[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3967 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 3967
To improve health care and benefits for veterans exposed to toxic
substances, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 17, 2021
Mr. Takano (for himself, Mrs. Luria, Mr. Ruiz, Ms. Slotkin, Mr. Trone,
Ms. Brownley, Mr. Levin of California, Mr. Pappas, Mr. Lamb, Mr. Brown,
Mr. Gallego, Ms. Underwood, Mr. Sablan, Mr. Mrvan, Mr. Allred, Ms.
Kaptur, Ms. Lois Frankel of Florida, Mr. Ryan, Mr. McGovern, Mr. Harder
of California, Mr. Fitzpatrick, Mr. Kilmer, Mr. Soto, Ms. Meng, Ms.
Strickland, and Ms. Spanberger) introduced the following bill; which
was referred to the Committee on Veterans' Affairs, and in addition to
the Committee on Armed Services, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To 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) References to Title 38, United States Code.--Except as
otherwise expressly provided, whenever in this title 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.
(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 FOR 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.
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, 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. Coordination by Department of Veterans Affairs of 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.
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.
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.
TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY FOR 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 specified in section 1119(b)(2).
``(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 the
Individual Longitudinal Exposure Record of the
Department 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.
(a) In General.--Section 1710(e), as amended by section 102(c), is
further amended--
(1) in paragraph (1), by adding at the end the following
new subparagraphs:
``(G) 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,
medical services, and nursing home care under subsection (a)(2)(F) for
any illness.
``(H) Subject to paragraph (2), a covered veteran (as defined in
section 1119(c) of this title) is eligible for hospital care, medical
services, and nursing home care under subsection (a)(2)(F) for any
illness.''; and
(2) in paragraph (2)(B)--
(A) by striking ``or (F)'' and inserting ``(F),
(G), or (H)''; and
(B) by striking ``service or testing'' and
inserting ``service, testing, or activity''.
(b) Resource Assessment and Report.--
(1) Initial assessment and report.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall--
(A) complete an assessment to determine--
(i) the personnel and material resources
necessary to implement the amendments made by
subsection (a); and
(ii) the total number of covered veterans,
as such term is defined in section 1119(c) of
title 38, United States Code (as added by
section 301), who receive hospital care or
medical services furnished by the Secretary
under chapter 17 of such title, disaggregated
by priority group specified in section 1705(a)
of such title; and
(B) submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate an
initial report containing the findings of the
assessment completed under subparagraph (A), including
a specific determination as to whether the Department
has the personnel and material resources necessary to
implement the amendments made by subsection (a).
(2) Subsequent reports.--If the initial report submitted
under paragraph (1)(B) contains a determination that the
Department does not have the personnel or material resources
necessary to implement the amendments made by subsection (a),
beginning not later than 90 days after the submission of such
initial report and every 90 days thereafter until the effective
date specified in subsection (c), the Secretary shall submit to
the Committees on Veterans' Affairs of the House of
Representatives and the Senate a subsequent report containing
an update to such determination.
(c) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that is the earlier of the following:
(1) The date on which the Secretary submits a report under
subsection (b) containing a determination that the Department
has the personnel and material resources necessary to implement
such amendments, and notifies the Law Revision Counsel of the
House of Representatives of the submission of the report so the
Law Revision Counsel may execute the amendments.
(2) The date that is 18 months after the date of the
enactment of this Act.
TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS
SEC. 201. SHORT TITLE.
This title 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.--
(1) Establishment.--Chapter 11 is amended by adding at the
end the following new subchapter:
``SUBCHAPTER VII--RESEARCH AND DETERMINATIONS RELATING TO PRESUMPTIONS
OF SERVICE CONNECTION BASED ON TOXIC EXPOSURE
``Sec. 1171. Procedures to determine presumptions of service connection
based on toxic exposure; definitions
``(a) Procedures.--The Secretary shall determine whether to
establish, or to remove, presumptions of service connection based on
toxic exposure pursuant to this subchapter, whereby--
``(1) the Formal Advisory Committee on Toxic Exposure under
section 1172 of this title--
``(A) provides advice to the Secretary on toxic
exposed veterans and cases in which veterans who,
during active military, naval, or air 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, or air
service;
``(B) provides to the Secretary recommendations on
corrections needed in the Individual Longitudinal
Exposure Record to better reflect veterans and
dependents described in subparagraph (A); and
``(C) provides to the Secretary recommendations
regarding which cases of possible toxic exposure
described in subparagraph (A) the Science Review Board
should review;
``(2) the Science Review Board under section 1173 of this
title--
``(A) reviews cases of possible toxic exposure
nominated by the Secretary;
``(B) reviews research nominated by the Secretary;
``(C) develops recommendations for new research;
and
``(D) determines the strength of evidence
supporting positive association between toxic exposure
and an illness;
``(3) the Working Group under section 1174 of this title
evaluates the conclusions of the Science Review Board and
recommends to the Secretary whether to establish or modify a
presumption of service connection; and
``(4) the Secretary prescribes regulations under section
1175 of this title.
``(b) Illness Defined.--In this subchapter, the term `illness'
includes a disease or other condition affecting the health of an
individual.
``(c) Nonapplication of Sunset Requirements.--Section 14 of the
Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an
entity established under this subchapter.
``Sec. 1172. Formal Advisory Committee on Toxic Exposure
``(a) Establishment.--(1) There is in the Veterans 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 one member shall be appointed from among
individuals who are representatives of disabled veterans.
``(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) Each member of the Committee shall be appointed for a two-
year term, and may serve not more than three successive terms.
``(5) A vacancy in the Committee shall be filled in the manner in
which the original appointment was made.
``(b) Consultation.--The Secretary may consult with, and seek the
advice of, the Committee with respect to cases in which veterans who,
during active military, naval, or air 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, or air service.
``(2) The assessments under paragraph (1) shall cover suspected and
known toxic exposures occurring during active military, naval, or air
service, including by identifying and evaluating new and emerging 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 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 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, or air service under subsection
(c), the Committee may develop a recommendation for the Secretary
regarding whether there should be a review of the health effects
related to the case of exposure conducted by the Science Review Board
established under section 1173 of this title.
``(2) Upon receipt of evidence suggesting that previous findings
regarding the periods and locations of exposure covered by an existing
presumption of service connection are no longer supported, the
Committee may nominate such evidence for evaluation by the Working
Group to modify the periods and locations.
``(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 intends to nominate to the
Science Review Board the review recommended by the Committee in
the report, and if not, an explanation of why, including
citations and sources.
``Sec. 1173. Science Review Board
``(a) Establishment.--(1) There is in the Veterans Health
Administration of the Department the Science Review Board (in this
section referred to as the `Board').
``(2)(A) The members of the Board shall be appointed by the
Secretary, in consultation with the National Academies of Sciences,
Engineering, and Medicine, from the general public from among
individuals who are distinguished in the fields of medicine, biological
sciences, or health administration.
``(B) An individual may not concurrently serve on the Board and the
Formal Advisory Committee on Toxic Exposure under section 1172 of this
title.
``(C) The Secretary shall determine the number, terms of service,
and pay and allowances of members of the Board appointed by the
Secretary.
``(b) Duties.--(1) Upon receiving a nomination for the evaluation
of research on the health effects of toxic exposures of members of the
active military, naval, or air service or dependents of such members
made by the Secretary, the Board shall--
``(A) evaluate the likelihood that a positive association
exists between an illness and a toxic exposure while serving in
the active military, naval, or air service; and
``(B) assess the toxic exposures and illnesses identified
by the Secretary and determine whether the evidence supports a
finding of a positive association between the toxic exposure
and the illness.
``(2) In carrying out paragraph (1)(B), the Board shall review 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.
``(3)(A) With respect to an evaluation conducted under this
subsection, if the Board determines that the evidence for a positive
association is categorized as either the sufficient or equipoise and
above categories, the Board shall estimate the size of the positive
association effect among those exposed by calculating the relative risk
and exposure prevalence.
``(B)(i) The Board shall use the relative risk and exposure
prevalence calculated under subparagraph (A) to estimate the service-
attributable fraction of illness in a military setting to determine the
probability of positive association for an individual.
``(ii) In calculating the service-attributable fraction of illness,
the Board shall consider the dose-response relationships.
``(4)(A) With respect to an evaluation conducted under this
subsection, if the Board determines that the evidence for a positive
association is categorized as the below equipoise category, the Board
shall develop a recommendation as to whether additional data gathering
and research are necessary.
``(B) If the Board recommends additional data gathering and
research pursuant to subparagraph (A), the Secretary shall seek to
enter into an agreement with the National Academies of Sciences,
Engineering, and Medicine, or another nonprofit, nongovernmental entity
that the Secretary determines has similar expertise and objectivity as
the National Academies, to conduct such data gathering and research.
``(c) Reports.--(1) For each evaluation conducted under subsection
(b) where the Board determines that the evidence for positive
association is categorized as either the sufficient or equipoise and
above categories, the Board shall submit to the Secretary a report
identifying the evidence found to reach such positive association
determinations.
``(2) In addition to submitting reports under paragraph (1), the
Board shall submit to the Secretary reports, at such times and at such
frequencies as the Board considers appropriate, containing such
recommendations as the Board may have for additional or new research on
matters relating to toxic exposures described in subsection (b)(1).
``(d) Responses From the Secretary.--(1) In response to each report
received by the Secretary under subsection (c)(1), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives, and make publicly available, a report on the
findings and opinions of the Secretary with respect to the report
received under such subsection.
``(2) Each report submitted under paragraph (1) of this subsection
shall include, with respect to a report received under subsection
(c)(1), the following:
``(A) The findings and opinions of the Secretary with
respect to the report received under subsection (c)(1).
``(B) Whether the Secretary intends to nominate to the
Working Group, established under section 1174(a) of this title,
the work of the Science Review Board covered by the report
received under subsection (c)(1) for further action, and if
not, an explanation of why, including citations and sources.
``Sec. 1174. Working group on presumptions of service connection
``(a) Establishment.--The Secretary shall establish a working group
(in this section referred to as the `Working Group') to--
``(1) evaluate--
``(A) the conclusions of the Science Review Board
contained in each report submitted under section
1173(c)(1) of this title; and
``(B) evidence nominated by the Formal Advisory
Committee on Toxic Exposure under section 1172(d)(2)
regarding the periods and locations of exposure covered
by an existing presumption of service connection; and
``(2) develop and submit to the Secretary a recommendation
with respect to whether--
``(A) to establish a presumption of service
connection for the toxic exposure and illness covered
by the report described in subparagraph (A) of
paragraph (1); or
``(B) to modify an existing presumption of service
connection described in subparagraph (B) of such
paragraph.
``(b) Recommendations.--(1) In making a recommendation under
subsection (a)(2), the Working Group shall--
``(A) in cases where the evidence for a positive
association is categorized as either the sufficient or
equipoise and above categories, as described in subparagraph
(A) or (B) of section 1173(b)(2) of this title, weigh such
evidence heavily in favor of establishing a presumption of
service connection;
``(B) take into consideration such factors as may be
determined appropriate by the Secretary; and
``(C) if the Working Group determines that additional
research, studies, or reports are appropriate before making a
final recommendation with respect to establishing or modifying
a presumption of service connection, submit to the Secretary a
description of such appropriate additional research, studies,
or reports.
``(2) At the same time as when the Working Group submits to the
Secretary a recommendation under paragraph (2) of subsection (a) with
respect to an evaluation under paragraph (1) of such subsection, the
Working Group shall submit to the Committees on Veterans' Affairs of
the Senate and the House of Representatives a description of such
recommendation.
``(c) Report.--The Secretary shall periodically publish on the
internet website of the Department a report identifying any factors for
the Working Group to consider under subsection (b)(1)(B), as determined
appropriate by the Secretary.
``Sec. 1175. Regulations regarding presumptions of service connection
based on toxic exposure
``(a) Action Upon Working Group Recommendation.--Not later than 60
days after the date on which the Secretary receives a recommendation to
establish or modify a presumption of service connection under section
1174(a)(2) of this title--
``(1) if the Secretary determines that the presumption, or
modification, is warranted, the Secretary shall issue proposed
regulations setting forth the presumption or revise regulations
to carry out such modification; or
``(2) if the Secretary determines that the presumption, or
modification, is not warranted, the Secretary shall publish in
the Federal Register a notice of the determination, including
the reasons supporting the determination.
``(b) Final Regulation.--Not later than 180 days after the date on
which the Secretary issues any proposed regulations under subsection
(a)(1), the Secretary shall issue final regulations. Such regulations
shall be effective on the date of issuance.
``(c) Removal of Presumption.--(1) The Secretary may issue
regulations to remove an illness from a presumption of service
connection previously established pursuant to a regulation issued under
subsection (b).
``(2) Whenever an illness is removed from regulations pursuant to
paragraph (1), or the periods and locations of exposure covered by a
presumption of service connection are modified under subsection (a)--
``(A) a veteran who was awarded compensation for such
illness on the basis of the presumption provided under such
regulations before the effective date of the removal or
modification shall continue to be entitled to receive
compensation on that basis; and
``(B) a survivor of a veteran who was awarded dependency
and indemnity compensation for the death of a veteran resulting
from such illness on the basis of such presumption shall
continue to be entitled to receive dependency and indemnity
compensation on such basis.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1165 the following new items:
``subchapter vii--research and determinations relating to presumptions
of service connection based on toxic exposure
``1171. Procedures to determine presumptions of service connection
based on toxic exposure; definitions.
``1172. Formal Advisory Committee on Toxic Exposure.
``1173. Science Review Board.
``1174. Working group on presumptions of service connection.
``1175. Regulations regarding presumptions of service connection based
on toxic exposure.''.
(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.''.
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.--Except as provided in subsection (b), 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) 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.--With respect to each claim identified under
subsection (a), 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 such subsection. 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.
``(c) Relation to Other Laws.--The Secretary shall carry out
subsection (a) to the degree that doing so does not conflict with any
other provision of law.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 11 of such title is amended by inserting after the item
relating to section 1165 the following new item:
``1167. Reevaluation of compensation determinations pursuant to changes
in presumptions of service connection.''.
(c) 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.
(a) In General.--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 Individual Longitudinal Exposure Record
Required.--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, or air service, the Secretary
shall, in adjudicating such claim, consider--
``(1) the Individual Longitudinal Exposure Record of the
veteran; and
``(2) if the Individual Longitudinal Exposure Record of the
veteran does not indicate that the veteran was subject to a
toxic exposure during active military, naval, or air 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 hazards listed in 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)(A) Subject to subparagraph (B), the substances, chemicals,
and airborne hazards listed in this paragraph are as follows:
``(i) Particulate matter, including the following:
``(I) PM-10.
``(II) PM-2.5.
``(ii) Polycyclic aromatic hydrocarbons (PAHs), including
the following:
``(I) Acenaphthene.
``(II) Acenaphthylene.
``(III) Anthracene.
``(IV) Benzo(a)anthracene.
``(V) Benzo(a)pyrene.
``(VI) Benzo(b)fluoranthene.
``(VII) Benzo(g,h,i)perylene.
``(VIII) Benzo(k)fluoranthene.
``(IX) Chrysene.
``(X) Dibenz(a,h)anthracene.
``(XI) Fluoranthene.
``(XII) Fluorene.
``(XIII) Indeno(1,2,3-cd)pyrene.
``(XIV) Naphthalene.
``(XV) Phenanthrene.
``(XVI) Pyrene.
``(iii) Volatile organic compounds (VOCs), including the
following:
``(I) Acetone.
``(II) Acrolein.
``(III) Benzene.
``(IV) Carbon Disulfide.
``(V) Chlorodifluoromethane.
``(VI) Chloromethane.
``(VII) Ethylbenzene.
``(VIII) Hexachlorobutadiene.
``(IX) Hexane.
``(X) m/p-Xylene.
``(XI) Methylene Chloride.
``(XII) Pentane.
``(XIII) Propylene.
``(XIV) Styrene.
``(XV) Toluene.
``(iv) Toxic organic halogenated dioxins and furans
(dioxins), including the following:
``(I) 1,2,3,4,6,7,8 HPCDD.
``(II) 1,2,3,4,6,7,8 HPCDF.
``(III) 1,2,3,4,7,8,9 HPCDF.
``(IV) 1,2,3,4,7,8 HXCDD.
``(V) 1,2,3,6,7,8 HXCDD.
``(VI) 1,2,3,7,8,9 HXCDD.
``(VII) 1,2,3,4,7,8 HXCDF.
``(VIII) 1,2,3,6,7,8 HXCDF.
``(IX) 1,2,3,7,8,9 HXCDF.
``(X) 1,2,3,7,8 PECDD.
``(XI) 1,2,3,7,8 PECDF.
``(XII) 2,3,4,6,7,8 HXCDF.
``(XIII) 2,3,4,7,8 PECDF.
``(XIV) 2,3,7,8 TCDD.
``(XV) 2,3,7,8 TCDF.
``(XVI) Octachlorodibenzodioxin.
``(XVII) Octachlorodibenzofuran.
``(v) Such other substances, chemicals, and airborne
hazards as the Secretary, in collaboration with the Secretary
of Defense, may determine appropriate.
``(B)(i) The Secretary may add to or remove from the list under
subparagraph (A) as the Secretary, in collaboration with the Secretary
of Defense, determines appropriate.
``(ii) 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 Congress a report identifying
any additions or removals made pursuant to subparagraph (A) 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, or air service while assigned to a
duty station in--
``(i) Bahrain;
``(ii) Iraq;
``(iii) Kuwait;
``(iv) Oman;
``(v) Qatar;
``(vi) Saudi Arabia;
``(vii) Somalia; or
``(viii) United Arab Emirates; or
``(B) on or after September 11, 2001, performed
active military, naval, or air service while assigned
to a duty station in--
``(i) Afghanistan;
``(ii) Djibouti;
``(iii) Egypt;
``(iv) Jordan;
``(v) Lebanon;
``(vi) Syria;
``(vii) Yemen;
``(viii) Uzbekistan;
``(ix) the Philippines; or
``(x) any other country determined relevant
by the Secretary.
``(2) The term `Individual Longitudinal Exposure Record'
includes any pilot program or other program used by the
Department of Veterans Affairs or the Department of Defense to
track how members of the Armed Forces or veterans have been
exposed to various occupational or environmental hazards.
``(3) The term `toxic exposure risk activity' has the
meaning given such term in section 1710(e)(4) of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 11 is amended by inserting after the item relating to section
1118 the following new item:
``1119. Presumptions of toxic exposure.''.
SEC. 303. MEDICAL NEXUS EXAMINATIONS FOR TOXIC EXPOSURE RISK
ACTIVITIES.
(a) In General.--Subchapter VI of chapter 11, as amended by section
203 of this Act, 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, or air 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) request a medical opinion 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 requested
under paragraph (1), the health care provider shall consider the total
potential exposure through all applicable military deployments, and the
synergistic, combined effect of all applicable toxic exposure risk
activities.
``(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 such term in
section 1710(e)(4) of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 11 of such title, as amended by title II of this Act, is
further amended by inserting after the item relating to section 1167,
as added by such title, the following new item:
``1168. 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.
(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, 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
Veterans Act''.
(b) Palomares.--Section 1112(c)(3)(B), as amended by section 401,
is further amended by adding at the end the following new clause:
``(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.''.
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, or air
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, or air
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, or air 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 103, 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) Clerical Amendments.--
(1) Section heading.--The heading for section 1116 is
amended by striking ``the Republic of Vietnam'' and inserting
``certain locations''.
(2) Table of sections.--The table of sections at the
beginning of chapter 11 is amended by striking the item
relating to section 1116 and inserting the following new item:
``1116. Presumptions of service connection for diseases associated with
exposure to certain herbicide agents;
presumption of exposure 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.
(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, to identify Gulf War Illness.''.
(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
303(a), 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, or air 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 specified in 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) Clerical Amendment.--The table of sections at the beginning of
chapter 11, as amended by section 302(b), is further amended by
inserting after the item relating to section 1119 the following new
item:
``1120. Presumption of service connection for certain diseases
associated with exposure to burn pits and
other toxins.''.
(d) 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. COORDINATION BY DEPARTMENT OF VETERANS AFFAIRS OF TOXIC
EXPOSURE RESEARCH.
(a) In General.--Subchapter II of chapter 73 is amended by adding
at the end the following new section:
``Sec. 7330D. Coordination of toxic exposure research
``(a) In General.--The Secretary shall coordinate all research
activities carried out or funded by the executive branch of the Federal
Government on the health consequences of toxic exposures experienced
during service in the Armed Forces.
``(b) Strategic Plan.--In carrying out subsection (a), the
Secretary shall establish a strategic plan, to be known as the Toxic
Exposure Research Strategic Plan, to ensure that the research
activities specified in such subsection are collaborative, transparent,
and highly coordinated.
``(c) Report.--Not later than one year after the date of the
enactment of the Honoring our Promise to Address Comprehensive Toxics
Act of 2021, and annually thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the House of Representatives and the
Senate a report on any research activities specified in subsection (a)
carried out during the year covered by the report.''.
(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. Coordination of toxic exposure research.''.
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, 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 Committee 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) 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.
(b) Elements.--The study under subsection (a) shall assess, with
respect to each veteran included in the study, the following:
(1) The age of the veteran.
(2) The period of service and length of service of the
veteran in the Armed Forces.
(3) Any military occupational speciality of the veteran.
(4) The gender of the veteran.
(5) 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 located in the
United States;
(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 103(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 103(a)(3).
(6) The term ``TRICARE program'' has the meaning given that
term in section 1072 of such title.
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, or air 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).
(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.
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, or air 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
establish a standard training curriculum 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 shall always
review and consider the Individual Longitudinal
Exposure Record program of the Department of
Veterans Affairs 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
establish a standard medical training curriculum 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.
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 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.
(2) 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.
(3) 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 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
Individual Longitudinal Exposure Record of the member.
(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 achieves full operation
capability, as determined by the Secretary of Defense, and every 180
days thereafter, the Secretary shall, in consultation with the
Secretary of Veterans Affairs, submit to the appropriate committees of
Congress a report on the data quality of the databases of the
Department of Defense that provide the information presented in the
Individual Longitudinal Exposure Record and the usefulness of the
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) 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 and the Secretary of
Veterans Affairs 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.
(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 and the Secretary of Veterans Affairs jointly consider
necessary.
(2) Benefit of the doubt.--In reviewing evidence provided
under paragraph (1), the Secretary of Defense and the Secretary
of Veterans Affairs 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 Veterans Affairs, in
consultation with 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).
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