A) to confront the scientific challenge of
producing clear associations between in-theater toxic
exposures and the illnesses confronting veterans who
served in Southwest Asia and beyond;
(B) to address the insufficient data hindering the
Secretary of Veterans Affairs, the Secretary of
Defense, and relevant partners from reaching proactive
determinations regarding such associations; and
(C) to improve evaluations associated with claims
for disability compensation that relate to toxic
exposure.
(b) Presumptions of Service Connection.--
(1) In general.--Subchapter II of chapter 11 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 1119. Presumptions of service connection for illnesses
associated with exposure to certain airborne hazards
``(a) Presumptions.--(1) For the purposes of section 1110 of this
title, and subject to section 1113 of this title, an illness specified
in subsection (d) becoming manifest in a covered veteran to a degree of
10 percent or more shall be considered to have been incurred in or
aggravated during active military, naval, or air service,
notwithstanding that there is no record of evidence of such illness
during a period of such service.
``(2) A covered veteran shall be presumed to have been exposed to
an airborne hazard specified in subsection (e) during service of the
covered veteran specified in subsection (f)(1) unless there is
affirmative evidence to establish that the covered veteran was not
exposed to any such airborne hazard during such service.
``(b) Medical Examinations and Opinions.--(1) If a covered veteran
submits to the Secretary a claim for disability compensation for a
diagnosed illness not specified in subsection (d) that includes an
assertion that the illness is related to airborne hazard exposure
(regardless of whether such assertion identifies a particular airborne
hazard specified in subsection (e)) or open burn pit exposure, and the
evidence of record is insufficient to establish service connection for
the illness, the Secretary shall provide to the covered veteran a
medical examination and obtain a medical opinion under section 5103A of
this title to determine whether the illness is at least as likely as
not caused by an airborne hazard specified in subsection (e).
``(2) In carrying out paragraph (1), if the diagnosed illness for
which a claim is submitted involves a sign or symptom specified in
section 1117(g) of this title, the Secretary shall ensure that--
``(A) the medical examination provided pursuant to such
paragraph includes an evaluation of each corresponding body
part or system that relates to the sign or symptom; and
``(B) the sign or symptom is considered in making the
determination under such paragraph.
``(3) In providing the Secretary with a medical opinion pursuant to
paragraph (1), a medical provider shall consider--
``(A) the total potential exposure to airborne hazards
through any service of the covered veteran specified in
subsection (f)(1) and the synergistic effect of combined
airborne hazards, including airborne hazards that involve
exposure through inhalation, dermal exposure, or ingestion; and
``(B) the medical evidence and scientific reporting
available at the time of the determination under paragraph (1).
``(c) Relationship to Presumptions for Illnesses Associated With
Service in Persian Gulf.--A determination that a presumption of service
connection is not warranted pursuant to this section shall not preclude
the Secretary from--
``(1) determining that a presumption of service connection
is warranted pursuant to section 1118 of this title; or
``(2) paying compensation to the veteran (or dependency and
indemnity compensation to a survivor of the veteran) pursuant
to section 1117 of this title.
``(d) Illnesses.--The illnesses specified in this subsection are
the following:
``(1) Asthma that was diagnosed after a period of service
specified in subsection (f)(1).
``(2)(A) Head cancer of any type.
``(B) Neck cancer of any type.
``(C) Respiratory cancer of any type.
``(D) Gastrointestinal cancer of any type.
``(E) Reproductive cancer of any type.
``(F) Lymphoma cancer of any type.
``(G) Lymphomatic cancer of any type.
``(H) Kidney cancer.
``(I) Brain cancer.
``(J) Melanoma.
``(3) Chronic obstructive pulmonary disease.
``(4) Chronic bronchitis.
``(5) Constrictive bronchiolitis or obliterative
bronchiolitis.
``(6) Emphysema.
``(7) Granulomatous disease.
``(8) Interstitial lung disease.
``(9) Pleuritis.
``(10) Pulmonary fibrosis.
``(11) Sarcoidosis.
``(12) Rhinitis.
``(13) Sinusitis.
``(e) Airborne Hazards.--The airborne hazards specified in this
subsection are the following:
``(1) Particulate matter, including the following:
``(A) PM-10.
``(B) PM-2.5.
``(2) Polycyclic aromatic hydrocarbons (PAHs), including
the following:
``(A) Acenaphthene.
``(B) Acenaphthylene.
``(C) Anthracene.
``(D) Benzo(a)anthracene.
``(E) Benzo(a)pyrene.
``(F) Benzo(b)fluoroanthene.
``(G) Benzo(g,h,i)perylene.
``(H) Benzo(k)fluoroanthene.
``(I) Chrysene.
``(J) Dibenze(a,h)anthracene.
``(K) Fluoranthene.
``(L) Fluorene.
``(M) Indeno(1,2,3-cd)pyrene.
``(N) Naphthalene.
``(O) Phenanthrene.
``(P) Pyrene.
``(3) Volatile organic compounds, including the following:
``(A) Acetone.
``(B) Acrolein.
``(C) Benzene.
``(D) Carbon disulfide.
``(E) Chlorofluoromethane.
``(F) Chloromethane.
``(G) Ethylbenzene.
``(H) Hexane.
``(I) Hexachlorobutadiene.
``(J) M/p-Xylene.
``(K) Methylene chloride.
``(L) Pentane.
``(M) Propylene.
``(N) Styrene.
``(O) Toluene.
``(4) Toxic organic halogenated dioxins and furans
(dioxins), including the following:
``(A) 1,2,3,4,6,7,8-HPCDD.
``(B) 1,2,3,4,6,7,8-HPCDF.
``(C) 1,2,3,4,7,8,9-HPCDF.
``(D) 1,2,3,4,7,8-HXCDD.
``(E) 1,2,3,4,7,8-HXCDF.
``(F) 1,2,3,6,7,8-HXCDD.
``(G) 1,2,3,6,7,8-HXCDF.
``(H) 1,2,3,7,8,9-HXCDD.
``(I) 1,2,3,7,8,9-HXCDF.
``(J) 1,2,3,7,8-PECDD.
``(K) 1,2,3,7,8-PECDF.
``(L) 2,3,4,6,7,8-HXCDF.
``(M) 2,3,4,7,8-PECDF.
``(N) 2,3,7,8-TCDD.
``(O) 2,3,7,8-TCDF.
``(P) Octachlorodibenzodioxin.
``(Q) Octachlorodibenzofuran.
``(5) Any other airborne hazard determined relevant by the
Secretary.
``(f) Definitions.--In this section:
``(1) The term `covered veteran' means any veteran who--
``(A) on or after August 2, 1990, performed active
military, naval, or air service while assigned to a
duty station in--
``(i) Bahrain;
``(ii) Iraq;
``(iii) Kuwait;
``(iv) Oman;
``(v) Qatar;
``(vi) Saudi Arabia;
``(vii) Somalia; or
``(viii) United Arab Emirates; or
``(B) on or after September 11, 2001, performed
active military, naval, or air service while assigned
to a duty station in--
``(i) Afghanistan;
``(ii) Djibouti;
``(iii) Egypt;
``(iv) Jordan;
``(v) Lebanon;
``(vi) Syria;
``(vii) Yemen;
``(viii) Uzbekistan;
``(ix) the Philippines; or
``(x) any other country determined relevant
by the Secretary.
``(2) The term `illness' means a disease or other condition
that affects the health of an individual on a basis other than
an acute or transient basis.
``(3) The term `open burn pit' has the meaning given such
term in section 201(c) of the Dignified Burial and Other
Veterans' Benefits Improvement Act of 2012 (Public Law 112-260;
38 U.S.C. 527 note), except that the area of land may be
located in any country specified in paragraph (1) or determined
relevant by the Secretary pursuant to such paragraph.
``(g) Effective Date of Award.--The effective date of an award
under this section shall be determined in accordance with section 5110
of this title, except that such date may not be earlier than the date
of the enactment of this Act.''.
(2) Clerical amendment.--The table of contents at the
beginning of chapter 11 of title 38, United States Code, is
amended by inserting after the item relating to section 1118
the following new item:
``1119. Presumptions of service connection for illnesses associated
with exposure to certain airborne
hazards.''.
(3) Implementation deadline.--The Secretary of Veterans
Affairs shall implement the amendments made by this subsection
by not later than 18 months after the date of the enactment of
this Act.
(c) Relationship to Presumptions for Illnesses Associated With
Service in the Persian Gulf.--Subchapter II of chapter 11 of title 38,
United States Code, is further amended--
(1) in section 1117, by adding at the end the following new
subsection:
``(i) A denial or termination of compensation paid to a veteran
pursuant to this section shall not preclude the Secretary from
determining that a presumption of service connection is warranted
pursuant to section 1119 of this title.''; and
(2) in section 1118, by adding at the end the following new
subsection:
``(f) A determination that a presumption of service connection is
not warranted pursuant to this section shall not preclude the Secretary
from determining that a presumption of service connection is warranted
pursuant to section 1119 of this title.''.
(d) Pending Cases.--
(1) Authority to stay.--The Secretary may stay a claim
described in paragraph (2) until the date on which the
Secretary commences the implementation of section 1119 of title
38, United States Code (as added by subsection (b)).
(2) Claims described.--A claim described in this
subparagraph is a claim for disability compensation that is
pending at the Veterans Benefits Administration, the Board of
Veterans' Appeals, the Court of Appeals for Veterans Claims, or
the Court of Appeals for the Federal Circuit, 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 1119
and that relates to--
(A) the service and illnesses covered by such
section 1119; or
(B) the service covered by such section 1119 and a
diagnosed illness asserted in the claim to be related
to airborne hazard exposure, regardless of whether such
assertion identifies a particular airborne hazard, or
open burn pit exposure.
(e) Standard Medical Training Curriculum.--
(1) Curriculum.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall establish a standard medical training curriculum for all
medical providers conducting examinations and providing
opinions under section 1119(b) of title 38, United States Code
(as added by subsection (b)), that provides a standardized
approach to conducting and providing examinations and opinions
in accordance with such section.
(2) Elements.--The Secretary shall include in the
curriculum under paragraph (1) an instruction for each medical
provider conducting an examination or providing an opinion to
consider the following:
(A) Relevant medical and scientific literature.
(B) Available information on the proximity,
intensity, and frequency of exposure of the individual
to airborne hazards.
(C) Medically unexplained chronic multisymptom
illnesses.
(D) All competent and credible evidence of record.
(3) Submission to congress.--Prior to implementation of the
curriculum under paragraph (1), the Secretary shall submit to
the Committees on Veterans' Affairs of the House of
Representatives and the Senate such curriculum.
(f) Definitions.--In this section:
(1) The terms ``illness'' and ``open burn pit'' have the
meaning given such terms in section 1119 of title 38, United
States Code (as added by subsection (b)).
(2) The term ``medically unexplained chronic multisymptom
illness'' has the meaning given such term in section
1117(a)(2)(B) of title 38, United States Code.
SEC. 3. ELIGIBILITY FOR CARE AND SERVICES BASED ON POTENTIAL EXPOSURE
TO CERTAIN AIRBORNE HAZARDS.
(a) Eligibility for Care and Services.--Section 1710(e) of title
38, United States Code, is amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(G)(i) Subject to paragraph (2), a covered veteran is
eligible for hospital care, medical services, and nursing home
care under subsection (a)(2)(F) for any diagnosed illness,
notwithstanding that there is insufficient medical evidence to
conclude that such illness is attributable to the service
specified in section 1119(f)(1) of this title.
``(ii) In this subparagraph, the term `covered veteran' has
the meaning given such term in section 1119 of this title.'';
and
(2) in paragraph (2)(B), by striking ``or (F)'' and
inserting ``(F), or (G)''.
(b) Resource Assessment and Report.--
(1) Initial assessment and report.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall--
(A) complete an assessment to determine--
(i) the personnel and material resources
necessary to implement the amendments made by
subsection (a); and
(ii) the total number of covered veterans,
as such term is defined in section 1119 of
title 38, United States Code (as added by
section 2(b)), who receive hospital care or
medical services furnished by the Secretary
under chapter 17 of such title, disaggregated
by priority group specified in section 1705(a)
of such title; and
(B) submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate an
initial report containing the findings of the
assessment completed under subparagraph (A), including
a specific determination as to whether the Department
has the personnel and material resources necessary to
implement the amendments made by subsection (a).
(2) Subsequent reports.--If the initial report submitted
under paragraph (1)(B) contains a determination that the
Department does not have the personnel or material resources
necessary to implement the amendments made by subsection (a),
beginning not later than 90 days after the submission of such
initial report and every 90 days thereafter until the effective
date specified in subsection (c), the Secretary shall submit to
the Committees on Veterans' Affairs of the House of
Representatives and the Senate a subsequent report containing
an update to such determination.
(c) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that is the earlier of the following:
(1) The date on which the Secretary submits a report under
subsection (b) containing a determination that the Department
has the personnel and material resources necessary to implement
such amendments.
(2) The date that is 18 months after the date of the
enactment of this Act.
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