[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3967 Engrossed in House (EH)]
<DOC>
117th CONGRESS
2d Session
H. R. 3967
_______________________________________________________________________
AN ACT
To improve health care and benefits for veterans exposed to toxic
substances, 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; REFERENCES TO TITLE 38, UNITED STATES CODE;
TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Honoring our
Promise to Address Comprehensive Toxics Act of 2021'' or the ``Honoring
our PACT Act of 2021''.
(b) Matters Relating to Amendments to Title 38, United States
Code.--
(1) References.--Except as otherwise expressly provided,
when in this Act an amendment or repeal is expressed in terms
of an amendment to, or repeal of, a section or other provision,
the reference shall be considered to be made to a section or
other provision of title 38, United States Code.
(2) Amendments to tables of contents.--Except as otherwise
expressly provided, when an amendment made by this Act to title
38, United States Code, adds a section or larger organizational
unit to that title or amends the designation or heading of a
section or larger organizational unit in that title, that
amendment also shall have the effect of amending any table of
sections in that title to alter the table to conform to the
changes made by the amendment.
(c) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; references to title 38, United States Code; table
of contents.
TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY
Subtitle A--Toxic-exposed Veterans
Sec. 101. Short title.
Sec. 102. Definitions relating to toxic-exposed veterans.
Sec. 103. Expansion of health care for specific categories of toxic-
exposed veterans and veterans supporting
certain overseas contingency operations.
Sec. 104. Assessments of implementation and operation.
Sec. 105. Revision of breast cancer mammography policy of Department of
Veterans Affairs to provide mammography
screening for veterans who served in
locations associated with toxic exposure.
Subtitle B--Certain Veterans of Combat Service and Other Matters
Sec. 111. Expansion of period of eligibility for health care for
certain veterans of combat service.
Sec. 112. Authorization period for emergency treatment in non-
Department of Veterans Affairs medical
facilities.
TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS
Sec. 201. Short title.
Sec. 202. Improvements to ability of Department of Veterans Affairs to
establish presumptions of service
connection based on toxic exposure.
Sec. 203. Reevaluation of claims for compensation involving
presumptions of service connection.
TITLE III--IMPROVING THE ESTABLISHMENT OF SERVICE CONNECTION PROCESS
FOR TOXIC-EXPOSED VETERANS
Sec. 301. Short title.
Sec. 302. Presumptions of toxic exposure.
Sec. 303. Medical nexus examinations for toxic exposure risk
activities.
TITLE IV--PRESUMPTIONS OF SERVICE CONNECTION
Sec. 401. Treatment of veterans who participated in cleanup of Enewetak
Atoll as radiation-exposed veterans for
purposes of presumption of service
connection of certain disabilities by
Department of Veterans Affairs.
Sec. 402. Treatment of veterans who participated in nuclear response
near Palomares, Spain, or Thule, Greenland,
as radiation-exposed veterans for purposes
of presumption of service connection of
certain disabilities by Department of
Veterans Affairs.
Sec. 403. Presumptions of service connection for diseases associated
with exposures to certain herbicide agents
for veterans who served in certain
locations.
Sec. 404. Addition of additional diseases associated with exposure to
certain herbicide agents for which there is
a presumption of service connection for
veterans who served in certain locations.
Sec. 405. Improving compensation for disabilities occurring in Persian
Gulf War veterans.
Sec. 406. Presumption of service connection for certain diseases
associated with exposure to burn pits and
other toxins.
TITLE V--RESEARCH MATTERS
Sec. 501. Interagency working group on toxic exposure research.
Sec. 502. Data collection, analysis, and report on treatment of
veterans for illnesses related to toxic
exposure.
Sec. 503. Studies related to veterans who served in Southwest Asia and
certain other locations.
Sec. 504. Study on health trends of post 9/11 veterans.
Sec. 505. Study on cancer rates among veterans.
Sec. 506. Study on feasibility and advisability of furnishing hospital
care and medical services to dependents of
veterans who participated in toxic exposure
risk activities.
Sec. 507. Study on health effects of waste related to Manhattan Project
on certain veterans.
Sec. 508. Study on toxic exposure and mental health outcomes.
Sec. 509. Study on veterans in Territories of the United States.
Sec. 510. Department of Veterans Affairs public website for toxic
exposure research.
Sec. 511. Biennial report on health effects of jet fuels used by Armed
Forces.
TITLE VI--IMPROVEMENT OF RESOURCES AND TRAINING REGARDING TOXIC-EXPOSED
VETERANS
Sec. 601. Short title; definitions.
Sec. 602. Publication of list of resources of Department of Veterans
Affairs for toxic-exposed veterans and
outreach program for such veterans and
caregivers and survivors of such veterans.
Sec. 603. Incorporation of toxic exposure questionnaire during primary
care appointments.
Sec. 604. Training for personnel of the Department of Veterans Affairs
with respect to toxic-exposed veterans.
Sec. 605. Guidelines for active duty military on potential risks and
prevention of toxic exposures.
TITLE VII--REGISTRIES, RECORDS, AND OTHER MATTERS
Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl
substances on military installations.
Sec. 702. Fort McClellan Health Registry.
Sec. 703. Independent study on Individual Longitudinal Exposure Record.
Sec. 704. Biannual report on Individual Longitudinal Exposure Record.
Sec. 705. Correction of exposure records by members of the Armed Forces
and veterans.
Sec. 706. Federal cause of action relating to water at Camp Lejeune,
North Carolina.
Sec. 707. Veterans Toxic Exposures Fund.
Sec. 708. Authorization of electronic notice in claims under laws
administered by the Secretary of Veterans
Affairs.
Sec. 709. Authorization of appropriations for expansion of claims
automation.
Sec. 710. Non-applicability of non-Department of Veterans Affairs
covenants not to compete to appointment of
Veterans Health Administration personnel.
Sec. 711. Recruitment of physicians on a contingent basis prior to
completion of training requirements.
Sec. 712. Authority for Secretary of Veterans Affairs to award grants
to States to improve outreach to veterans.
Sec. 713. Study and report on herbicide agent exposure in Panama Canal
Zone.
Sec. 714. Budget information for alternatives to burn pits.
Sec. 715. Authorization of appropriations for expansion of claims
automation.
Sec. 716. Burn pit registry updates.
Sec. 717. Burn pit transparency.
TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY
Subtitle A--Toxic-exposed Veterans
SEC. 101. SHORT TITLE.
This title may be cited as the ``Conceding Our Veterans' Exposures
Now And Necessitating Training Act'' or the ``COVENANT Act''.
SEC. 102. DEFINITIONS RELATING TO TOXIC-EXPOSED VETERANS.
(a) In General.--Section 1710(a)(2)(F) is amended by striking ``who
was exposed to a toxic substance, radiation, or other conditions, as
provided in subsection (e)'' and inserting ``in accordance with
subsection (e), who is a toxic-exposed veteran''.
(b) Definitions of Toxic Exposure and Toxic-exposed Veteran.--
Section 101 is amended by adding at the end the following new
paragraphs:
``(37) The term `toxic exposure' includes the following:
``(A) A toxic exposure risk activity, as defined in section
1710(e)(4) of this title.
``(B) An exposure to a substance, chemical, or airborne
hazard identified in the list under section 1119(b)(2) of this
title.
``(38) The term `toxic-exposed veteran' means a veteran described
in section 1710(e)(1) of this title.''.
(c) Definition of Toxic Exposure Risk Activity.--Section 1710(e)(4)
is amended by adding at the end the following new subparagraph:
``(C) The term `toxic exposure risk activity' means any
activity--
``(i) that requires a corresponding entry in an
exposure tracking record system (as defined in section
1119(c) of this title) for the veteran who carried out
the activity; or
``(ii) that the Secretary determines qualifies for
purposes of this subsection when taking into account
what is reasonably prudent to protect the health of
veterans.''.
SEC. 103. EXPANSION OF HEALTH CARE FOR SPECIFIC CATEGORIES OF TOXIC-
EXPOSED VETERANS AND VETERANS SUPPORTING CERTAIN OVERSEAS
CONTINGENCY OPERATIONS.
(a) In General.--
(1) Expansion.--Subsection (e) of section 1710, as amended
by section 102(c), is further amended--
(A) in paragraph (1), by adding at the end the
following new subparagraphs:
``(G) Beginning not later than the applicable date specified in
paragraph (6), and subject to paragraph (2), a veteran who participated
in a toxic exposure risk activity while serving on active duty, active
duty for training, or inactive duty training is eligible for hospital
care (including mental health services and counseling), medical
services, and nursing home care under subsection (a)(2)(F) for any
illness.
``(H) Beginning not later than the applicable date specified in
paragraph (6), and subject to paragraph (2), a covered veteran (as
defined in section 1119(c) of this title) is eligible for hospital care
(including mental health services and counseling), medical services,
and nursing home care under subsection (a)(2)(F) for any illness.
``(I)(i) Beginning not later than the applicable date specified in
paragraph (6), and subject to paragraph (2), a veteran who deployed in
support of a contingency operation specified in clause (ii) is eligible
for hospital care (including mental health services and counseling),
medical services, and nursing home care under subsection (a)(2)(F) for
any illness.
``(ii) A contingency operation specified in this clause is any of
the following:
``(I) Operation Enduring Freedom.
``(II) Operation Freedom's Sentinel.
``(III) Operation Iraqi Freedom.
``(IV) Operation New Dawn.
``(V) Operation Inherent Resolve.
``(VI) Resolute Support Mission.''; and
(B) in paragraph (2)(B)--
(i) by striking ``or (F)'' and inserting
``(F), (G), (H), or (I)''; and
(ii) by striking ``service or testing'' and
inserting ``service, testing, or activity''.
(2) Phase in.--Such subsection is further amended by adding
at the end the following new paragraph:
``(6)(A) The Secretary shall determine the dates in subparagraphs
(G), (H), and (I) of paragraph (1) as follows:
``(i) October 1, 2024, with respect to a veteran described
in such subparagraph (G) or (H) who was discharged or released
from the active military, naval, air, or space service during
the period beginning on August 2, 1990, and ending on September
11, 2001.
``(ii) October 1, 2026, with respect to a veteran described
in such subparagraph (G) or (H) who was discharged or released
from the active military, naval, air, or space service during
the period beginning on September 12, 2001, and ending on
December 31, 2006.
``(iii) October 1, 2028, with respect to a veteran
described in such subparagraph (G) or (H) who was discharged or
released from the active military, naval, air, or space service
during the period beginning on January 1, 2007, and ending on
December 31, 2012.
``(iv) October 1, 2030, with respect to a veteran described
in such subparagraph (G) or (H) who was discharged or released
from the active military, naval, air, or space service during
the period beginning on January 1, 2013, and ending on December
31, 2018.
``(v) October 1, 2032, with respect to a veteran described
in such subparagraph (I).
``(B) The Secretary may modify a date specified in subparagraph (A)
to an earlier date, as the Secretary determines appropriate based on
the number of veterans receiving hospital care, medical services, and
nursing home care under subparagraphs (G), (H), and (I) of paragraph
(1) and the resources available to the Secretary. If the Secretary
determines to so modify a date, the Secretary shall--
``(i) notify the Committees on Veterans' Affairs of the
House of Representatives and the Senate of the proposed
modification; and
``(ii) publish such modified date in the Federal
Register.''.
(b) Outreach Plans.--With respect to each of clauses (i) through
(v) of section 1710(e)(6)(A) of title 38, United States Code (as added
by subsection (a)(2)), not later than 180 days prior to the date
specified in the clause (including a date modified pursuant to such
section), the Secretary shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a plan to
conduct outreach to the veterans referred to in the clause to notify
such veterans of their eligibility for hospital care, medical services,
or nursing home care under subparagraph (G), (H), or (I), of section
1710(e)(1) of such title, as the case may be.
SEC. 104. ASSESSMENTS OF IMPLEMENTATION AND OPERATION.
(a) Initial Resource Assessment and Report.--Not later than 180
days after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall--
(1) complete an assessment to determine--
(A) the personnel and material resources necessary
to implement section 103 (including the amendments made
by such section); and
(B) the total number of covered veterans, as such
term is defined in section 1119(c) of title 38, United
States Code (as added by section 302), 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
(2) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a report containing the
findings of the assessment completed under paragraph (1),
including a specific determination as to whether the Department
has the personnel and material resources necessary to implement
section 103.
(b) Information Systems.--Not later than October 1, 2024, the
Secretary shall establish information systems to assess the
implementation of section 103, including the amendments made by such
section, and use the results of assessments under such systems to
inform the reports under subsection (c).
(c) Annual Reports.--
(1) Reports.--Not later than October 1, 2025, and on an
annual basis thereafter until October 1, 2033, the Secretary
shall submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a report on the
following:
(A) The effect of the implementation of, and the
provision and management of care under, section 103,
(including the amendments made by such section) on the
demand by veterans described in subparagraphs (G), (H),
and (I) of section 1710(e)(1) of title 38, United
States Code (as added by such section 103) for health
care services furnished by the Secretary.
(B) Any differing patterns of demand for health
care services by such veterans, disaggregated by
factors such as the relative distance of the veteran
from medical facilities of the Department and whether
the veteran had previously received hospital care or
medical services furnished by the Secretary under
chapter 17 of such title.
(C) The extent to which the Secretary has met such
demand.
(D) Any changes, during the year covered by the
report, in the delivery patterns of health care
furnished by the Secretary under chapter 17 of such
title, and the fiscal impact of such changes.
(2) Matters.--Each report under paragraph (1) shall
include, with respect to the year covered by the report,
detailed information on the following:
(A) The total number of veterans enrolled in the
patient enrollment system who, during such year,
received hospital care or medical services furnished by
the Secretary under chapter 17 of title 38, United
States Code.
(B) Of the veterans specified in subparagraph (A),
the number of such veterans who, during the preceding
three fiscal years, had not received such care or
services.
(C) With respect to the veterans specified in
subparagraph (B), the cost of providing health care to
such veterans during the year covered by the report,
shown in total and disaggregated by--
(i) the level of care; and
(ii) whether the care was provided through
the Veterans Community Care Program.
(D) With respect to the number of veterans
described in subparagraphs (G), (H), and (I) of section
1710(e)(1) of title 38, United States Code (as added by
section 103), the following (shown in total and
disaggregated by medical facility of the Department, as
applicable):
(i) The number of such veterans who, during
the year covered by the report, enrolled in the
patient enrollment system.
(ii) The number of such veterans who
applied for, but were denied, such enrollment.
(iii) The number of such veterans who were
denied hospital care or a medical service
furnished by the Secretary that was considered
to be medically necessary but not of an
emergency nature.
(E) The numbers and characteristics of, and the
type and extent of health care furnished by the
Secretary to, veterans enrolled in the patient
enrollment system (shown in total and disaggregated by
medical facility of the Department).
(F) The numbers and characteristics of, and the
type and extent of health care furnished by the
Secretary to, veterans not enrolled in the patient
enrollment system (disaggregated by each class of
eligibility for care under section 1710 of title 38,
United States Code, and further shown as a total per
class and disaggregated by medical facility of the
Department).
(G) The specific fiscal impact (shown in total and
disaggregated by geographic health care delivery areas)
of changes in the delivery patterns of health care
furnished by the Secretary under chapter 17 of such
title as a result of the implementation of section 103
(including the amendments made by such section).
(d) Definitions.--In this section:
(1) The term ``patient enrollment system'' means the
patient enrollment system of the Department of Veterans Affairs
established and operated under section 1705 of title 38, United
States Code.
(2) The term ``Veterans Community Care Program'' means the
program established under section 1703 of title 38, United
States Code.
SEC. 105. REVISION OF BREAST CANCER MAMMOGRAPHY POLICY OF DEPARTMENT OF
VETERANS AFFAIRS TO PROVIDE MAMMOGRAPHY SCREENING FOR
VETERANS WHO SERVED IN LOCATIONS ASSOCIATED WITH TOXIC
EXPOSURE.
(a) In General.--Section 7322 of title 38, United States Code, is
amended--
(1) in subsection (a), by striking ``The'' and inserting
``In General.--The'';
(2) in subsection (b)--
(A) by striking ``The'' and inserting ``Standards
for Screening.--The''; and
(B) in paragraph (2)(B), by inserting ``a record of
service in a location and during a period specified in
subsection (d),'' after ``risk factors,''; and
(3) by adding at the end the following new subsections:
``(c) Eligibility for Screening for Veterans Exposed to Toxic
Substances.--The Under Secretary for Health shall ensure that, under
the policy developed under subsection (a), any veteran who, during
active military, naval, or air service, was deployed in support of a
contingency operation in a location and during a period specified in
subsection (d), is eligible for a mammography screening by a health
care provider of the Department.
``(d) Locations and Periods Specified.--(1) The locations and
periods specified in this subsection are the following:
``(A) Iraq during following periods:
``(i) The period beginning on August 2, 1990, and
ending on February 28, 1991.
``(ii) The period beginning on March 19, 2003, and
ending on such date as the Secretary determines burn
pits are no longer used in Iraq.
``(B) The Southwest Asia theater of operations, other than
Iraq, during the period beginning on August 2, 1990, and ending
on such date as the Secretary determines burn pits are no
longer used in such location, including the following
locations:
``(i) Kuwait.
``(ii) Saudi Arabia.
``(iii) Oman.
``(iv) Qatar.
``(C) Afghanistan during the period beginning on September
11, 2001, and ending on such date as the Secretary determines
burn pits are no longer used in Afghanistan.
``(D) Djibouti during the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Djibouti.
``(E) Syria during the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Syria.
``(F) Jordan during the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Jordan.
``(G) Egypt during the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Egypt.
``(H) Lebanon during the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Lebanon.
``(I) Yemen during the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Yemen.
``(J) Such other locations and corresponding periods as set
forth by the Airborne Hazards and Open 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).
``(K) Such other locations and corresponding periods as the
Secretary, in collaboration with the Secretary of Defense, may
determine appropriate in a report submitted under paragraph
(2).
``(2) Not later than two years after the date of the enactment of
the Supporting Expanded Review for Veterans In Combat Environments Act
of 2021, and not less frequently than once every two years thereafter,
the Secretary of Veterans Affairs, in collaboration with the Secretary
of Defense, shall submit to Congress a report specifying other
locations and corresponding periods for purposes of paragraph (1)(K).
``(3) A location under this subsection shall not include any body
of water around or any airspace above such location.
``(4) In this subsection, the term `burn pit' means an area of land
that is used for disposal of solid waste by burning in the outdoor
air.''.
(b) Report on Breast Cancer Rates for Veterans Deployed to Certain
Areas.--Not later than two years after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report that
compares the rates of breast cancer among members of the Armed Forces
deployed to the locations and during the periods specified in section
7322(d) of title 38, United States Code, as added by subsection (a), as
compared to members of the Armed Forces who were not deployed to those
locations during those periods and to the civilian population.
Subtitle B--Certain Veterans of Combat Service and Other Matters
SEC. 111. EXPANSION OF PERIOD OF ELIGIBILITY FOR HEALTH CARE FOR
CERTAIN VETERANS OF COMBAT SERVICE.
(a) Expanded Period.--Section 1710(e)(3) is amended--
(1) in subparagraph (A)--
(A) by striking ``January 27, 2003'' and inserting
``September 11, 2001''; and
(B) by striking ``five-year period'' and inserting
``10-year period'';
(2) by amending subparagraph (B) to read as follows:
``(B) With respect to a veteran described in paragraph
(1)(D) who was discharged or released from the active military,
naval, air, or space service after September 11, 2001, and
before October 1, 2013, but did not enroll to receive such
hospital care, medical services, or nursing home care under
such paragraph pursuant to subparagraph (A) before October 1,
2022, the one-year period beginning on October 1, 2022.''; and
(3) by striking subparagraph (C).
(b) Clarification of Coverage.--Section 1710(e)(1)(D) is amended by
inserting after ``Persian Gulf War'' the following: ``(including any
veteran who, in connection with service during such period, received
the Armed Forces Expeditionary Medal, Service Specific Expeditionary
Medal, Combat Era Specific Expeditionary Medal, Campaign Specific
Medal, or any other combat theater award established by a Federal
statute or an Executive order)''.
(c) Outreach Plan.--Not later than December 1, 2022, the Secretary
shall submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a plan to conduct outreach to veterans
described in subparagraph (B) of section 1710(e)(3) of title 38, United
States Code, as amended by subsection (a)(2), to notify such veterans
of their eligibility for hospital care, medical services, or nursing
home care pursuant to such subparagraph.
(d) Report on Enrollments.--Not later than January 30, 2024, the
Secretary shall submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a report identifying, with
respect to the one-year period beginning on October 1, 2022, the number
of veterans described in section 1710(e)(3)(B) of title 38, United
States Code, as amended by subsection (a)(2), who, during such period,
enrolled in the patient enrollment system of the Department of Veterans
Affairs established and operated under section 1705 of such title.
(e) Effective Date.--This section and the amendments made by this
section shall take effect on October 1, 2022.
SEC. 112. AUTHORIZATION PERIOD FOR EMERGENCY TREATMENT IN NON-
DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.
Section 1703(a)(3) of title 38, United States Code, is amended--
(1) by striking ``A covered veteran'' and inserting ``(A)
Except as provided by subparagraph (B), a covered veteran'';
and
(2) by adding at the end the following new subparagraph:
``(B) In the case of an emergency which existed at the time of
admission of a covered veteran to a health care provider, the Secretary
shall deem the care or services received by the veteran during such
admission to be authorized under subparagraph (A) if the covered
veteran (or an individual acting on behalf of the covered veteran)
makes an application for such authorization during the period following
such admission that the Secretary determines appropriate for purposes
of this paragraph, except such period may not be less than 96 hours.''.
TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS
SEC. 201. SHORT TITLE.
This subtitle may be cited as the ``Fairly Assessing Service-
related Toxic Exposure Residuals Presumptions Act'' or the ``FASTER
Presumptions Act''.
SEC. 202. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF VETERANS AFFAIRS TO
ESTABLISH PRESUMPTIONS OF SERVICE CONNECTION BASED ON
TOXIC EXPOSURE.
(a) Advisory Committees, Panels, and Boards.--Chapter 11 is amended
by adding at the end the following new subchapter:
``SUBCHAPTER VII--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 of this title--
``(A) provides advice to the Secretary on toxic-
exposed veterans and cases in which veterans who,
during active military, naval, air, or space service,
may have experienced a toxic exposure or their
dependents may have experienced a toxic exposure while
the veterans were serving in the active military,
naval, air, or space service;
``(B) provides to the Secretary recommendations on
corrections needed in the Individual Longitudinal
Exposure Record, or successor system, to better reflect
veterans and dependents described in subparagraph (A);
and
``(C) provides to the Secretary recommendations
regarding which cases of possible toxic exposure should
be reviewed; and
``(2) the Secretary provides for formal evaluations of such
recommendations under section 1173 of this title; and
``(3) the Secretary issues regulations under section 1174
of this title.
``(b) Illness Defined.--In this subchapter, the term `illness'
includes a disease or other condition affecting the health of an
individual, including mental and physical health.
``Sec. 1172. Formal Advisory Committee on Toxic Exposure
``(a) Establishment.--(1) There is in the Veterans Health
Administration of the Department the Formal Advisory Committee on Toxic
Exposure (in this section referred to as the `Committee').
``(2)(A) The Committee shall be composed of nine members appointed
as follows:
``(i) Five members shall be appointed by the Secretary.
``(ii) One member shall be appointed by the Speaker of the
House of Representatives.
``(iii) One member shall be appointed by the minority
leader of the House of Representatives.
``(iv) One member shall be appointed by the majority leader
of the Senate.
``(v) One member shall be appointed by the minority leader
of the Senate.
``(B) The members appointed under subparagraph (A) shall meet the
following criteria:
``(i) Not more than three members shall be appointed from
among individuals who are officials or employees of the
Veterans Benefits Administration or the Veterans Health
Administration.
``(ii) 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.
``(iii) At least two members shall represent an
organization recognized by the Secretary for the representation
of veterans under section 5902 of this title.
``(iv) 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 of the Committee, including with respect to any additional pay
and allowances for members who are officials or employees of the
Federal Government.
``(4)(A) Except as provided by subparagraph (B), each member of the
Committee shall be appointed for a two-year term, and may serve not
more than three successive terms.
``(B) With respect to the five members who are initially appointed
by the Secretary under subparagraph (A)(i), the Secretary shall
determine the length of the term of each such member in a manner that
ensures the expiration of the terms on a staggered basis.
``(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 cases in which veterans who,
during active military, naval, air, or space service, are suspected of
having experienced a toxic exposure or dependents of veterans who may
have experienced a toxic exposure during such service.
``(c) Assessments.--(1) The Committee shall assess cases of the
toxic exposure of veterans and their dependents that occurred during
active military, naval, air, or space service, including by conducting
ongoing surveillance and reviewing such exposure described in
scientific literature, media reports, information from veterans, and
information from Congress.
``(2) The assessments under paragraph (1) shall cover suspected and
known toxic exposures occurring during active military, naval, air, or
space service, including by identifying and evaluating new and emerging
toxic exposures that are not recognized under existing presumptions of
service connection.
``(3) The Committee may conduct an assessment under paragraph (1)
in response to comments by a person described in subsection (e)(2), by
a majority vote of the members of the Committee.
``(4) The Committee shall on a periodic basis assess the Individual
Longitudinal Exposure Record, or successor system, to ensure the
accuracy of data collected.
``(d) Research Recommendations.--(1) Following an assessment of a
case of the toxic exposure of veterans or their dependents that
occurred during active military, naval, air, or space service under
subsection (c), the Committee may develop a recommendation for formal
evaluation under section 1173 of this title to conduct a review of the
health effects related to the case of exposure if the Committee
determines that the research may change the current understanding of
the relationship between an exposure to an environmental hazard and
adverse health outcomes in humans.
``(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 formal evaluation under
section 1173 of this title to modify the periods and locations.
``(e) 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.
``(f) Reports by the Committee.--Not less frequently than once each
year, the Committee shall submit to the Secretary and the Committees on
Veterans' Affairs of the Senate and the House of Representatives, and
make publicly available, a report on--
``(1) recommendations for research under subsection (d), if
any; and
``(2) recommendations for such legislative or
administrative action as the Committee considers necessary for
the Committee to be more effective in carrying out the
requirements of this section.
``(g) Responses by Secretary.--In response to each report submitted
under subsection (f), the Secretary shall submit to the Secretary and
the Committees on Veterans' Affairs of the Senate and the House of
Representatives, and make publicly available, a report on--
``(1) the findings and opinions of the Secretary with
respect to the report most recently submitted under subsection
(f); and
``(2) whether the Secretary will conduct research
recommended under subsection (f) included in the report, and if
not, an explanation of why, including citations and sources.
``(h) Nonapplication of Sunset Requirements.--Section 14 of the
Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the
Committee.
``Sec. 1173. Formal evaluation of recommendations
``(a) Formal Evaluation.--The Secretary shall establish a process
to conduct a formal evaluation with respect to each recommendation made
by the Formal Advisory Committee on Toxic Exposure under section 1172
of this title--
``(1) to conduct research regarding the health effects
related to a case of toxic exposure; or
``(2) to evaluate evidence regarding the periods and
locations of exposure covered by an existing presumption of
service connection.
``(b) Evidence, Data, and Factors.--The Secretary shall ensure that
each formal evaluation under paragraph (1) covers the following:
``(1) Scientific evidence, based on the review of available
scientific literature, including human, toxicological, animal,
and methodological studies, and other factors.
``(2) Claims data, based on the review of claim rate, grant
rate, and service connection prevalence, and other factors.
``(3) Other factors the Secretary determines appropriate,
such as--
``(A) the level of disability and mortality caused
by the health effects related to the case of toxic
exposure being evaluated;
``(B) the level of assistance required to remain in
the community because of such health effects;
``(C) the quantity and quality of the information
available and reviewed;
``(D) the feasibility of and period for generating
relevant information and evidence;
``(E) whether such health effects are combat- or
deployment-related; and
``(F) the ubiquity or rarity of the health effects.
``(c) Conduct of Evaluations.--(1) The Secretary shall ensure that
each formal evaluation under subsection (a)--
``(A) reviews scientific evidence in a manner that--
``(i) conforms to principles of scientific and data
integrity;
``(ii) is free from suppression or distortion of
scientific or technological findings, data,
information, conclusions, or technical results; and
``(B)(i) evaluates the likelihood that a positive
association exists between an illness and a toxic exposure
while serving in the active military, naval, air, or space
service; and
``(ii) assesses the toxic exposures and illnesses and
determines whether the evidence supports a finding of a
positive association between the toxic exposure and the
illness.
``(2) In carrying out paragraph (1)(B)(ii), a formal evaluation
under subsection (a) shall include reviewing all relevant data to
determine the strength of evidence for a positive association based on
the following four categories:
``(A) The `sufficient' category, where the evidence is
sufficient to conclude that a positive association exists.
``(B) The `equipoise and above' category, where the
evidence is sufficient to conclude that a positive association
is at least as likely as not, but not sufficient to conclude
that a positive association exists.
``(C) The `below equipoise' category, where the evidence is
not sufficient to conclude that a positive association is at
least as likely as not, or is not sufficient to make a
scientifically informed judgment.
``(D) The `against' category, where the evidence suggests
the lack of a positive association.
``(d) Recommendation for Rulemaking.--Not later than 120 days after
the date on which a formal evaluation is commenced, the element of the
Department that conducts the evaluation shall submit to the Secretary a
recommendation with respect to establishing a presumption of service
connection for the toxic exposure and illness, or modifying an existing
presumption of service connection, covered by the evaluation.
``Sec. 1174. Regulations regarding presumptions of service connection
based on toxic exposure
``(a) Action Upon Recommendation.--Not later than 160 days after
the date on which the Secretary receives a recommendation to establish
or modify a presumption of service connection under section 1173 of
this title--
``(1) if the Secretary determines that the presumption, or
modification, is warranted, the Secretary shall commence
issuing regulations in accordance with the provisions of
subchapter II of chapter 5 of title 5 (commonly referred to as
the Administrative Procedures Act) setting forth the
presumption or commence revising 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) 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 (a).
``(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. 1175. Authority to modify process; congressional oversight
``(a) Authority.--(1) The Secretary may modify the process under
which the Secretary conducts formal evaluations under section 1173 of
this title and issues regulations under section 1174 if--
``(A) such evaluations cover the evidence, data, and
factors required by subsection (b) of such section 1173; and
``(B) a period of 180 days has elapsed following the date
on which the Secretary submits the notice under paragraph (2)
regarding the modification.
``(2) If the Secretary proposes to modify the process under which
the Secretary conducts formal evaluations under section 1173 of this
title or issues regulations under section 1174, the Secretary shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a notice of the proposed modifications
containing the following:
``(A) A description of the proposed modifications.
``(B) A description of any exceptions to the requirements
of such sections that are proposed because of limited available
scientific evidence, and a description of how such evaluations
will be conducted.
``(b) Reports and Briefings.--(1)(A) Not later than two years after
the date of the enactment of the Honoring our Promise to Address
Comprehensive Toxics Act of 2021, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the implementation of, and recommendations for, this
subchapter.
``(B) The Secretary shall develop the report under subparagraph (A)
in consultation with organizations recognized by the Secretary for the
representation of veterans under section 5902 of this title and any
other entity the Secretary determines appropriate.
``(2) On a quarterly basis during the two-year period beginning on
the date of the enactment of the Honoring our Promise to Address
Comprehensive Toxics Act of 2021, the Secretary shall provide to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a briefing on the implementation of this subchapter.
``(c) Independent Review.--The Secretary shall seek to enter into
an agreement with a nongovernmental entity or a federally funded
research and development center to conduct a review of the
implementation of this subchapter. Not later than 540 days after the
date of the enactment of the Honoring our Promise to Address
Comprehensive Toxics Act of 2021, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report containing such review.''.
(b) Conforming Amendments.--Chapter 11 is amended--
(1) in section 1116--
(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 Honoring our Promise to Address
Comprehensive Toxics Act of 2021 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) in section 1116B(b)(2)(A), by inserting ``pursuant to
subchapter VII of this chapter,'' before ``the Secretary
determines''; and
(3) in section 1118--
(A) by striking subsections (b) through (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 Honoring our Promise to Address
Comprehensive Toxics Act of 2021 regarding a presumption of service
connection based on a toxic exposure under this section is made
pursuant to subchapter VII of this chapter.''.
(c) Rule of Construction.--Nothing in section 1172(a)(2)(A) of
title 38, United States Code, as added by subsection (a), shall be
construed so as to require the advice and consent of the Senate in the
appointment of members of the Formal Advisory Committee on Toxic
Exposure.
SEC. 203. REEVALUATION OF CLAIMS FOR COMPENSATION INVOLVING
PRESUMPTIONS OF SERVICE CONNECTION.
(a) In General.--Subchapter VI of chapter 11 is amended by adding
at the end the following new section:
``Sec. 1167. Reevaluation of compensation determinations pursuant to
changes in presumptions of service connection
``(a) Reevaluation.--Whenever a law, including through a regulation
or Federal court decision, establishes or modifies a presumption of
service connection, the Secretary shall--
``(1) identify all claims for compensation under this
chapter that--
``(A) were submitted to the Secretary;
``(B) were evaluated and denied by the Secretary
before the date on which such provision of law went
into effect; and
``(C) might have been evaluated differently had the
establishment or modification been applicable to the
claim;
``(2) allow for the reevaluation of such claims at the
election of the veteran; and
``(3) notwithstanding section 5110 of this title, with
respect to claims approved pursuant to such reevaluation,
provide compensation under this chapter effective as if the
establishment or modification of the presumption of service
connection had been in effect on the date of the submission of
the original claim described in paragraph (1).
``(b) Outreach.--The Secretary shall conduct outreach to inform
relevant veterans that they may elect to have a claim be reevaluated in
light of the establishment or modification of a presumption of service
connection described in subsection (a). Such outreach shall include the
following:
``(1) The Secretary shall publish on the internet website
of the Department a notice that such veterans may elect to have
a claim so reevaluated.
``(2) The Secretary shall notify, in writing or by
electronic means, veterans service organizations of the ability
of such veterans to elect to have a claim so reevaluated.''.
(b) Application.--Section 1167 of title 38, United States Code, as
added by subsection (a), shall apply with respect to presumptions of
service connection established or modified on or after the date of the
enactment of this Act, including pursuant to amendments made by this
Act.
TITLE III--IMPROVING THE ESTABLISHMENT OF SERVICE CONNECTION PROCESS
FOR TOXIC-EXPOSED VETERANS
SEC. 301. SHORT TITLE.
This title may be cited as the ``Veterans Burn Pits Exposure
Recognition Act''.
SEC. 302. PRESUMPTIONS OF TOXIC EXPOSURE.
Subchapter II of chapter 11 is amended by adding at the end the
following new section:
``Sec. 1119. Presumptions of toxic exposure
``(a) Consideration of Records.--If a veteran submits to the
Secretary a claim for compensation for a service-connected disability
under section 1110 of this title with evidence of a disability and a
toxic exposure that occurred during active military, naval, air, or
space service, the Secretary may, in adjudicating such claim,
consider--
``(1) any record of the veteran in an exposure tracking
record system; and
``(2) if no record of the veteran in an exposure tracking
record system indicates that the veteran was subject to a toxic
exposure during active military, naval, air, or space service,
the totality of the circumstances of the service of the
veteran.
``(b) Presumption of Specific Toxic Exposure for Members Who Served
in Certain Locations.--(1) The Secretary shall, for purposes of section
1110 and chapter 17 of this title, presume that any covered veteran was
exposed to the substances, chemicals, and airborne hazards identified
in the list under paragraph (2) during the service of the covered
veteran specified in subsection (c)(1), unless there is affirmative
evidence to establish that the covered veteran was not exposed to any
such substances, chemicals, or hazards in connection with such service.
``(2) The Secretary shall establish and maintain a list that
contains an identification of one or more such substances, chemicals,
and airborne hazards as the Secretary, in collaboration with the
Secretary of Defense, may determine appropriate for purposes of this
section.
``(3) Beginning not later than two years after the date of the
enactment of the Honoring our Promise to Address Comprehensive Toxics
Act of 2021, and not less frequently than once every two years
thereafter, the Secretary shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a report
identifying any additions or removals to the list under paragraph (2)
during the period covered by the report.
``(c) Definitions.--In this section:
``(1) The term `covered veteran' means any veteran who--
``(A) on or after August 2, 1990, performed active
military, naval, air, or space 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, air, or space 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 `exposure tracking record system'--
``(A) means any system, program, or pilot program
used by the Secretary of Veterans Affairs or the
Secretary of Defense to track how veterans or members
of the Armed Forces have been exposed to various
occupational or environmental hazards; and
``(B) includes the Individual Longitudinal Exposure
Record, or successor system.
``(3) The term `toxic exposure risk activity' has the
meaning given such term in section 1710(e)(4) of this title.''.
SEC. 303. MEDICAL NEXUS EXAMINATIONS FOR TOXIC EXPOSURE RISK
ACTIVITIES.
Subchapter VI of chapter 11, as amended by section 203, is further
amended by adding at the end the following new section:
``Sec. 1168. Medical nexus examinations for toxic exposure risk
activities
``(a) Medical Examinations and Medical Opinions.--(1) Except as
provided in subsection (b), if a veteran submits to the Secretary a
claim for compensation for a service-connected disability under section
1110 of this title with evidence of a disability and evidence of
participation in a toxic exposure risk activity during active military,
naval, air, or space service, and such evidence is not sufficient to
establish a service connection for the disability, the Secretary
shall--
``(A) provide the veteran with a medical examination under
section 5103A(d) of this title; and
``(B) obtain a medical opinion (to be requested by the
Secretary in connection with the medical examination under
subparagraph (A)) as to whether it is at least as likely as not
that there is a nexus between the disability and the toxic
exposure risk activity.
``(2) When providing the Secretary with a medical opinion under
paragraph (1)(B) for a veteran, the health care provider shall
consider--
``(A) the total potential exposure through all applicable
military deployments of the veteran; and
``(B) the synergistic, combined effect of all toxic
exposure risk activities of the veteran.
``(3) The requirement under paragraph (2)(B) shall not be construed
as requiring a health care provider to consider the synergistic,
combined effect of each of the substances, chemicals, and airborne
hazards identified in the list under section 1119(b)(2) of this title.
``(b) Exception.--Subsection (a) shall not apply if the Secretary
determines there is no indication of an association between the
disability claimed by the veteran and the toxic exposure risk activity
for which the veteran submitted evidence.
``(c) Toxic Exposure Risk Activity Defined.--In this section, the
term `toxic exposure risk activity' has the meaning given that term in
section 1710(e)(4) of this title.''.
TITLE IV--PRESUMPTIONS OF SERVICE CONNECTION
SEC. 401. TREATMENT OF VETERANS WHO PARTICIPATED IN CLEANUP OF ENEWETAK
ATOLL AS RADIATION-EXPOSED VETERANS FOR PURPOSES OF
PRESUMPTION OF SERVICE CONNECTION OF CERTAIN DISABILITIES
BY DEPARTMENT OF VETERANS AFFAIRS.
(a) Short Title.--This section may be cited as the ``Mark Takai
Atomic Veterans Healthcare Parity Act''.
(b) Enewetak Atoll.--Section 1112(c)(3)(B) is amended by adding at
the end the following new clause:
``(v) Cleanup of Enewetak Atoll during the period
beginning on January 1, 1977, and ending on December
31, 1980.''.
SEC. 402. TREATMENT OF VETERANS WHO PARTICIPATED IN NUCLEAR RESPONSE
NEAR PALOMARES, SPAIN, OR THULE, GREENLAND, AS RADIATION-
EXPOSED VETERANS FOR PURPOSES OF PRESUMPTION OF SERVICE
CONNECTION OF CERTAIN DISABILITIES BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) Short Title.--This section may be cited as the ``Palomares or
Thule Veterans Act''
(b) Palomares or Thule.--Section 1112(c)(3)(B), as amended by
section 401, is further amended by adding at the end the following new
clauses:
``(vi) Onsite participation in the response effort
following the collision of a United States Air Force B-
52 bomber and refueling plane that caused the release
of four thermonuclear weapons in the vicinity of
Palomares, Spain, during the period beginning January
17, 1966, and ending March 31, 1967.
``(vii) Onsite participation in the response effort
following the on-board fire and crash of a United
States Air Force B-52 bomber that caused the release of
four thermonuclear weapons in the vicinity of Thule Air
Force Base, Greenland, during the period beginning
January 21, 1968, and ending September 25, 1968.''.
SEC. 403. PRESUMPTIONS OF SERVICE CONNECTION FOR DISEASES ASSOCIATED
WITH EXPOSURES TO CERTAIN HERBICIDE AGENTS FOR VETERANS
WHO SERVED IN CERTAIN LOCATIONS.
(a) Short Title.--This section may be cited as the ``Veterans Agent
Orange Exposure Equity Act''.
(b) In General.--Section 1116, as amended by section 202, is
further amended--
(1) by striking ``, during active military, naval, air, or
space service, served in the Republic of Vietnam during the
period beginning on January 9, 1962, and ending on May 7,
1975'' each place it appears and inserting ``performed covered
service'';
(2) by striking ``performed active military, naval, air, or
space service in the Republic of Vietnam during the period
beginning on January 9, 1962, and ending on May 7, 1975'' each
place it appears and inserting ``performed covered service'';
and
(3) by adding at the end the following new subsection:
``(d) In this section, the term `covered service' means active
military, naval, air, or space service--
``(1) performed in the Republic of Vietnam during the
period beginning on January 9, 1962, and ending on May 7, 1975;
``(2) performed in Thailand at any United States or Royal
Thai base during the period beginning on January 9, 1962, and
ending on June 30, 1976, without regard to where on the base
the veteran was located or what military job specialty the
veteran performed;
``(3) performed in Laos during the period beginning on
December 1, 1965, and ending on September 30, 1969;
``(4) performed in Cambodia at Mimot or Krek, Kampong Cham
Province during the period beginning on April 16, 1969, and
ending on April 30, 1969; or
``(5) performed on Guam or American Samoa, or in the
territorial waters thereof, during the period beginning on
January 9, 1962, and ending on July 31, 1980, or served on
Johnston Atoll or on a ship that called at Johnston Atoll
during the period beginning on January 1, 1972, and ending on
September 30, 1977.''.
(c) Eligibility for Hospital Care and Medical Services.--Section
1710(e)(4), as amended by section 102(c), is further amended by
striking subparagraph (A) and inserting the following new subparagraph:
``(A) The term `Vietnam-era herbicide-exposed veteran'
means a veteran who--
``(i) performed covered service, as defined in
section 1116(d) of this title; or
``(ii) the Secretary finds may have been exposed
during such service to dioxin or was exposed during
such service to a toxic substance found in a herbicide
or defoliant used for military purposes during such
period.''.
(d) Conforming Amendment.--The heading for section 1116 is amended
by striking ``the Republic of Vietnam'' and inserting ``certain
locations''.
SEC. 404. ADDITION OF ADDITIONAL DISEASES ASSOCIATED WITH EXPOSURE TO
CERTAIN HERBICIDE AGENTS FOR WHICH THERE IS A PRESUMPTION
OF SERVICE CONNECTION FOR VETERANS WHO SERVED IN CERTAIN
LOCATIONS.
(a) Short Title.--This section may be cited as the ``Fair Care for
Vietnam Veterans Act''.
(b) Additional Diseases.--Section 1116(a)(2), as amended by section
9109 of the William M. (Mac) Thornberry National Defense Authorization
Act for Fiscal Year 2021 (Public Law 116-283), is further amended by
adding at the end the following new subparagraphs:
``(L) Hypertension.
``(M) Monoclonal gammopathy of undetermined
significance.''.
SEC. 405. IMPROVING COMPENSATION FOR DISABILITIES OCCURRING IN PERSIAN
GULF WAR VETERANS.
(a) Reduction in Threshold of Eligibility.--Subsection (a)(1) of
section 1117 is amended by striking ``became manifest--'' and all that
follows through the period at the end and inserting ``became manifest
to any degree at any time.''.
(b) Permanent Extension of Period of Eligibility.--Such section is
further amended--
(1) by striking subsection (b);
(2) by redesignating subsections (c) and (d) as subsections
(b) and (c), respectively; and
(3) in subsection (a)(2)(C), by striking ``under subsection
(d)'' and inserting ``under subsection (c)''.
(c) Establishing Singular Disability-based Questionnaire.--Such
section is further amended by inserting after subsection (c) (as
redesignated by subsection (b)) the following new subsection (d):
``(d) If a Persian Gulf veteran at a medical facility of the
Department presents with any one symptom associated with Gulf War
Illness, the Secretary shall ensure that health care personnel of the
Department use a disability benefits questionnaire, or successor
questionnaire, designed to identify Gulf War Illness, in addition to
any other diagnostic actions the personnel determine appropriate.''.
(d) Expansion of Definition of Persian Gulf Veteran.--Subsection
(f) of such section is amended by inserting ``, Afghanistan, Israel,
Egypt, Turkey, Syria, or Jordan,'' after ``operations''.
(e) Training.--Such section is further amended by adding at the end
the following new subsection:
``(i)(1) The Secretary shall take such actions as may be necessary
to ensure that health care personnel of the Department are
appropriately trained to effectively carry out this section.
``(2) Not less frequently than once each year, the Secretary shall
submit to Congress a report on the actions taken by the Secretary to
carry out paragraph (1).''.
SEC. 406. PRESUMPTION OF SERVICE CONNECTION FOR CERTAIN DISEASES
ASSOCIATED WITH EXPOSURE TO BURN PITS AND OTHER TOXINS.
(a) Short Title.--This section may be cited as the ``Presumptive
Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act''.
(b) In General.--Subchapter II of chapter 11, as amended by section
302, is further amended by inserting after section 1119 the following
new section:
``Sec. 1120. Presumption of service connection for certain diseases
associated with exposure to burn pits and other toxins
``(a) Presumption of Service Connection.--For the purposes of
section 1110 of this title, and subject to section 1113 of this title,
a disease specified in subsection (b) becoming manifest in a covered
veteran shall be considered to have been incurred in or aggravated
during active military, naval, air, or space service, notwithstanding
that there is no record of evidence of such disease during the period
of such service.
``(b) Diseases Specified.--The diseases specified in this
subsection are the following:
``(1) Asthma that was diagnosed after service of the
covered veteran as specified in subsection (c).
``(2) The following types of cancer:
``(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.
``(K) Pancreatic cancer.
``(3) Chronic bronchitis.
``(4) Chronic obstructive pulmonary disease.
``(5) Constrictive bronchiolitis or obliterative
bronchiolitis.
``(6) Emphysema.
``(7) Granulomatous disease.
``(8) Interstitial lung disease.
``(9) Pleuritis.
``(10) Pulmonary fibrosis.
``(11) Sarcoidosis.
``(12) Chronic sinusitis.
``(13) Chronic rhinitis.
``(14) Glioblastoma.
``(15) Any other disease for which the Secretary
determines, pursuant to regulations prescribed under subchapter
VII that a presumption of service connection is warranted based
on a positive association with a substance, chemical, or
airborne hazard identified in the list under section 1119(b)(2)
of this title.
``(c) Covered Veteran Defined.--In this section, the term `covered
veteran' has the meaning given that term in section 1119(c) of this
title.''.
(c) Conforming Amendment.--Section 1113 is amended by striking ``or
1118'' each place it appears and inserting ``1118, or 1120''.
TITLE V--RESEARCH MATTERS
SEC. 501. INTERAGENCY WORKING GROUP ON TOXIC EXPOSURE RESEARCH.
(a) In General.--Subchapter II of chapter 73 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7330D. Interagency working group on toxic exposure research
``(a) Establishment.--(1) The Secretary shall establish the Toxic
Exposure Research Working Group (in this section referred to as the
`Working Group').
``(2) The Working Group shall consist of employees, selected by the
Secretary, of the following:
``(A) The Department.
``(B) The Department of Defense.
``(C) The Department of Health and Human Services.
``(D) The Environmental Protection Agency.
``(E) Other Federal entities involved in research
activities regarding the health consequences of toxic exposures
experienced during active military, naval, air, or space
service.
``(b) Functions.--The Working Group shall perform the following
functions:
``(1) Identify collaborative research activities and
resources available among entities represented by members of
the Working Group to conduct such collaborative research
activities.
``(2) Develop a 5-year strategic plan for Federal entities
represented in the Working Group to carry out collaborative
research activities.
``(c) Reporting.--The Secretary shall submit, to the Committees on
Veterans' Affairs of the Senate and House of Representatives, the
following:
``(1) Not later than one year after the date of the
enactment of the Act, a report on the establishment of the
Working Group under subsection (a).
``(2) Not later than two years after the date of enactment
of the Act, a report containing the collaborative research
activities identified, and the Strategic Plan developed, by the
Working Group, under subsection (b).
``(3) Annually during the 5-year period covered by the
strategic plan under subsection (b), a progress reports on
implementation of the Strategic Plan under subsection (b).
``(d) Termination.--The Working Group shall terminate after
submitting the final report under subsection (c).
``(e) Definitions.--For purposes of this section--
``(1) The term `Act' means the Honoring our Promise to
Address Comprehensive Toxics Act of 2021.
``(2) The term `collaborative research activity' means a
research activity--
``(A) conducted by an entity represented by a
member of the Working Group;
``(B) funded by the Federal Government; and
``(C) regarding the health consequences of toxic
exposures experienced during active military, naval,
air, or space service.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such subchapter is amended by inserting after the item relating to
section 7330C the following new item:
``7330D. Interagency working group on toxic exposure research.''.
(c) Implementation.--The Secretary of Veterans Affairs shall
establish the Working Group under section 7330D of such title, as added
by subsection (a), not later than one year after the date of the
enactment of this Act.
SEC. 502. DATA COLLECTION, ANALYSIS, AND REPORT ON TREATMENT OF
VETERANS FOR ILLNESSES RELATED TO TOXIC EXPOSURE.
(a) In General.--The Secretary of Veterans Affairs shall compile
and analyze, on a continuous basis, all clinical data that--
(1) is obtained by the Secretary in connection with
hospital care (including mental health services and
counseling), medical services, or nursing home care furnished
to a veteran for an illness under section 1710(a)(2)(F) of
title 38, United States Code, as amended by section 102; and
(2) is likely to be scientifically useful, as determined by
the Secretary, in determining whether a positive association
exists between the illness of the veteran and a toxic exposure.
(b) Consent of Patients.--The Secretary shall ensure that the
compilation and analysis of the clinical data of a veteran under
subsection (a) shall be conducted, and such data shall be used, in a
manner that is consistent with the informed consent of the veteran and
in compliance with all applicable Federal law.
(c) Annual Report.--Not later than one year after the date of the
enactment of this Act, and annually thereafter, the Secretary shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report containing--
(1) any data compiled under subsection (a);
(2) an analysis of any such data;
(3) a description of the types and incidences of illnesses
identified by the Secretary pursuant to such subsection;
(4) an explanation by the Secretary for the incidence of
such illnesses and such alternate explanations for the
incidence of such illnesses as the Secretary may consider
reasonable; and
(5) a description of the views of the Secretary regarding
the scientific validity of drawing conclusions from the
incidence of such illnesses, as evidenced by the data compiled
under subsection (a), regarding the existence of a positive
association between such illness and a toxic exposure.
(d) Definitions.--In this section:
(1) The term ``toxic exposure'' has the meaning given that
term in section 101 of title 38, United States Code.
(2) The term ``illness'' has the meaning given that term in
section 1171 of such title, as added by section 202.
SEC. 503. STUDIES RELATED TO VETERANS WHO SERVED IN SOUTHWEST ASIA AND
CERTAIN OTHER LOCATIONS.
(a) Analysis on Mortality in Covered Veterans.--
(1) Analysis.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall conduct an updated analysis of total and respiratory
disease mortality in covered veterans.
(2) Elements.--The analysis under paragraph (1) shall
include, to the extent practicable, the following:
(A) Metrics of airborne exposures.
(B) The location and timing of any deployments of
the veteran.
(C) The military occupational specialty of the
veteran.
(D) The Armed Force in which the veteran served.
(E) The preexisting health status of the veteran,
including with respect to asthma.
(F) Such personal information of the veteran as the
Secretary may consider relevant, 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 conduct an
epidemiological study of covered veterans that involves--
(1) the use of improved spatio-temporal estimates of
ambient air pollution exposures that leverage advances in
retrospective exposure assessment; and
(2) the collection of detailed information on the covered
veterans studied through medical records, administrative data,
and other existing sources, including, with respect to the
covered veterans--
(A) personal information, 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.--
(1) Study.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall conduct a toxicology
study, to include variability, to replicate toxic exposures of
healthy, young members of the Armed Forces, as well as
potentially susceptible members, with preexisting health
conditions.
(2) Elements.--The study under paragraph (1) shall
include--
(A) an analysis of results for mechanistic markers
and clinically relevant outcomes; and
(B) a validation of any serum, tissue, or other
biomarkers of toxic exposure, susceptibility, or effect
with respect to the subjects of the study.
(d) Covered Veteran Defined.--In this section, the term ``covered
veteran'' has the meaning given that term in section 1119(c) of title
38, United States Code, as added by section 302.
SEC. 504. STUDY ON HEALTH TRENDS OF POST 9/11 VETERANS.
(a) Study.--The Secretary of Veterans Affairs shall conduct an
epidemiological study on the health trends of veterans who served in
the Armed Forces after September 11, 2001.
(b) Elements.--The study under subsection (a) shall assess, with
respect to each veteran included in the study, the following:
(1) The race and ethnicity of the veteran.
(2) The age of the veteran.
(3) The period of service and length of service of the
veteran in the Armed Forces.
(4) Any military occupational speciality of the veteran.
(5) The gender of the veteran.
(6) The disability status of the veteran.
(c) Report.--Not later than two years after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate a
report on the study under subsection (a).
SEC. 505. STUDY ON CANCER RATES AMONG VETERANS.
(a) Study.--The Secretary of Veterans Affairs shall conduct a study
on the incidence of cancer in veterans, to determine trends in the
rates of the incidence of cancer in veterans, and on available early
detection diagnostics, to determine the feasibility and advisability of
including such diagnostics as part of the health care furnished to
veterans by the Secretary.
(b) Elements.--The study under subsection (a) shall assess, with
respect to each veteran included in the study, the following:
(1) The race and ethnicity of the veteran.
(2) The age of the veteran.
(3) The period of service and length of service of the
veteran in the Armed Forces.
(4) Any military occupational speciality of the veteran.
(5) The gender of the veteran.
(6) Any type of cancer that the veteran has.
(c) Report.--Not later than two years after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate a
report on the study under subsection (a).
SEC. 506. STUDY ON FEASIBILITY AND ADVISABILITY OF FURNISHING HOSPITAL
CARE AND MEDICAL SERVICES TO DEPENDENTS OF VETERANS WHO
PARTICIPATED IN TOXIC EXPOSURE RISK ACTIVITIES.
(a) Study.--The Secretary of Veterans Affairs shall conduct a study
on the feasibility and advisability of furnishing hospital care and
medical services to qualifying dependents of veterans described in
section 1710(e)(1)(G) of title 38, United States Code, as added by
section 103(a)(1), for any illness determined by the Secretary to be
connected to a toxic exposure risk activity carried out by the veteran,
as determined by the Secretary, notwithstanding that there is
insufficient medical evidence to conclude that such illness is
attributable to such activity.
(b) Elements.--The study under subsection (a) shall include--
(1) an assessment of the impact of furnishing hospital care
and medical services to qualifying dependents as described in
such subsection on the ability of the Department of Veterans
Affairs to furnish hospital care and medical services to
veterans;
(2) an assessment of the potential cost of furnishing
hospital care and medical services to qualifying dependents as
described in such subsection;
(3) an estimate of the resources required to furnish such
care and services;
(4) an assessment of any stress or other effect furnishing
such care and services would have on the claims and appeals
system of the Department;
(5) an estimate of the number of qualifying dependents who
would be eligible for such care and services; and
(6) an assessment of the feasibility of adjudicating claims
for such care and services.
(c) Phased-In Application.--In conducting the study under
subsection (a), the Secretary shall assess the feasibility and
advisability of phasing in the furnishing of hospital care and medical
services to qualifying dependents described in such subsection by the
decade in which such toxic exposure risk activity occurred, starting
with the most recent decade.
(d) Review of Toxic Exposure Cases Regarding Liability of
Department of Defense.--In conducting the study under subsection (a),
the Secretary shall--
(1) review known cases of toxic exposure on military
installations of the Department of Defense;
(2) analyze the liability of the Department of Defense in
each such case; and
(3) assess whether the Secretary of Defense should provide
care and services relating to such toxic exposures under the
TRICARE program.
(e) Report.--Not later than two years after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
on the study conducted under subsection (a).
(f) Definitions.--In this section:
(1) The terms ``hospital care'' and ``medical services''
have the meanings given those terms in section 1701 of title
38, United States Code.
(2) The term ``illness'' has the meaning given that term in
section 1171 of such title, as added by section 202.
(3) The term ``qualifying dependent'' means--
(A) a dependent of a veteran described in section
1710(e)(1)(G) of title 38, United States Code, as added
by section 104(a)(1), who resided with the veteran
during the period in which, and on the installation at
which, the veteran participated in a toxic exposure
risk activity;
(B) an individual who was in utero of such a
veteran or other qualifying dependent when the veteran
participated in a toxic exposure risk activity; or
(C) a dependent of such a veteran who is not
described in subparagraph (A) or (B) but who may have
an illness that is connected to the toxic exposure risk
activity of the veteran, as determined by the
Secretary.
(4) The term ``toxic exposure'' has the meaning given that
term in section 101 of such title, as added by section 102(b).
(5) The term ``toxic exposure risk activity'' has the
meaning given that term in section 1710(e)(4) of such title, as
added by section 102(c).
(6) The term ``TRICARE program'' has the meaning given that
term in section 1072 of such title.
SEC. 507. STUDY ON HEALTH EFFECTS OF WASTE RELATED TO MANHATTAN PROJECT
ON CERTAIN VETERANS.
(a) Study.--The Secretary of Veterans Affairs shall conduct a study
on the health trends of veterans who, while serving in the active
military, naval, air, or space service--
(1) participated in activities relating to the Manhattan
Project (including activities relating to covered waste) in
connection with such service; or
(2) resided at or near, as determined by the Secretary, the
locations described in subsection (b).
(b) Covered Locations.--The locations described in this subsection
are the following locations in the county of St. Louis, Missouri:
(1) Coldwater Creek.
(2) The St. Louis Airport Site.
(3) The West Lake Landfill.
(4) Any other location in the county of St. Louis, Missouri
that is proximate to covered waste, as determined by the
Secretary.
(c) Elements.--The study under subsection (a) shall assess, with
respect to each veteran included in the study, the following:
(1) The age, gender, and race of the veteran.
(2) The period and location of exposure to covered waste.
(3) Any type of cancer, or other illness associated with
toxic exposure, that the veteran has.
(4) A comparison of the overall health condition of the
veteran, including any illness of the veteran identified
pursuant to paragraph (3), with the overall health condition of
past and present civilian populations residing at the same
location of exposure.
(d) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate a
report on the study under subsection (a).
(e) Definitions.--In this section:
(1) The term ``covered waste'' means any waste arising from
activities carried out in connection with the Manhattan
Project.
(2) The term ``illness'' has the meaning given that term in
section 1171 of title 38, United States Code, as added by
section 202.
(3) The term ``toxic exposure'' has the meaning given that
term in section 101 of such title, as added by section 102(b).
SEC. 508. STUDY ON TOXIC EXPOSURE AND MENTAL HEALTH OUTCOMES.
(a) Study Required.--The Secretary of the Department of Veterans
Affairs shall enter into an agreement with the National Academies of
Sciences, Engineering, and Medicine for the conduct of a study of
veterans to assess possible relationships between toxic exposures
experienced during service in the Armed Forces and mental health
outcomes, including chronic multisymptom illness, traumatic brain
injury, post-traumatic stress disorder, depression, psychosis, suicide
attempts, and suicide deaths.
(b) Elements.--For each veteran included in the study under
subsection (a), the following information shall be collected and
assessed:
(1) Age.
(2) Gender.
(3) Race and ethnicity.
(4) Period and length of service in the Armed Forces.
(5) History of toxic exposure during service in the Armed
Forces.
(6) Any diagnosis of chronic multisymptom illness.
(7) Any diagnosis of a mental health or cognitive disorder.
(8) Any history of suicide attempt or suidcidality.
(9) If the veteran died by suicide.
(c) Report.--Not later than two years after the date after the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a report
containing the findings of the study conducted under subsection (a).
SEC. 509. STUDY ON VETERANS IN TERRITORIES OF THE UNITED STATES.
(a) GAO Study.--
(1) In general.--The Comptroller General of the United
States shall conduct a study on the state of access and
barriers to benefits and services furnished under laws
administered by the Secretary of Veterans Affairs to veterans
in Territories of the United States, including deficits in the
availability and accessibility of such benefits and services
compared to veterans elsewhere in the United States.
(2) Elements.--The study under paragraph (1) shall
include--
(A) the number of veterans in each Territory of the
United States;
(B) the number of veterans in each Territory who
are enrolled in the system of annual patient enrollment
of the Department of Veterans Affairs under section
1705(a) of title 38, United States Code;
(C) the number of veterans in each Territory who
are eligible for services under section 1710 of such
title but who are not enrolled as described in
subparagraph (B);
(D) a detailed description of obstacles facing
veterans in each Territory in accessing health care
services, including those involving the availability of
such services to veterans in the Territory in which the
veterans reside, and the distance required of veterans
to journey to receive services at a regional medical
center of the Veterans Health Administration, a
community-based outpatient clinic, or other full-
service medical facility of the Department, or death
center, respectively;
(E) a detailed description of obstacles facing
veterans in each Territory in accessing readjustment
counseling services, including those involving the
availability of such services to veterans in the
Territory in which the veterans reside, and the
distance required of veterans to journey to receive
services at a readjustment counseling services center
of the Department;
(F) a detailed description of obstacles facing
veterans in each Territory in accessing other veterans
benefits, including those involving the availability of
benefits and services to veterans in the Territory in
which the veterans reside, and the distance required of
the veterans to journey to the nearest office of the
Veterans Benefits Administration;
(G) an analysis of the staffing and recordkeeping
levels and quality of the offices of the Department
charged with serving veterans in the Territories,
including the availability of the full- and part-time
staff of each office to the veterans they are charged
with serving, and the continuity of care provided by
such staff to such veterans;
(H) an analysis of the availability of the Veterans
Community Care Program established under section 1703
of title 38, United States Code, to veterans in each
Territory;
(I) an analysis of the economic and health
consequences for veterans in each Territory resulting
from obstacles to accessing adequate assistance and
health care at facilities of the Department;
(J) an analysis of the access to assistance and
health care provided to veterans in the aftermath of
major disasters declared in each of the Territories
since September 4, 2017; and
(K) recommendations for improving access of
veterans in the Territories to benefits and services
furnished by the Secretary, and reducing barriers and
deficits in the availability and accessibility of such
benefits and services compared to veterans elsewhere in
the United States.
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to Congress a final report setting forth the results of
the study conducted under subsection (a), including the recommendations
developed under paragraph (2)(K) of such subsection.
(c) Territory Defined.--In this section, the term ``Territory''
includes American Samoa, the Commonwealth of the Northern Marianas
Islands, Guam, Puerto Rico, and the Virgin Islands.
SEC. 510. DEPARTMENT OF VETERANS AFFAIRS PUBLIC WEBSITE FOR TOXIC
EXPOSURE RESEARCH.
(a) Website.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
establish, and maintain thereafter, a publically accessible internet
website of the Department of Veterans Affairs that serves as a
clearinghouse for the publication of all toxic exposure research
carried out or funded by the executive branch of the Federal
Government.
(b) Relation to War Related Illness and Injury Study Center.--The
website developed and maintained under subsection (a) shall be housed
under the website of the War Related Illness and Injury Study Center of
the Department of Veterans Affairs, or successor center.
(c) Coordination.--In carrying out subsection (a), the Secretary
shall coordinate with--
(1) the heads of each Federal department or agency carrying
out or funding toxic exposure research;
(2) the War Related Illness and Injury Study Center of the
Department of Veterans Affairs, or successor center; and
(3) any working group of the Department of Veterans Affairs
or other similar entity responsible for coordinating toxic
exposure research.
(d) Definitions.--In this section:
(1) The term ``toxic exposure'' has the meaning given that
term in section 101 of title 38, United States Code, as added
by section 102(b).
(2) The term ``toxic exposure research'' means research on
the health consequences of toxic exposures experienced during
service in the Armed Forces.
SEC. 511. BIENNIAL REPORT ON HEALTH EFFECTS OF JET FUELS USED BY ARMED
FORCES.
Not later than one year after the date of the enactment of this
Act, and biennially thereafter during the subsequent eight-year period,
the Secretary of Veterans Affairs shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate, and
make publicly available, a report that includes--
(1) a discussion of the effect of various different types
of jet fuels used by the Armed Forces on the health of
individuals by length of exposure;
(2) an identification of the immediate symptoms of jet fuel
exposure that may indicate future health risks;
(3) a chronology of health safeguards implemented by the
Armed Forces intended to reduce the exposure of members of the
Armed Foces to jet fuel; and
(4) an identification of any areas relating to jet fuel
exposure about which new research needs to be conducted.
TITLE VI--IMPROVEMENT OF RESOURCES AND TRAINING REGARDING TOXIC-EXPOSED
VETERANS
SEC. 601. SHORT TITLE; DEFINITIONS.
(a) Short Title.--This title may be cited as the ``Toxic Exposure
in the American Military Act'' or the ``TEAM Act''.
(b) Definitions.--In this title, the terms ``active military,
naval, air, or space service'', ``toxic exposure'', and ``toxic-exposed
veteran'' have the meanings given those terms in section 101 of title
38, United States Code.
SEC. 602. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF VETERANS
AFFAIRS FOR TOXIC-EXPOSED VETERANS AND OUTREACH PROGRAM
FOR SUCH VETERANS AND CAREGIVERS AND SURVIVORS OF SUCH
VETERANS.
(a) Publication of List of Resources.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter, the
Secretary of Veterans Affairs shall publish a list of resources
of the Department of Veterans Affairs for--
(A) toxic-exposed veterans, including with respect
to--
(i) disability compensation under chapter
11 of title 38, United States Code; and
(ii) hospital care, medical services, and
nursing home care under section 1710(a)(2)(F)
of such title;
(B) caregivers of toxic-exposed veterans who are
participating in the program of comprehensive
assistance for family caregivers under section 1720G(a)
of such title; and
(C) survivors of toxic-exposed veterans who are
receiving death benefits under the laws administered by
the Secretary.
(2) Update.--The Secretary shall periodically update the
list published under paragraph (1).
(3) Languages.--The Secretary shall publish the list under
paragraph (1) in languages including the following:
(A) English.
(B) Spanish.
(C) Chinese.
(D) The seven other most commonly spoken languages
in the United States.
(b) Outreach.--The Secretary shall develop, with input from the
community, an informative outreach program for veterans on illnesses
that may be related to toxic exposure, including outreach with respect
to benefits and support programs. Information distributed under the
outreach program shall be treated as a fact sheet of the Department of
Veterans Affairs for purposes of making the information available in
multiple languages pursuant to section 2 of the Veterans and Family
Information Act (Public Law 117-62; 38 U.S.C. 6303 note).
(c) Veterans Organizations.--To the extent practicable, the
Secretary shall share with national veterans service organizations and
other veterans groups, including such organizations and groups that
improve access by veterans to health care and benefits, the list of
resources under subsection (a) and the outreach program under
subsection (b).
SEC. 603. INCORPORATION OF TOXIC EXPOSURE QUESTIONNAIRE DURING PRIMARY
CARE APPOINTMENTS.
(a) In General.--The Secretary of Veterans Affairs shall
incorporate a clinical questionnaire to help determine potential toxic
exposures during active military, naval, air, or space service as part
of the initial screening conducted for an appointment of a veteran with
a primary care provider of the Department of Veterans Affairs to
improve understanding by the Department of toxic exposures of veterans
while serving in the Armed Forces.
(b) Determination of Questions.--The questions included in the
questionnaire required under subsection (a) shall be determined by the
Secretary with input from medical professionals.
SEC. 604. TRAINING FOR PERSONNEL OF THE DEPARTMENT OF VETERANS AFFAIRS
WITH RESPECT TO TOXIC-EXPOSED VETERANS.
(a) Health Care Personnel.--The Secretary of Veterans Affairs shall
provide to health care personnel of the Department of Veterans Affairs
education and training to identify, treat, and assess the impact on
toxic-exposed veterans of illnesses related to toxic exposure and
inform such personnel of how to ask for additional information from
veterans regarding different toxic exposures.
(b) Benefits Personnel.--
(1) Standard claims processor training curriculum.--
(A) Curriculum.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall
ensure that a standard training curriculum exists for
processors of claims under the laws administered by the
Secretary who review claims for disability benefits
relating to service-connected disabilities based on
toxic exposure, including employees who adjudicate such
claims.
(B) Matters included.--The Secretary shall ensure
that the training under subparagraph (A) includes the
following explanations with respect to claims relating
to toxic exposure:
(i) A lack of a presumption of service
connection is not by itself sufficient to
determine that service connection does not
exist.
(ii) The claims adjudicator shall always
consider whether direct service connection is
applicable and request, as needed, an advisory
medical opinion pursuant to section 1168 of
title 38, United States Code, as added by
section 303.
(iii) The claims adjudicator may review and
consider any record of the claimant in an
exposure tracking record system pursuant to
section 1119 of such title, as added by section
302, but a lack of such information is not by
itself sufficient to determine that such
exposure did not occur or sufficient to deny
the claim.
(C) Provision of training.--The Secretary shall--
(i) provide training under subparagraph (A)
to each employee described in such subparagraph
not less frequently than annually; and
(ii) 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.
(2) Standard medical examiner training curriculum.--
(A) Curriculum.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall
ensure that a standard medical training curriculum
exists for medical providers who conduct examinations
and provide opinions pursuant to section 1168 of title
38, United States Code, as added by section 303,
regardless of whether the provider is an employee of
the Department or a contractor.
(B) Standardized approach.--The Secretary shall
ensure that the curriculum established under
subparagraph (A)--
(i) provides a standardized approach to
conducting and providing examinations and
opinions in accordance with such section 1168;
and
(ii) instructs medical providers to
consider, when conducting an examination or
providing an opinion--
(I) relevant medical and scientific
literature;
(II) the proximity, intensity, and
frequency of exposure of the individual
to the identified toxic exposure;
(III) medically unexplained chronic
multisymptom illnesses; and
(IV) all competent and credible
evidence of record.
SEC. 605. GUIDELINES FOR ACTIVE DUTY MILITARY ON POTENTIAL RISKS AND
PREVENTION OF TOXIC EXPOSURES.
Not later than 90 days after the date of the enactment of this Act,
the Secretary of Defense and the Secretary of Veterans Affairs shall
jointly coordinate and establish guidelines to be used during training
of members of the Armed Forces serving on active duty to provide the
members awareness of the potential risks of toxic exposures and ways to
prevent being exposed during combat.
TITLE VII--REGISTRIES, RECORDS, AND OTHER MATTERS
SEC. 701. REGISTRY OF INDIVIDUALS EXPOSED TO PER- AND POLYFLUOROALKYL
SUBSTANCES ON MILITARY INSTALLATIONS.
(a) Establishment of Registry.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) establish and maintain a registry for eligible
individuals who may have been exposed to per- and
polyfluoroalkyl substances (in this section referred to
as ``PFAS'') due to the environmental release of
aqueous film-forming foam (in this section referred to
as ``AFFF'') on military installations to meet the
requirements of military specification MIL-F-24385F;
(B) include any information in such registry that
the Secretary determines necessary to ascertain and
monitor the health effects of the exposure of members
of the Armed Forces to PFAS associated with AFFF;
(C) develop a public information campaign to inform
eligible individuals about the registry, including how
to register and the benefits of registering; and
(D) periodically notify eligible individuals of
significant developments in the study and treatment of
conditions associated with exposure to PFAS.
(2) Coordination.--The Secretary of Veterans Affairs shall
coordinate with the Secretary of Defense in carrying out
paragraph (1).
(b) Reports.--
(1) Initial report.--Not later than one year after the date
of the enactment of this Act, the Secretary of Defense shall
submit to Congress a report regarding the following:
(A) Sources of PFAS on military installations other
than AFFF.
(B) Any recommendation of the Secretary regarding
whether to expand eligibility for the registry to
individuals exposed to sources of PFAS described in
subparagraph (A).
(2) Interim report.--Not later than two years after the
date on which the registry under subsection (a) is established,
the Secretary of Veterans Affairs shall submit to Congress an
initial report containing the following:
(A) An assessment of the effectiveness of actions
taken by the Secretary of Veterans Affairs and the
Secretary of Defense to collect and maintain
information on the health effects of exposure to PFAS.
(B) Recommendations to improve the collection and
maintenance of such information.
(C) Using established and previously published
epidemiological studies, recommendations regarding the
most effective and prudent means of addressing the
medical needs of eligible individuals with respect to
exposure to PFAS.
(3) Followup report.--Not later than five years after
submitting the initial report under paragraph (1), the
Secretary of Veterans Affairs shall submit to Congress a
followup report containing the following:
(A) An update to the initial report submitted under
paragraph (1).
(B) An assessment of whether and to what degree the
content of the registry established under subsection
(a) is current and scientifically up to date.
(4) Independent scientific organization.--The Secretary of
Veterans Affairs shall enter into an agreement with an
independent scientific organization to prepare the reports
under paragraphs (1) and (2).
(c) Recommendations for Additional Exposures To Be Included.--Not
later than five years after the date of the enactment of this Act, and
every five years thereafter, the Secretary of Veterans Affairs, in
consultation with the Secretary of Defense and the Administrator of the
Environmental Protection Agency, shall submit to Congress
recommendations for additional chemicals with respect to which
individuals exposed to such chemicals should be included in the
registry established under subsection (a).
(d) Eligible Individual Defined.--In this section, the term
``eligible individual'' means any individual who, on or after a date
specified by the Secretary of Veterans Affairs through regulations,
served or is serving in the Armed Forces at a military installation
where AFFF was used or at another location of the Department of Defense
where AFFF was used.
SEC. 702. FORT MCCLELLAN HEALTH REGISTRY.
(a) Establishment.--The Secretary of Veterans Affairs shall
establish and maintain a special record to be known as the Fort
McClellan Health Registry (in this section referred to as the
``Registry'').
(b) Contents.--Except as provided in subsection (c), the Registry
shall include the following information:
(1) A list containing the name of each individual who,
while serving as a member of the Armed Forces, was stationed at
Fort McClellan, Alabama, at any time during the period
beginning January 1, 1935, and ending on May 20, 1999, and
who--
(A) applies for care or services from the
Department of Veterans Affairs under chapter 17 of
title 38, United States Code;
(B) files a claim for compensation under chapter 11
of such title on the basis of any disability which may
be associated with such service;
(C) dies and is survived by a spouse, child, or
parent who files a claim for dependency and indemnity
compensation under chapter 13 of such title on the
basis of such service;
(D) requests from the Secretary a health
examination under subsection (d); or
(E) receives from the Secretary a health
examination similar to the health examination referred
to in subparagraph (D) and requests inclusion in the
Registry.
(2) Relevant medical data relating to the health status of,
and other information that the Secretary considers relevant and
appropriate with respect to, each individual described in
paragraph (1) who--
(A) grants to the Secretary permission to include
such information in the Registry; or
(B) at the time the individual is listed in the
Registry, is deceased.
(c) Individuals Submitting Claims or Making Requests Before Date of
Enactment.--If in the case of an individual described in subsection
(b)(1) the application, claim, or request referred to in such
subsection was submitted, filed, or made before the date of the
enactment of this Act, the Secretary shall, to the extent feasible,
include in the Registry such individual's name and the data and
information, if any, described in subsection (b)(2) relating to the
individual.
(d) Examinations.--Upon the request of a veteran who was stationed
at Fort McClellan, Alabama, at any time during the period beginning
January 1, 1935, and ending on May 20, 1999, the Secretary shall
provide the veteran with a health examination (including any
appropriate diagnostic tests) and consultation and counseling with
respect to the results of the examination and the tests.
(e) Outreach.--
(1) Ongoing outreach to individuals listed in registry.--
The Secretary shall, from time to time, notify individuals
listed in the Registry of significant developments in research
on the health consequences of potential exposure to a toxic
substance or environmental hazard related to service at Fort
McClellan.
(2) Examination outreach.--The Secretary shall carry out
appropriate outreach activities with respect to the provision
of any health examinations (including any diagnostic tests) and
consultation and counseling services under subsection (d).
(f) Consultation.--The Secretary of Veterans Affairs shall consult
with the Secretary of Defense to acquire information maintained by the
Secretary of Defense that the Secretary of Veterans Affairs considers
necessary to establish and maintain the Registry.
SEC. 703. INDEPENDENT STUDY ON INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.
(a) In General.--Not later than 60 days after the date of the
enactment of this Act, the Secretary of Defense shall enter into a
contract with an independent research entity described in subsection
(b) to carry out a comprehensive study of the development of the
Individual Longitudinal Exposure Record, or successor system, to
determine--
(1) the quality of the location data, occupational and
environmental exposure data, and health surveillance data; and
(2) whether a member of the Armed Forces can be reasonably
assured that any toxic exposure they experience during service
in the Armed Forces will be accurately reflected in the record
of the member in such Individual Longitudinal Exposure Record.
(b) Independent Research Entity.--The entity described in this
subsection is an independent research entity that is a not-for-profit
entity or a federally funded research and development center with
appropriate expertise and analytical capability to carry out the study
required under subsection (a).
(c) Toxic Exposure Defined.--In this section, the term ``toxic
exposure'' has the meaning given that term in section 101(37) of title
38, United States Code, as added by section 102(b).
SEC. 704. BIANNUAL REPORT ON INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.
(a) In General.--Not later than one year after the date on which
the Individual Longitudinal Exposure Record, or successor system,
achieves full operation capability, as determined by the Secretary of
Defense, and every 180 days thereafter, the Secretary of Defense, in
consultation with the Secretary of Veterans Affairs, shall submit to
the appropriate committees of Congress a report on--
(1) the data quality of the databases of the Department of
Defense that provide the information presented in such
Individual Longitudinal Exposure Record; and
(2) the usefulness of such Individual Longitudinal Exposure
Record in supporting members of the Armed Forces and veterans
in receiving health care and benefits from the Department of
Defense and the Department of Veterans Affairs.
(b) Elements.--Each report required by subsection (a) shall
include, for the period covered by the report, the following:
(1) An identification of toxic exposure events that may not
be fully captured by the current systems of the Department of
Defense for environmental, occupational, and health monitoring,
and recommendations for how to improve those systems.
(2) An analysis of the quality of the location data used by
the Department of Defense in determining toxic exposures of
members of the Armed Forces and veterans, and recommendations
for how to improve the quality of that location data if
necessary.
(c) Report on National Guard Use of ILER.--Not later than one year
after the date of the enactment of this Act, the Secretary of Defense
shall submit to the appropriate committees of Congress a report on the
feasibility of modifying the Individual Longitudinal Exposure Record to
ensure that a member of the National Guard who is deployed in the
United States in connection with a natural disaster, without regard to
duty status (including any duty under title 10 or title 32, United
States Code, or State active duty), may record information regarding a
suspected exposure by the member to toxic substances during such
deployment.
(d) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Armed Services and the
Committee on Veterans' Affairs of the Senate; and
(B) the Committee on Armed Services and the
Committee on Veterans' Affairs of the House of
Representatives.
(2) Toxic exposure.--The term ``toxic exposure'' has the
meaning given that term in section 101(37) of title 38, United
States Code, as added by section 102(b).
SEC. 705. CORRECTION OF EXPOSURE RECORDS BY MEMBERS OF THE ARMED FORCES
AND VETERANS.
(a) In General.--The Secretary of Defense shall provide a means for
members of the Armed Forces and veterans to update their records as
necessary to reflect a toxic exposure by such member or veteran in the
Individual Longitudinal Exposure Record, or successor system.
(b) Evidence.--
(1) Provision of evidence.--To update a record under
subsection (a), a member of the Armed Forces or veteran, as the
case may be, shall provide such evidence as the Secretary of
Defense considers necessary.
(2) Benefit of the doubt.--In reviewing evidence provided
under paragraph (1), the Secretary of Defense shall give the
benefit of the doubt to the member of the Armed Forces or
veteran who provided the evidence, as the case may be, in a
manner that is equivalent to the benefit of the doubt required
under section 5107(b) of title 38, United States Code.
(3) Regulations.--The Secretary of Defense shall prescribe
by regulation the evidence considered necessary under paragraph
(1).
(c) Toxic Exposure Defined.--In this section, the term ``toxic
exposure'' has the meaning given that term in section 101(37) of title
38, United States Code, as added by section 102(b).
SEC. 706. FEDERAL CAUSE OF ACTION RELATING TO WATER AT CAMP LEJEUNE,
NORTH CAROLINA.
(a) In General.--An individual, including a veteran (as defined in
section 101 of title 38, United States Code), or the legal
representative of such an individual, who resided, worked, or was
otherwise exposed (including in utero exposure) for not less than 30
days during the period beginning on August 1, 1953, and ending on
December 31, 1987, to water at Camp Lejeune, North Carolina, that was
supplied by, or on behalf of, the United States may bring an action in
the United States District Court for the Eastern District of North
Carolina to obtain appropriate relief for harm that was caused by
exposure to the water at Camp Lejeune.
(b) Burdens and Standard of Proof.--
(1) In general.--The burden of proof shall be on the party
filing the action to show one or more relationships between the
water at Camp Lejeune and the harm.
(2) Standards.--To meet the burden of proof described in
paragraph (1), a party shall produce evidence showing that the
relationship between exposure to the water at Camp Lejeune and
the harm is--
(A) sufficient to conclude that a causal
relationship exists; or
(B) sufficient to conclude that a causal
relationship is at least as likely as not.
(c) Exclusive Jurisdiction and Venue.--The United States District
Court for the Eastern District of North Carolina shall have exclusive
jurisdiction over any action filed under subsection (a), and shall be
the exclusive venue for such an action. Nothing in this subsection
shall impair the right of any party to a trial by jury.
(d) Exclusive Remedy.--
(1) In general.--An individual, or legal representative of
an individual, who brings an action under this section for a
harm described in subsection (a), including a latent disease,
may not thereafter bring a tort action against the United
States for such harm pursuant to any other law.
(2) Health and disability benefits relating to water
exposure.--Any award made to an individual, or legal
representative of an individual, under this section shall be
offset by the amount of any disability award, payment, or
benefit provided to the individual, or legal representative--
(A) under--
(i) any program under the laws administered
by the Secretary of Veterans Affairs;
(ii) the Medicare program under title XVIII
of the Social Security Act (42 U.S.C. 1395 et
seq.); or
(iii) the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et
seq.); and
(B) in connection with health care or a disability
relating to exposure to the water at Camp Lejeune.
(e) Immunity Limitation.--The United States may not assert any
claim to immunity in an action under this section that would otherwise
be available under section 2680(a) of title 28, United States Code.
(f) No Punitive Damages.--Punitive damages may not be awarded in
any action under this section.
(g) Disposition by Federal Agency Required.--An individual may not
bring an action under this section before complying with section 2675
of title 28, United States Code.
(h) Exception for Combatant Activities.--This section does not
apply to any claim or action arising out of the combatant activities of
the Armed Forces.
(i) Applicability; Period for Filing.--
(1) Applicability.--This section shall apply only to a
claim accruing before the date of enactment of this Act.
(2) Statute of limitations.--A claim in an action under
this section may not be commenced after the later of--
(A) the date that is two years after the date of
enactment of this Act; or
(B) the date that is 180 days after the date on
which the claim is denied under section 2675 of title
28, United States Code.
(3) Inapplicability of other limitations.--Any applicable
statute of repose or statute of limitations, other than under
paragraph (2), shall not apply to a claim under this section.
SEC. 707. VETERANS TOXIC EXPOSURES FUND.
Chapter 3 is amended by adding at the end the following new
section:
``Sec. 324. Veterans Toxic Exposures Fund
``(a) Establishment.--There is hereby established in the Treasury
of the United States an account to be known as the ``Veterans Toxic
Exposures Fund'' (the ``Fund''), to be administered through the
Department of Veterans Affairs, to provide for investment in the
delivery of veterans' health care, research, and benefits associated
with hazardous exposure in service.
``(b) Authorization of Appropriations.--There is authorized to be
appropriated to the Fund for fiscal year 2023 and each subsequent
fiscal year such sums as are necessary to increase funding, over the
fiscal year 2021 level for the Veterans Health Administration of the
Department of Veterans Affairs, for any expenses incident to the
delivery of veterans' health care and benefits associated with exposure
to environmental hazards in service, including administrative expenses,
such as claims processing and appeals, and for medical research related
to hazardous exposures. Amounts appropriated to the Fund pursuant to
this subsection shall be counted as direct spending under the
Congressional Budget and Impoundment Control Act of 1974 and any other
Act.
``(c) Estimates for Congressional Consideration.--The Secretary
shall include in documents submitted to Congress in support of the
President's budget submitted pursuant to section 1105 of title 31,
United States Code, detailed estimates of the sums described in
subsection (b) for the applicable fiscal year.
``(d) Procedures for Estimates.--The Secretary, after consultation
with the Committees on Appropriations of the House of Representatives
and the Senate, may establish policies and procedures for developing
the annual detailed estimates required in subsection (c).''.
SEC. 708. AUTHORIZATION OF ELECTRONIC NOTICE IN CLAIMS UNDER LAWS
ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS.
Title 38, United States Code, is amended as follows:
(1) By striking section 5100 and inserting the following:
``Sec. 5100. Definitions
``In this chapter:
``(1) The term `claimant' means any individual applying
for, or submitting a claim for, any benefit under the laws
administered by the Secretary.
``(2) The term `notice' means a communication issued
through means (including electronic means) prescribed by the
Secretary.''.
(2) In section 5104, by adding at the end the following new
subsection:
``(c) The Secretary may provide notice under subsection (a)
electronically if a claimant (or the claimant's representative) elects
to receive such notice electronically. A claimant (or the claimant's
representative) may revoke such an election at any time, by means
prescribed by the Secretary.
``(d) The Secretary shall annually--
``(1) solicit recommendations from stakeholders on how to
improve notice under this section; and
``(2) publish such recommendations on a publicly available
website of the Department.''.
(3) In section 5104B(c), in the matter preceding paragraph
(1) by striking ``in writing'' and inserting ``to the claimant
(and any representative of such claimant)''.
(4) In section 7104--
(A) in the heading, by adding ``; decisions;
notice'' at the end; and
(B) by striking subsection (e) and inserting the
following:
``(e) After reaching a decision on an appeal, the Board shall
promptly issue notice (as that term is defined in section 5100 of this
title) of such decision to the following:
``(1) The appellant.
``(2) Any other party with a right to notice of such
decision.
``(3) Any authorized representative of the appellant or
party described in paragraph (2).
``(f) The Secretary may provide notice under subsection (e)
electronically if a claimant (or the claimant's representative) elects
to receive such notice electronically. A claimant (or the claimant's
representative) may revoke such an election at any time, by means
prescribed by the Secretary.''.
(5) In section 7105(b)(1)(A), by striking ``mailing'' and
inserting ``issuance''.
(6) In section 7105A(a), by striking ``mailed'' and
inserting ``issued''.
(7) In section 7266(a), by striking ``mailed'' and
inserting ``issued''.
SEC. 709. AUTHORIZATION OF APPROPRIATIONS FOR EXPANSION OF CLAIMS
AUTOMATION.
There is authorized to be appropriated to the Secretary of Veterans
Affairs $30,000,000 for fiscal year 2023 to support expected increased
claims processing for newly eligible veterans pursuant to this Act and
the amendments made by this Act by--
(1) supporting the automation of processing claims by the
Veterans Benefits Administration of the Department of Veterans
Affairs;
(2) adding self-service features to the system by which
individuals file claims;
(3) removing duplicative efforts regarding the processing
of claims; and
(4) reducing the dependency of the Department on the legacy
claim system.
SEC. 710. NON-APPLICABILITY OF NON-DEPARTMENT OF VETERANS AFFAIRS
COVENANTS NOT TO COMPETE TO APPOINTMENT OF VETERANS
HEALTH ADMINISTRATION PERSONNEL.
(a) In General.--Subchapter I of chapter 74 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7414. Effect of non-Department covenants not to compete
``(a) Non-Applicability.--Except as provided in subsection (b), in
the case of an individual who is an applicant for appointment to a
position in the Veterans Health Administration described in section
7401 of this title, any covenant not to compete into which the
individual has entered with a non-Department facility or party shall
have no force or effect with respect to the appointment of the
individual to such a position.
``(b) Service Obligation.--(1) Any individual who is appointed to
such a position in the Veterans Health Administration shall, as a
condition of such appointment, agree to provide clinical services at a
Department medical facility for the duration of the period described in
paragraph (2).
``(2) The period described in this paragraph is the period that
begins on the date on which an individual is appointed to such a
position and ends on the latter of the following dates:
``(A) The date that is one year after such date of
appointment.
``(B) The date of the termination of any covenant not to
compete entered into between the individual and a non-
Department facility or party.
``(3) The Secretary may waive the requirement under paragraph (1)
with respect to an individual at the discretion of the Secretary.
``(c) Termination of Department Employment.--In the case of an
individual who is appointed to such a position in the Veterans Health
Administration who has entered into a covenant not to compete that is
rendered non-applicable pursuant to subsection (a), if the individual's
employment at the Veterans Health Administration is terminated for any
reason before the specified termination date of such covenant,
subsection (a) shall not apply with respect to such covenant after the
date of the termination of the individual's employment at the Veterans
Health Administration.
``(d) Covenant Not To Compete.--In this section, the term `covenant
not to compete' means an agreement--
``(1) between an employee and employer or a contractor and
principal that restricts such employee or contractor from
performing--
``(A) any work for another employer for a specified
period of time;
``(B) any work in a specified geographical area; or
``(C) work for another employer performing work
that is similar to the work such employee or contractor
performed for the employer or principal, included as a
party to the agreement; and
``(2) that is entered into after the date of enactment of
this Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7413 the following new item:
``7414. Effect of non-Department covenants not to compete.''.
SEC. 711. RECRUITMENT OF PHYSICIANS ON A CONTINGENT BASIS PRIOR TO
COMPLETION OF TRAINING REQUIREMENTS.
Section 7402 of title 38, United States Code, is amended--
(1) in subsection (b)(1)--
(A) in the matter preceding subparagraph (A) by
inserting ``or to be offered an appointment to such
position on a contingent basis under subsection (h)''
after ``position''; and
(B) by striking subparagraph (B) and inserting the
following:
``(B)(i) have completed a residency leading to board
eligibility in a specialty, satisfactory to the Secretary; or
``(ii) with respect to an offer for an appointment on a
contingent basis under subsection (h), complete such a
residency by not later than two years after the date of such
offer; and''; and
(2) by adding at the end the following new subsection:
``(h)(1) The Secretary may appoint an individual under subsection
(b)(1) on a contingent basis in accordance with this subsection if the
Secretary reasonably anticipated that the individual will have
completed the requirements for appointment under such subsection (b)(1)
by not later than two years after the date on which the individual is
so appointed.
``(2) An individual who is appointed to a position on a contingent
basis under paragraph (1) shall be appointed to such position on a
permanent basis if, by not later than two years after the date of the
contingent appointment, the individual completes all the requirements
for appointment under subsection (b)(1).
``(3) An individual who is appointed on a contingent basis under
paragraph (1) who fails to complete the requirements for appointment
under subsection (b)(1) by not later than two years after the date on
which the individual is so appointed may not be appointed to such
position on a permanent basis.''.
SEC. 712. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS
TO STATES TO IMPROVE OUTREACH TO VETERANS.
(a) In General.--Chapter 63 of title 38, United States Code, is
amended--
(1) by redesignating sections 6307 and 6308 and sections
6308 and 6309, respectively; and
(2) by inserting after section 6306 the following new
section 6307:
``Sec. 6307. Grants to States to improve outreach to veterans
``(a) Purpose.--It is the purpose of this section to provide for
assistance by the Secretary to States to carry out programs that--
``(1) improve outreach and assistance to veterans and the
spouses, children, and parents of veterans, to ensure that such
individuals are fully informed about any veterans and veterans-
related benefits and programs (including State veterans
programs) for which they may be eligible; and
``(2) facilitate opportunities for such individuals to
receive competent, qualified services in the preparation,
presentation, and prosecution of veterans benefits claims.
``(b) Authority.--The Secretary may award grants to States--
``(1) to carry out, coordinate, improve, or otherwise
enhance outreach activities;
``(2) to increase the number of county or tribal veterans
service officers serving in the State by hiring new, additional
such officers; or
``(3) to expand, carry out, coordinate, improve, or
otherwise enhance existing programs, activities, and services
of the State's existing organization that has been recognized
by the Department of Veterans Affairs pursuant to section 5902,
in the preparation, presentation, and prosecution of claims for
veterans benefits through representatives who hold positions as
county or Tribal veterans service officers.
``(c) Application.--(1) To be eligible for a grant under this
section, a State shall submit to the Secretary an application therefor
at such time, in such manner, and containing such information as the
Secretary may require.
``(2) Each application submitted under paragraph (1) shall include
the following:
``(A) A detailed plan for the use of the grant.
``(B) A description of the programs through which the State
will meet the outcome measures developed by the Secretary under
subsection (i).
``(C) A description of how the State will distribute grant
amounts equitably among counties (or Tribal lands, as the case
may be) with varying levels of urbanization.
``(D) A plan for how the grant will be used to meet the
unique needs of American Indian or Alaska Native veterans,
elderly veterans, women veterans, and veterans from other
underserved communities.
``(d) Distribution.--The Secretary shall seek to ensure that grants
awarded under this section are equitably distributed among States with
varying levels of urbanization.
``(e) Priority.--The Secretary shall prioritize awarding grants
under this section that will serve the following areas:
``(1) Areas with a critical shortage of county or tribal
veterans service officers.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(f) Use of County or Tribal Veterans Service Officers.--A State
that receives a grant under this section to carry out an activity
described in subsection (b)(1) shall carry out the activity through--
``(1) a county or Tribal veterans service officer of the
State; or
``(2) if the State does not have a county or tribal
veterans service officer, or if the county or Tribal veterans
service officers of the State cover only a portion of that
State, an appropriate entity of a State, local, or Tribal
government, or another publicly funded entity, as determined by
the Secretary.
``(g) Required Activities.--Any grant awarded under this section
shall be used--
``(1) to expand existing programs, activities, and
services;
``(2) to hire and maintain new, additional county or Tribal
veterans service officers; or
``(3) for travel and transportation to facilitate carrying
out paragraph (1) or (2).
``(h) Other Permissible Activities.--A grant under this section may
be used to provide education and training, including on-the-job
training, for State, county, local, and tribal government employees who
provide (or when trained will provide) veterans outreach services in
order for those employees to obtain and maintain accreditation in
accordance with procedures approved by the Secretary.
``(i) Outcome Measures.--(1) The Secretary shall develop and
provide to each State that receives a grant under this section written
guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1), the
Secretary shall consider the following goals:
``(A) Increasing the use of veterans and veterans-related
benefits, particularly among vulnerable populations.
``(B) Increasing the number of county and tribal veterans
service officers recognized by the Secretary for the
representation of veterans under chapter 59 of this title.
``(j) Tracking Requirements.--(1) With respect to each grant
awarded under this section, the Secretary shall track the use of
veterans benefits among the population served by the grant, including
the average period of time between the date on which a veteran or other
eligible claimant applies for such a benefit and the date on which the
veteran or other eligible claimant receives the benefit, disaggregated
by type of benefit.
``(2) Not less frequently than annually during the life of the
grant program established under this section, the Secretary shall
submit to Congress a report on--
``(A) the information tracked under paragraph (1);
``(B) how the grants awarded under this section serve the
unique needs of American Indian or Alaska Native veterans,
elderly veterans, women veterans, and veterans from other
underserved communities; and
``(C) other information provided by States pursuant to the
grant reporting requirements.
``(k) Performance Review.--(1) The Secretary shall--
``(A) review the performance of each State that receives a
grant under this section; and
``(B) make information regarding such performance publicly
available.
``(l) Remediation Plan.--(1) In the case of a State that receives a
grant under this section and does not meet the outcome measures
developed by the Secretary under subsection (i), the Secretary shall
require the State to submit a remediation plan under which the State
shall describe how and when it plans to meet such outcome measures.
``(2) The Secretary may not award a subsequent grant under this
section to a State described in paragraph (1) unless the Secretary
approves the remediation plan submitted by the State.
``(m) Maximum Amount.--The amount of a grant awarded under this
section may not exceed 10 percent of amounts made available for grants
under this section for the fiscal year in which the grant is awarded.
``(n) Supplement, Not Supplant.--Any grant awarded under this
section shall be used to supplement and not supplant State and local
funding that is otherwise available.
``(o) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary for each of fiscal years 2023 through
2027, $50,000,000 to carry out this section.
``(p) Definitions.--In this section:
``(1) The term `county or tribal veterans service officer'
includes a local equivalent veterans service officer.
``(2) The term `State' includes each Indian Tribe, the
District of Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands, and any territory
or possession of the United States.
``(3) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of this
title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 63 of such title is amended by striking the items relating to
sections 6307 and 6308 and inserting the following new items:
``6307. Grants to States to improve outreach to veterans.
``6308. Outreach for eligible dependents.
``6309. Biennial report to Congress.''.
(c) Authorization of Additional Full-time Equivalent Employee.--
During fiscal years 2023 through 2027, the Secretary of Veterans
Affairs may hire an additional full-time equivalent employee in the
Office of the General Counsel of the Department of Veterans Affairs, as
compared to the number of full-time equivalent employees that would
otherwise be authorized for such office, to carry out duties under the
accreditation, discipline, and fees program.
SEC. 713. STUDY AND REPORT ON HERBICIDE AGENT EXPOSURE IN PANAMA CANAL
ZONE.
(a) Study.--The Secretary of Defense shall conduct a study on the
exposure of members of the Armed Forces to herbicide agents, including
Agent Orange and Agent Purple, in the Panama Canal Zone during the
period beginning on January 1, 1958, and ending on December 31, 1999.
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
on the study conducted under subsection (a).
SEC. 714. BUDGET INFORMATION FOR ALTERNATIVES TO BURN PITS.
The Secretary of Defense shall include in the budget submission of
the President under section 1105(a) of title 31, United States Code,
for each of fiscal years 2023 through 2027, a dedicated budget line
item for incinerators and waste-to-energy waste disposal alternatives
to burn pits.
SEC. 715. AUTHORIZATION OF APPROPRIATIONS FOR EXPANSION OF CLAIMS
AUTOMATION.
There is authorized to be appropriated to the Secretary of Veterans
Affairs $150,000,000 for fiscal year 2023 to continue the modernization
and expansion of capabilities and capacity of the Veterans Benefits
Management System of the Department of Veterans Affairs to support
expected increased claims processing for newly eligible veterans
pursuant to this Act and the amendments made by this Act.
SEC. 716. BURN PIT REGISTRY UPDATES.
(a) Individuals Eligible to Update.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall take actions necessary to ensure that the burn pit
registry may be updated with the cause of death of a deceased
registered individual by--
(A) an individual designated by such deceased
registered individual; or
(B) if no such individual is designated, an
immediate family member of such deceased registered
individual.
(2) Designation.--The Secretary shall provide, with respect
to the burn pit registry, a process by which a registered
individual may make a designation for purposes of paragraph
(1)(A).
(b) Definitions.--In this section:
(1) The term ``burn pit registry'' means the 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).
(2) The term ``immediate family member'', with respect to a
deceased individual, means--
(A) the spouse, parent, brother, sister, or adult
child of the individual;
(B) an adult person to whom the individual stands
in loco parentis; or
(C) any other adult person--
(i) living in the household of the
individual at the time of the death of the
individual; and
(ii) related to the individual by blood or
marriage.
(3) The term ``registered individual'' means an individual
registered with the burn pit registry.
SEC. 717. BURN PIT TRANSPARENCY.
(a) Short Title.--This section may be cited as the ``SFC Heath
Robinson Burn Pit Transparency Act''.
(b) Notifications and Reports Regarding Reported Cases of Burn Pit
Exposure.--
(1) Quarterly notifications.--
(A) In general.--On a quarterly basis, the
Secretary of Veterans Affairs shall submit to the
appropriate congressional committees a report on each
reported case of burn pit exposure by a covered veteran
reported during the previous quarter.
(B) Elements.--Each report submitted under
subparagraph (A) shall include, with respect to each
reported case of burn pit exposure of a covered veteran
included in the report, the following:
(i) Notice of the case, including the
medical facility at which the case was
reported.
(ii) Notice of, as available--
(I) the enrollment status of the
covered veteran with respect to the
patient enrollment system of the
Department of Veterans Affairs under
section 1705(a) of title 38, United
States Code;
(II) a summary of all health care
visits by the covered veteran at the
medical facility at which the case was
reported that are related to the case;
(III) the demographics of the
covered veteran, including age, sex,
and race;
(IV) any non-Department of Veterans
Affairs health care benefits that the
covered veteran receives;
(V) the Armed Force in which the
covered veteran served and the rank of
the covered veteran;
(VI) the period in which the
covered veteran served;
(VII) each location of an open burn
pit from which the covered veteran was
exposed to toxic airborne chemicals and
fumes during such service;
(VIII) the medical diagnoses of the
covered veteran and the treatment
provided to the veteran; and
(IX) whether the covered veteran is
registered in the Airborne Hazards and
Open Burn Pit Registry.
(C) Protection of information.--The Secretary shall
ensure that the reports submitted under subparagraph
(A) do not include the identity of covered veterans or
contain other personally identifiable data.
(2) Annual report on cases.--
(A) In general.--Not later than 180 days after the
date of the enactment of this Act, and annually
thereafter, the Secretary of Veterans Affairs, in
collaboration with the Secretary of Defense, shall
submit to the appropriate congressional committees a
report detailing the following:
(i) The total number of covered veterans.
(ii) The total number of claims for
disability compensation under chapter 11 of
title 38, United States Code, approved and the
total number denied by the Secretary of
Veterans Affairs with respect to a covered
veteran, and for each such denial, the
rationale of the denial.
(iii) A comprehensive list of--
(I) the conditions for which
covered veterans seek treatment; and
(II) the locations of the open burn
pits from which the covered veterans
were exposed to toxic airborne
chemicals and fumes.
(iv) Identification of any illnesses
relating to exposure to open burn pits that
formed the basis for the Secretary to award
benefits, including entitlement to service
connection or an increase in disability rating.
(v) The total number of covered veterans
who died after seeking care for an illness
relating to exposure to an open burn pit.
(vi) Any updates or trends with respect to
the information described in clauses (i), (ii),
(iii), (iv), and (v) that the Secretary
determines appropriate.
(B) Matters included in first report.--The
Secretary shall include in the first report under
paragraph (1) information specified in paragraph (1)(B)
with respect to reported cases of burn pit exposure
made during the period beginning January 1, 1990, and
ending on the day before the date of the enactment of
this Act.
(3) Information regarding the airborne hazards and open
burn pit registry.--
(A) Notice.--The Secretary of Veterans Affairs
shall ensure that a medical professional of the
Department of Veterans Affairs informs a veteran of the
Airborne Hazards and Open Burn Pit Registry if the
veteran presents at a medical facility of the
Department for treatment that the veteran describes as
being related to, or ancillary to, the exposure of the
veteran to toxic airborne chemicals and fumes caused by
open burn pits.
(B) Display.--In making information public
regarding the number of participants in the Airborne
Hazards and Open Burn Pit Registry, the Secretary shall
display such numbers by both State and by congressional
district.
(4) Comptroller general report.--Not later than 180 days
after the date of the enactment of this Act, the Comptroller
General of the United States shall submit to the appropriate
congressional committees a report containing an assessment of
the effectiveness of any memorandum of understanding or
memorandum of agreement entered into by the Secretary of
Veterans Affairs with respect to--
(A) the processing of reported cases of burn pit
exposure; and
(B) the coordination of care and provision of
health care relating to such cases at medical
facilities of the Department of Veterans Affairs and at
non-Department facilities.
(5) Definitions.--In this section:
(A) The term ``Airborne Hazards and Open Burn Pit
Registry'' means the registry established by the
Secretary of Veterans Affairs 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).
(B) The term ``appropriate congressional
committees'' means--
(i) the Committee on Veterans' Affairs and
the Committee on Armed Services of the Senate;
and
(ii) The Committee on Veterans' Affairs and
the Committee on Armed Services of the House of
Representatives.
(C) The term ``covered veteran'' means a veteran
who presents at a medical facility of the Department of
Veterans Affairs (or in a non-Department facility
pursuant to section 1703 or 1703A of title 38, United
States Code) for treatment that the veteran describes
as being related to, or ancillary to, the exposure of
the veteran to toxic airborne chemicals and fumes
caused by open burn pits at any time while serving in
the Armed Forces.
(D) The term ``open burn pit'' has the meaning
given that 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).
(E) The term ``reported case of burn pit exposure''
means each instance in which a veteran presents at a
medical facility of the Department of Veterans Affairs
(or in a non-Department facility pursuant to section
1703 or 1703A of title 38, United States Code) for
treatment that the veteran describes as being related
to, or ancillary to, the exposure of the veteran to
toxic airborne chemicals and fumes caused by open burn
pits at any time while serving in the Armed Forces.
Passed the House of Representatives March 3, 2022.
Attest:
Clerk.
117th CONGRESS
2d Session
H. R. 3967
_______________________________________________________________________
AN ACT
To improve health care and benefits for veterans exposed to toxic
substances, and for other purposes.