[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2607 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 2607
To amend title 38, United States Code, to establish in the Department
of Veterans Affairs procedures to determine presumptions of service
connection based on toxic exposure, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 15, 2021
Mr. Trone introduced the following bill; which was referred to the
Committee on Veterans' Affairs, and in addition to the Committee on
Armed Services, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to establish in the Department
of Veterans Affairs procedures to determine presumptions of service
connection based on toxic exposure, 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 ``Fairly Assessing Service-related
Toxic Exposure Residuals Presumptions Act'' or the ``FASTER
Presumptions Act''.
SEC. 2. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF VETERANS AFFAIRS TO
ESTABLISH PRESUMPTIONS OF SERVICE CONNECTION BASED ON
TOXIC EXPOSURE.
(a) Advisory Committees, Panels, and Boards.--
(1) Establishment.--Chapter 11 of title 38, United States
Code, is amended by adding at the end the following new
subchapter:
``SUBCHAPTER VII--RESEARCH AND DETERMINATIONS RELATING TO PRESUMPTIONS
OF SERVICE CONNECTION BASED ON TOXIC EXPOSURE
``Sec. 1171. Procedures to determine presumptions of service connection
based on toxic exposure; definitions
``(a) Procedures.--The Secretary shall determine whether to
establish, or to remove, presumptions of service connection based on
toxic exposure pursuant to this subchapter, whereby--
``(1) the Formal Advisory Committee on Toxic Exposure under
section 1172 assesses research regarding veterans who, during
active military, naval, or air service, were exposed to toxic
substances, commissions additional research, and provides
nominations for the Science Review Board to evaluate the
research;
``(2) the Science Review Board under section 1173 evaluates
research nominated by the Formal Advisory Committee on Toxic
Exposure and determines the strength of evidence supporting a
positive association between exposure to a toxic substance and
an illness;
``(3) the Working Group under section 1174 evaluates the
conclusions of the Science Review Board and recommends to the
Secretary whether to establish or modify a presumption of
service connection; and
``(4) the Secretary prescribes regulations under section
1175.
``(b) Illness Defined.--In this subchapter, the term `illness'
includes a disease or other condition affecting the health of an
individual.
``(c) Nonapplication of Sunset Requirements.--Section 14 of the
Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an
entity established under this subchapter.
``Sec. 1172. Formal Advisory Committee on Toxic Exposure
``(a) Establishment.--(1) There is in the Veterans Benefits
Administration of the Department the Formal Advisory Committee on Toxic
Exposure (in this section referred to as the `Committee').
``(2) The Secretary shall appoint not more than 10 members to the
Committee, of which--
``(A) at least one member shall be appointed from among
individuals who are officials or employees of the Veterans
Benefits Administration or the Veterans Health Administration;
``(B) at least one member shall be appointed from among
individuals who are officials or employees of other departments
or agencies of the Federal Government, including the Department
of Defense and the Agency of Toxic Substances and Disease
Registry of the Centers for Disease Control and Prevention;
``(C) at least three members shall be appointed from among
individuals who are representatives of disabled veterans; and
``(D) at least one member shall be appointed from among
individuals in the private sector, State or local government,
or academia, who are experts in toxicology and epidemiology.
``(3) The Secretary shall determine the pay and allowances of the
members, including with respect to any additional pay and allowances
for members who are officials or employees of the Federal Government.
``(4) Each member of the Committee shall be appointed for a two-
year term, and may serve not more than three successive terms.
``(5) A vacancy in the Committee shall be filled in the manner in
which the original appointment was made.
``(b) Consultation.--The Secretary may consult with, and seek the
advice of, the Committee with respect to disability-related questions
relating to veterans who, during active military, naval, or air
service, are suspected of having been exposed to toxic substances.
``(c) Assessments.--(1) The Committee shall assess the exposure of
veterans to toxic substances that occurred during active military,
naval, or air service.
``(2) The assessments under paragraph (1) shall cover suspected and
known toxic exposures occurring during active military, naval, or air
service, including by identifying and evaluating new and emerging
exposures that are not recognized under existing presumptions of
service connection.
``(3) The Committee may conduct an assessment under paragraph (1)
in response to a recommendation by the Science Review Board pursuant to
section 1173(c)(2)(B) of this title or the Working Group under section
1174(c)(1)(B).
``(4) In assessing the exposure of veterans to toxic substances
under paragraph (1), the Commission shall determine whether--
``(A) under subsection (d), further research into the
exposure is warranted;
``(B) under subsection (e), the existing research being
assessed is sufficient to nominate to the Science Review Board
under section 1173 of this title for evaluation;
``(C) under subsection (f), there is sufficient evidence
regarding an existing presumption of service connection for
review by the Science Review Board or Working Group under
section 1174 of this title, as the case may be; or
``(D) no further action is warranted.
``(d) Research.--(1)(A) Following an assessment of the exposure of
veterans to toxic substances that occurred during active military,
naval, or air service under subsection (c), the Committee may
commission an appropriate entity (including an element of the
Department, an academic entity, or a private-sector entity) to conduct
additional research into the exposure and the health effects of the
exposure, including such research to be conducted in response to data
and analyses provided by the Secretary of Defense or the Secretary of
Veterans Affairs relating to suspected toxic exposure occurring during
such service.
``(B) In carrying out subparagraph (A), the Committee shall
determine whether additional research is needed with respect to the
following:
``(i) Identification of the composition of suspected toxic
substances.
``(ii) Exposure assessments.
``(iii) Epidemiological studies.
``(iv) Toxicology and mechanistic studies.
``(C) In carrying out subparagraph (A), the Committee shall
consider the following information:
``(i) All available health tracking data.
``(ii) All available surveillance data.
``(iii) All germane research previously considered by the
Committee.
``(2) In assessing the suitability of topics for additional
research pursuant to subparagraph (A), the Committee shall consider the
following:
``(A) Conditions of service in the active military, naval,
or air service, known or suspected exposure to agents, and
circumstances of exposure.
``(B) Existing evidence of a connection between illnesses
and service in the active military, naval, or air service, and
the size or ability to define the group of affected veterans.
``(C) In accordance with subsection (g), input from persons
who may be affected by the actions of the Committee.
``(D) Exposure assessments, including data on activities of
the Armed Forces or exposures that may be classified.
``(E) Existing health tracking and surveillance, including
veterans and members of the active military, naval, or air
service, such as the burn pit registry established under
section 201 of the Dignified Burial and Other Veterans'
Benefits Improvement Act of 2012 (Public Law 112-260; 38 U.S.C.
527 note).
``(F) Research, including laboratory research discoveries
and findings from studies of members of the active military,
naval, or air service and civilian workers who were exposed to
toxic substances.
``(G) The effect of sex, gender, age, race, and ethnicity
on health outcomes.
``(3) The Committee shall ensure that the research commissioned
under paragraph (1) is tailored to produce results or conclusions
necessary for the Science Review Board to make a fully informed
assessment.
``(e) Nomination.--If the Committee determines further action is
appropriate with respect to an assessment of the exposure of veterans
to toxic substances that occurred during active military, naval, or air
service under subsection (c), the Committee may nominate the Science
Review Board to evaluate either or both, as the case may be--
``(1) the existing research included in the assessment; or
``(2) the further research conducted pursuant to subsection
(d).
``(f) Review of Existing Presumptions.--(1) Upon receipt of
evidence suggesting that previous findings supporting a positive
association between an exposure and an illness are no longer valid, the
Committee may nominate such exposure or illness for review by the
Science Review Board.
``(2) Upon receipt of evidence suggesting that previous findings
regarding the periods and locations of exposure covered by an existing
presumption of service connection are no longer supported, the
Committee may nominate such evidence for evaluation by the Working
Group to modify the periods and locations.
``(g) Input.--(1) Not less than quarterly, the Committee shall
provide an opportunity for persons described in paragraph (2) to
present written or oral comments to the Committee.
``(2) The persons described in this paragraph are persons who may
be affected by the actions of the Committee, including--
``(A) veterans, the families of veterans, veterans service
organizations and representatives, researchers, and other
members of the general public; and
``(B) departments and agencies of the Federal Government.
``(h) Reports to Congress.--On a biennial basis, the Committee
shall submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate, and make publicly available, a report
on the actions of the Committee. Each such report shall include, with
respect to the period covered by the report, the following:
``(1) A description of--
``(A) the exposure and evidence considered by the
Committee;
``(B) any research commissioned by the Committee;
and
``(C) the rationale of the nominations made by the
Committee to the Science Review Board for further
evaluation.
``(2) A description of each specific action recommended by
the Committee described in subsection (c)(3).
``(3) Each report received by the Committee under section
1173(c)(2) of this title.
``Sec. 1173. Science Review Board
``(a) Establishment.--(1) There is in the Department the Science
Review Board (in this section referred to as the `Board').
``(2)(A) The members of the Board shall be appointed by the
Secretary from the general public from among individuals who are
distinguished in the fields of medicine, biological sciences, or health
administration.
``(B) An individual may not concurrently serve on the Board and the
Formal Advisory Committee on Toxic Exposure under section 1172 of this
title.
``(C) The Secretary shall determine the number, terms of service,
and pay and allowances of members of the Board appointed by the
Secretary.
``(b) Duties.--(1) Upon receiving a nomination for the evaluation
of research on the health effects of exposure of members of the active
military, naval, or air service to toxic substances made by the Formal
Advisory Committee on Toxic Exposure pursuant to section 1172 of this
title, the Board shall--
``(A) evaluate the likelihood that an illness is associated
with an exposure to a toxic substance while serving in the
active military, naval, or air service; and
``(B) assess the exposures and illnesses identified by the
Committee and determine whether the evidence supports a finding
of a positive association between the exposure and the illness.
``(2) In carrying out paragraph (1)(B), the Board shall review all
relevant data to determine, with respect to the strength of evidence
for a positive association, that there is--
``(A) sufficient evidence of an association;
``(B) limited or suggestive evidence of an association;
``(C) inadequate or insufficient evidence to determine an
association; or
``(D) limited or suggestive evidence of no association.
``(3) With respect to an evaluation conducted under this
subsection, if the Board determines that the evidence for a positive
association is inadequate or insufficient to determine an association
as described in paragraph (2)(C), the Board shall develop a
recommendation as to whether additional data gathering and research are
necessary.
``(c) Reports.--(1) For each evaluation conducted under subsection
(b) where the Board determines that the evidence for a positive
association is either sufficient or limited or suggestive of an
association, as described in subparagraph (A) or (B) of paragraph (2)
of such subsection, the Board shall submit to the Secretary, the
Working Group under section 1174 of this title, and to the Committees
on Veterans' Affairs of the House of Representatives and the Senate a
report identifying the evidence found to reach such positive
association determinations.
``(2) For each evaluation conducted under subsection (b) where the
Board determines that the evidence for positive association is
inadequate or insufficient to determine an association as described in
paragraph (2)(C) of such subsection, the Board shall submit to the
Secretary, the Formal Advisory Committee on Toxic Exposure, and to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report--
``(A) identifying the evidence found to reach such positive
association determinations; and
``(B) containing the recommendations under subsection
(b)(3) as to whether additional data gathering and research are
necessary and an outline of a report request proposal for such
additional data and research.
``Sec. 1174. Working group on presumptions of service connection
``(a) Establishment.--The Secretary shall establish a working group
(in this section referred to as the `Working Group') to--
``(1) evaluate--
``(A) the conclusions of the Science Review Board
contained in each report submitted under section
1173(c)(1) of this title; and
``(B) evidence nominated by the Formal Advisory
Committee on Toxic Exposure under section 1172(f)(2)
regarding the periods and locations of exposure covered
by an existing presumption of service connection; and
``(2) make a recommendation to the Secretary with respect
to whether to--
``(A) establish a presumption of service connection
for the toxic exposure and illness covered by the
report described in subparagraph (A) of paragraph (1);
or
``(B) modify an existing presumption of service
connection described in subparagraph (B) of such
paragraph.
``(b) Evaluations.--(1) In evaluating the conclusions of the
Science Review Board, the Working Group shall consider factors, in
addition to the conclusions of the Board, that the Working Group
determines appropriate.
``(2) The Working Group shall provide a period of not fewer than 60
days for persons described in section 1172(g)(2) of this title to
present written comments to the Working Group with respect to each
evaluation made under this section.
``(c) Recommendations.--(1) In making a recommendation under
subsection (a)(2), the Working Group shall--
``(A) in cases where the evidence for a positive
association is either sufficient or limited or suggestive of an
association, as described in subparagraph (A) or (B) of section
1173(b)(2) of this title, weigh heavily in favor of
establishing a presumption of service connection; and
``(B) if the Working Group determines that additional
research, studies, or reports are appropriate before making a
final recommendation with respect to establishing or modifying
a presumption of service connection, submit to the Formal
Advisory Committee a description of such appropriate additional
research, studies, or reports.
``(2) Not later than 60 days after the date on which the comment
period under subsection (b)(2) ends with respect to an evaluation made
under this section, the Working Group shall submit to the Secretary and
to the Committees on Veterans' Affairs of the House of Representatives
and the Senate a description of the recommendation made under
subsection (a)(2).
``Sec. 1175. Regulations regarding presumptions of service connection
based on toxic exposure
``(a) Action Upon Working Group Recommendation.--Not later than 60
days after the date on which the Secretary receives a recommendation to
establish or modify a presumption of service connection under section
1174(c)(2) of this title--
``(1) if the Secretary determines that the presumption, or
modification, is warranted, the Secretary shall issue proposed
regulations setting forth the presumption or revise regulations
to carry out such modification; or
``(2) if the Secretary determines that the presumption, or
modification, is not warranted, the Secretary shall publish in
the Federal Register a notice of the determination, including
the reasons supporting the determination.
``(b) Final Regulation.--Not later than 90 days after the date on
which the Secretary issues any proposed regulations under subsection
(a)(1), the Secretary shall issue final regulations. Such regulations
shall be effective on the date of issuance.
``(c) Removal of Presumption.--(1) The Secretary may issue
regulations to remove an illness from a presumption of service
connection previously established pursuant to a regulation issued under
subsection (b).
``(2) Whenever an illness is removed from regulations pursuant to
paragraph (1), or the periods and locations of exposure covered by a
presumption of service connection are modified under subsection (a)--
``(A) a veteran who was awarded compensation for such
illness on the basis of the presumption provided under such
regulations before the effective date of the removal or
modification shall continue to be entitled to receive
compensation 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 such illness on the basis of such presumption shall
continue to be entitled to receive dependency and indemnity
compensation on such basis.
``Sec. 1176. Expert Advisory Panel on Constrictive Bronchiolitis
``(a) Establishment.--There is in the Department the Expert
Advisory Panel on Constrictive Bronchiolitis (in this section referred
to as the `Panel').
``(b) Membership.--(1) The Panel shall be appointed by the
Secretary from the general public from among individuals who are--
``(A) experts in pulmonary pathology;
``(B) experts in other fields the Secretary determines
appropriate, such as pulmonary medicine, toxicology,
epidemiology, exposure assessment, and radiology; and
``(C) individuals representing the veterans community.
``(2) The Secretary shall determine the number, terms of service,
and pay and allowances of members of the Panel appointed by the
Secretary.
``(c) Duties.--The panel shall develop specific guidelines for
research conducted by the Department of symptomatic veterans who served
in the active military, naval, or air service in the Southwest Asia
theater of operations whom the differential diagnosis includes
bronchiolitis. The Panel shall--
``(1) determine the adequacy of lung biopsy approaches and
recommend to the Secretary best practices;
``(2) make recommendations to the Secretary for processing,
handling, and storing lung biopsies;
``(3) establish histologic and pathology criteria for
confirming diagnoses; and
``(4) submit to the Secretary and to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate reports on the findings and results of such research.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1163 the following new items:
``subchapter vii--research and determinations relating to presumptions
of service connection based on toxic exposure
``1171. Procedures to determine presumptions of service connection
based on toxic exposure; definitions.
``1172. Formal Advisory Committee on Toxic Exposure.
``1173. Science Review Board.
``1174. Working group on presumptions of service connection.
``1175. Regulations regarding presumptions of service connection based
on toxic exposure.
``1176. Expert Advisory Panel on Constrictive Bronchiolitis.''.
(b) Conforming Amendments.--Chapter 11 of title 38, United States
Code, is amended as follows:
(1) Section 1116 is amended--
(A) by striking subsections (b), (c), (d), and (e);
(B) by inserting after subsection (a) the following
new subsection (b):
``(b) The Secretary shall ensure that any determination made on or
after the date of the enactment of the FASTER Presumptions Act
regarding a presumption of service connection based on exposure to an
herbicide agent under this section is made pursuant to subchapter VII
of this chapter, including with respect to assessing reports received
by the Secretary from the National Academy of Sciences under section 3
of the Agent Orange Act of 1991 (Public Law 102-4).''; and
(C) by redesignating subsection (f) as subsection
(c).
(2) Section 1116B(b)(2)(A) is amended by inserting
``pursuant to subchapter VII of this chapter,'' before ``the
Secretary determines''.
(3) Section 1118 is amended--
(A) by striking subsections (b), (c), (d), and (e);
and
(B) by inserting after subsection (a) the following
new subsection (b):
``(b) The Secretary shall ensure that any determination made on or
after the date of the enactment of the FASTER Presumptions Act
regarding a presumption of service connection based on exposure to a
toxic substance under this section is made pursuant to subchapter VII
of this chapter.''.
(c) Access to Health Care.--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), as determined
appropriate by the Secretary, a toxin-exposed veteran is
eligible for hospital care and medical services under
subsection (a)(2)(F) for any diagnosed illness that the
Secretary determines is covered by, or reasonably could be
covered by, pending research during the period beginning on the
date on which the Formal Advisory Committee on Toxic Exposure
begins assessing such research under section 1172(c) of this
title and ending on the date specified in clause (ii).
``(ii) The date specified in this clause is the following:
``(I) In cases of pending research for which the
Secretary determines under section 1175(a)(1) of this
title that a presumption of service connection is
warranted, the date on which the toxin-exposed veteran
is otherwise eligible for hospital care and medical
services pursuant to this section by reason of
regulations issued under such section 1175.
``(II) In cases of pending research for which the
Secretary determines under section 1175(a)(2) that a
presumption of service connection is not warranted, the
date, if any, that the Secretary determines
appropriate.
``(iii) In this subparagraph:
``(I) The term `pending research' means research
assessed or commissioned by the Formal Advisory
Committee on Toxic Exposure under section 1172
regarding the exposure of veterans to toxic substances.
``(II) The term `toxin-exposed veteran' means a
veteran--
``(aa) whose service in the active
military, naval, or air service is covered by
pending research; and
``(bb) who is not otherwise eligible for
hospital care and medical services pursuant to
this paragraph.''; and
(2) in paragraph (2)(B), by striking ``or (F)'' and
inserting ``(F), or (G)''.
SEC. 3. IMPROVEMENTS TO DATA COLLECTION AND USE.
(a) Plan.--The Secretary of Defense, in consultation with the
Secretary of Veterans Affairs, shall develop and implement a plan to
strengthen the data collection with respect to members of the Armed
Forces, including members of the reserve components, who are exposed to
toxic substances while serving in the Armed Forces. The plan shall
provide for the following:
(1) Detailing methods of continuous in-service
surveillance, including data collection and analysis, of such
exposures and the physical and mental health of the members.
(2) Surveilling such exposures and the health of members
from accession through separation, including, where possible,
through the use of wearable and portable devices to assess
health outcomes, and extend such surveillance indefinitely
post-separation for those veterans with suspected exposure to
toxic substances.
(3) Ensuring consistent surveillance efforts across the
Armed Forces.
(4) Determining the feasibility of collecting biological
samples and the means by which such collection could be
accomplished, including, at a minimum, through use of wearable
and portable devices and the collection of blood and urine, to
measure exposure in deployed environments.
(5) Maintaining a repository of data and biological samples
available for prospective research.
(6) With respect to each member, tracking the military
occupational specialty, deployment history, disease risk
factors, sex, gender, age, race, and ethnicity.
(b) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs and the Committees on Armed Services of the House of
Representatives and the Senate, and annually thereafter for five years,
a report containing the plan developed under subsection (a) and the
status of implementing the plan.
(c) Integration.--The Secretary of Defense shall integrate research
access considerations of the plan developed under subsection (a) into
the electronic health record modernization program and the individual
longitudinal exposure record program.
(d) Determinations.--The Secretary of Veterans Affairs, in
consultation with the Formal Advisory Committee on Toxic Exposure
established under section 1172 of title 38, United States Code, as
added by section 2, shall determine--
(1) whether studies of respiratory health outcomes from
other countries, including Australia, Canada, France, Poland,
Sweden, and the United Kingdom, provide useful data, and
whether the structure of these studies could be emulated in the
United States to improve participation rates; and
(2) whether the health records of veterans from health care
systems other than the Department of Veterans Affairs,
including private-sector health providers, the Centers for
Medicare & Medicaid Services, and the TRICARE program, can be
accessed for research purposes.
(e) Sharing of Information.--The Secretary of Veterans Affairs
shall provide to the Formal Advisory Committee on Toxic Exposure and
the Science Review Board established under section 1173 of title 38,
United States Code, as added by section 2, the results of surveillance
conducted pursuant to the plan developed under subsection (a),
including data collection and analysis.
SEC. 4. STUDIES RELATING TO VETERANS WHO SERVED IN SOUTHWEST ASIA.
(a) Analysis.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall initiate
or sponsor an updated analysis of total and respiratory disease
mortality in covered veterans. The study shall include, to the extent
practicable--
(1) metrics of airborne exposures;
(2) the location and timing of deployments;
(3) the military occupational specialty;
(4) the Armed Force in which the veteran served;
(5) pre-existing health status, including with respect to
asthma; and
(6) relevant personal information, including cigarette and
e-cigarette smoking history, diet, sex, gender, age, race, and
ethnicity.
(b) Epidemiological Study.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall sponsor an
epidemiological study of covered veterans that uses the following:
(1) Improved spatio-temporal estimates of ambient air
pollution exposures using advances in retrospective exposure
assessment.
(2) Detailed information on the study subjects obtained
through medical records, administrative data, and other
existing sources, that include--
(A) personal characteristics, including cigarette
and e-cigarette smoking history, diet, sex, gender,
age, race, and ethnicity;
(B) deployment history, including locations,
periods, and number of deployments;
(C) biospecimen data; and
(D) supplementary health status and outcomes data,
including imaging and physiological parameters.
(c) Toxicology Study.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall sponsor a toxicology
study to include variability to replicate exposures of healthy, young
members of the Armed Forces, as well as potentially susceptible
members, with preexisting health conditions. The study shall--
(1) analyze the study results for mechanistic markers and
clinically relevant outcomes; and
(2) validate serum, tissue, and other biomarkers of
exposure, susceptibility, or effect.
(d) Covered Veteran Defined.--The term ``covered veteran'' means
any veteran who--
(1) on or after August 2, 1990, served on active duty in--
(A) Bahrain;
(B) Iraq;
(C) Kuwait;
(D) Oman;
(E) Qatar;
(F) Saudi Arabia;
(G) Somalia; or
(H) United Arab Emirates; or
(2) on or after September 11, 2001, served on active duty
in--
(A) Afghanistan;
(B) Djibouti;
(C) Egypt;
(D) Jordan;
(E) Lebanon;
(F) Syria; or
(G) Yemen.
SEC. 5. TRAINING TO IMPROVE CLAIMS ADJUDICATIONS.
(a) Training on Adjudication.--The Secretary of Veterans Affairs
shall provide training to each covered employee to improve the handling
of claims for compensation and pension benefits that relate to toxic
exposure. The Secretary shall provide such training annually and, in
addition to the annual training, when the Secretary determines that a
significant development has occurred in law or regulation with respect
to such claims, such as the Secretary establishing a new presumption of
service connection.
(b) Matters Included.--
(1) All trainees.--The training under subsection (a) shall
include the following explanations with respect to claims
relating to toxic exposure:
(A) A lack of a presumption of service connection
is not by itself sufficient to determine that service
connection does not exist.
(B) The claims adjudicator shall always consider
whether direct service connection is applicable and
request, as needed, an advisory medical opinion under
section 5109 of title 38, United States Code.
(C) While information included in the individual
longitudinal exposure record program of the Department
of Veterans Affairs may be used to corroborate
assertions of toxic exposure, a lack of such
information, or a lack of other corroborating evidence
of toxic exposure, is not by itself sufficient to
determine that such exposure did not occur or
sufficient to deny the claim.
(2) Veterans service representatives.--In addition to the
matters under paragraph (1), the Secretary shall ensure that
each employee described in subsection (d)(1) receives an
individualized assessment of--
(A) the ability of the employee to identify claims
qualifying for presumptive service connection; and
(B) the compliance of the employee with
standardized development requirements.
(3) Rating veterans service representative.--In addition to
the matters under paragraph (1), the Secretary shall ensure
that each employee described in subsection (d)(2) receives an
individualized assessment of--
(A) the ability of the employee to identify claims
qualifying for presumptive service connection; and
(B) the compliance of the employee with the
schedule of ratings for disabilities adopted under
section 1155 of title 38, United States Code.
(4) Compensation and pension medical examiners.--In
addition to the matters under paragraph (1), the Secretary
shall ensure that each employee described in subsection (d)(3)
receives an individualized assessment of--
(A) the ability of the employee to identify claims
qualifying for presumptive service connection; and
(B) the compliance of the employee with
standardized examination and medical opinion
procedures.
(c) Provision of Training.--With respect to employees described in
paragraph (1) or (2) of subsection (d), the Secretary shall--
(1) ensure that the training under subsection (a) is
provided as part of the initial training program for such
employees;
(2) place each employee under a second signature review
period for claims relating to toxic exposure until the employee
meets the required grade scale level quality standard for such
claims; and
(3) using the Systematic Technical Accuracy Review program,
or such successor program, conduct a nationwide, quarterly,
randomized review of the quality of adjudication of claims
relating to toxic exposure.
(d) Covered Employee Defined.--In this section, the term ``covered
employee'' means employees of the Department of Veterans Affairs who
handle claims for compensation and pension benefits, including--
(1) employees who adjudicate claims;
(2) employees who apply the schedule of ratings for
disabilities adopted under section 1155 of title 38, United
States Code, and prepare rating decisions; and
(3) employees or contractors who provide medical
examinations or medical opinions pursuant to section 5103A(d)
of such title.
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