[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3003 Reported in Senate (RS)]
<DOC>
Calendar No. 145
117th CONGRESS
1st Session
S. 3003
To improve health care and benefits for veterans exposed to toxic
substances, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 19, 2021
Mr. Tester, from the Committee on Veterans' Affairs, reported the
following original bill; which was read twice and placed on the
calendar
_______________________________________________________________________
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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Comprehensive and
Overdue Support for Troops of War Act of 2021'' or the ``COST of War
Act of 2021''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--EXPANSION OF HEALTH CARE FOR TOXIC EXPOSURE VETERANS
Sec. 101. Health care for certain toxic exposure veterans.
Sec. 102. Expansion of health care eligibility for certain veterans
exposed to open burn pits.
Sec. 103. Expansion of health care eligibility for veterans awarded
certain medals.
Sec. 104. Study on feasibility and advisability of furnishing hospital
care and medical services to dependents of
veterans who participated in toxic exposure
risk activities.
TITLE II--REFORMS TO THE TOXIC EXPOSURE PRESUMPTION PROCESS
Sec. 201. Improvements to ability of Department of Veterans Affairs to
establish presumptions of service
connection based on toxic exposure.
Sec. 202. Technical corrections.
TITLE III--REFORMS TO THE SERVICE CONNECTION PROCESS FOR TOXIC EXPOSURE
VETERANS
Sec. 301. Presumptions of toxic exposure.
Sec. 302. Presumption of exposure to airborne hazards and substances
from burn pits.
Sec. 303. Medical nexus examinations for toxic exposures.
TITLE IV--EXPANSION OF PRESUMPTIONS OF SERVICE CONNECTION FOR FORGOTTEN
VETERANS
Sec. 401. Mark Takai Atomic Veterans Healthcare Parity Act of 2021.
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 the Republic of
Vietnam.
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--STRENGTHENING FEDERAL RESEARCH ON TOXIC EXPOSURES
Sec. 501. Coordination by Department of Veterans Affairs of toxic
exposure research.
Sec. 502. Collection, analysis, and report on treatment of veterans for
medical conditions related to toxic
exposure.
Sec. 503. Studies relating to veterans who served in Southwest Asia.
Sec. 504. Study on health trends of post 9/11 veterans.
Sec. 505. Study on cancer rates among veterans.
TITLE VI--IMPROVING SUPPORT TO TOXIC EXPOSURE VETERANS
Sec. 601. Definitions.
Sec. 602. Publication of list of resources of Department of Veterans
Affairs for toxic exposure 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 exposure veterans.
Sec. 605. SFC Heath Robinson Burn Pit Transparency Act.
TITLE VII--STRENGTHENING RECORD-KEEPING OF TOXIC EXPOSURES BY
DEPARTMENT OF DEFENSE
Sec. 701. Definitions.
Sec. 702. Independent study on Individual Longitudinal Exposure Record.
Sec. 703. Biannual report on Individual Longitudinal Exposure Record.
Sec. 704. Correction of toxic exposure records.
TITLE I--EXPANSION OF HEALTH CARE FOR TOXIC EXPOSURE VETERANS
SEC. 101. HEALTH CARE FOR CERTAIN TOXIC EXPOSURE VETERANS.
(a) In General.--Section 1710(e) of title 38, United States Code,
is amended--
(1) paragraph (1), by adding at the end the following new
subparagraph:
``(G) Subject to paragraph (2), any 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, notwithstanding that there is insufficient medical
evidence to conclude that such illness is attributable to such toxic
exposure risk activity.''; and
(2) in paragraph (2)(B)--
(A) by striking ``or (F)'' and inserting ``(F), or
(G)''; and
(B) by striking ``service or testing'' and
inserting ``service, testing, or activity''.
(b) Definitions.--Section 101 of such title 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.
``(B) An exposure to a toxic or hazardous substance
that is subject to regulation by the Occupational
Safety and Health Administration.
``(38) The term `toxic exposure veteran' means any veteran
who--
``(A) carried out a toxic exposure risk activity;
or
``(B) received or receives hospital care, medical
services, or nursing home care pursuant to section
1710(e)(1) of this title.
``(39) The term `toxic exposure risk activity' means any
activity--
``(A) that requires a corresponding entry in the
Individual Longitudinal Exposure Record of the veteran
who carried out the activity; or
``(B) that the Secretary determines qualifies for
purposes of section 1710(e)(1) of this title when
taking into account what is reasonably prudent to
protect the health of veterans.
``(40) 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.''.
SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR CERTAIN VETERANS
EXPOSED TO OPEN BURN PITS.
(a) In General.--Section 1710(e) of title 38, United States Code,
as amended by section 101(a)(2)(A), is further amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(H)(i) Subject to paragraph (2), a covered veteran is eligible
for hospital care, medical services, and nursing home care under
subsection (a)(2)(F) for any illness.
``(ii) For purposes of this subparagraph, a covered veteran is a
veteran who--
``(I) is eligible for inclusion in the Airborne Hazards and
Open Burn Pit Registry; or
``(II) has been identified by the Secretary of Defense to
have been possibly exposed, inside or outside the United
States, during active duty, active duty for training, or
inactive duty training, to an open burn pit.
``(iii) In this subparagraph:
``(I) The term `Airborne Hazards and Open Burn Pit
Registry' means the registry established by the Secretary 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).
``(II) 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).''; and
(2) in paragraph (2)(B), as amended by section
101(a)(2)(A), by striking ``or (G)'' and inserting ``(G), or
(H)''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that is 90 days after the date of the enactment
of this Act.
SEC. 103. EXPANSION OF HEALTH CARE ELIGIBILITY FOR VETERANS AWARDED
CERTAIN MEDALS.
(a) In General.--Section 1710(e) of title 38, United States Code,
as amended by section 102(a)(1), is further amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(I) Subject to paragraph (2), a veteran is eligible for hospital
care, medical services, and nursing home care under subsection
(a)(2)(F) for any illness if the veteran was awarded any of the
following:
``(i) The Afghanistan Campaign Medal.
``(ii) The Armed Forces Expeditionary Medal.
``(iii) The Global War on Terrorism Expeditionary Medal.
``(iv) The Inherent Resolve Campaign Medal.
``(v) The Iraqi Campaign Medal.
``(vi) The Southwest Asia Service Medal.''; and
(2) in paragraph (2)(B), as amended by section 102(a)(2),
by striking ``or (H)'' and inserting ``(H), or (I)''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that is 90 days after the date of the enactment
of this Act.
SEC. 104. STUDY ON FEASIBILITY AND ADVISABILITY OF FURNISHING HOSPITAL
CARE AND MEDICAL SERVICES TO DEPENDENTS OF VETERANS WHO
PARTICIPATED IN TOXIC EXPOSURE RISK ACTIVITIES.
(a) In General.--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 101(a)(1), for any illness or condition 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 or
condition is attributable to such activity.
(b) Elements of Study.--The study required under subsection (a)
shall--
(1) assess 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) assess the potential cost of furnishing hospital care
and medical services to qualifying dependents as described in
such subsection;
(3) estimate the resources required to furnish such care
and services;
(4) assess any stress or other impact furnishing such care
and services would have on the claims and appeals system of the
Department;
(5) estimate the number of qualifying dependents who would
be eligible for such care and services; and
(6) assess 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 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 installations
of the Department of Defense in the United States;
(2) explore the liability of the Department of Defense in
each such case; and
(3) assess whether the Department 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) Hospital care and medical services.--The terms
``hospital care'' and ``medical services'' have the meanings
given those terms in section 1701 of title 38, United States
Code.
(2) Qualifying dependent.--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 101(a)(2) 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 or condition that is connected to the toxic
exposure risk activity of the veteran, as determined by
the Secretary.
(3) TRICARE program.--The term ``TRICARE program'' has the
meaning given that term in section 1072(7) of title 10, United
States Code.
TITLE II--REFORMS TO THE TOXIC EXPOSURE PRESUMPTION PROCESS
SEC. 201. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF VETERANS AFFAIRS TO
ESTABLISH PRESUMPTIONS OF SERVICE CONNECTION BASED ON
TOXIC EXPOSURE.
(a) Advisory Committees, Panels, and Boards.--
(1) Establishment.--Chapter 11 of title 38, United States
Code, is amended by adding at the end the following new
subchapter:
``SUBCHAPTER VII--RESEARCH AND DETERMINATIONS RELATING TO PRESUMPTIONS
OF SERVICE CONNECTION BASED ON TOXIC EXPOSURE
``Sec. 1171. Procedures to determine presumptions of service connection
based on toxic exposure; definitions
``(a) Procedures .--The Secretary shall determine whether to
establish, to modify, or to remove presumptions of service connection
based on toxic exposure pursuant to this subchapter, whereby--
``(1) the Toxic Exposure Review Commission advises the
Secretary and makes recommendations pursuant to section 1172 of
this title;
``(2) the National Academies of Sciences, Engineering, and
Medicine, reviews and evaluates the available scientific
evidence pursuant to an agreement under section 1173 of this
title;
``(3) the working group established under section 1174 of
this title evaluates the conclusions of the National Academies
of Sciences, Engineering, and Medicine pursuant to the
agreement described in paragraph (2) and makes recommendations
to the Secretary under such section; 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 FACA.--The Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to an entity established under this
subchapter.
``Sec. 1172. Toxic Exposure Review Commission
``(a) Establishment.--The Secretary shall establish an independent
commission to be known as the `Toxic Exposure Review Commission' (in
this section referred to as the `Commission').
``(b) Purpose.--The Commission shall--
``(1) advise the Secretary on questions relating to toxic
exposures that require scientific research; and
``(2) assist in the consideration of possible presumptions
of service connection relating to toxic exposure.
``(c) Duties.--(1) The Commission shall carry out the following
duties:
``(A) Collect any relevant information from the Department
of Defense and other sources to identify possible toxic
exposures relating to service during active duty, active duty
for training, or inactive duty training in order to determine
the need for a comprehensive review under an agreement with the
National Academies of Sciences, Engineering, and Medicine under
section 1173 of this title.
``(B) Recommend to the Secretary, by majority vote, whether
a review should be conducted under an agreement with the
National Academies of Sciences, Engineering, and Medicine under
section 1173 of this title.
``(C) Recommend to the Secretary, by majority vote, whether
new, independent studies regarding the health outcomes of toxic
exposures, or any other new, independent studies that the
Commission deems necessary and appropriate, should be
conducted.
``(D) Annually report to Congress on progress regarding the
duties set forth in subparagraphs (A) through (C), any
recommendations made to the Secretary, and any responses of the
Secretary to such recommendations.
``(2)(A) Relevant information may be collected under paragraph
(1)(A) from the following:
``(i) Any Federal agency as the Commission considers
necessary to carry out this section.
``(ii) Public meetings or hearings, which may be held to
take such testimony and receive such evidence as the Commission
considers advisable to carry out the duties of the Commission.
``(B) Upon request of the chairperson of the Commission, the head
of a Federal agency shall furnish information collected under
subparagraph (A)(i) to the Commission unless such information is
classified.
``(d) Membership.--(1)(A) The Commission shall be composed of nine
members, appointed as follows:
``(i) Two members appointed by the majority leader of the
Senate.
``(ii) Two members appointed by the minority leader of the
Senate.
``(iii) Two members appointed by the Speaker of the House
of Representatives.
``(iv) Two members appointed by the minority leader of the
House of Representatives.
``(v) One member appointed by the Secretary.
``(B) The initial members of the Commission shall be appointed
under subparagraph (A) not later than 180 days after the date of the
enactment of the Comprehensive and Overdue Support for Troops of War
Act of 2021.
``(2) In appointing individuals under paragraph (1)(A), the
majority leader of the Senate, the minority leader of the Senate, the
Speaker of the House of Representatives, the minority leader of the
House of Representatives, and the Secretary shall jointly ensure that
at least five members of the Commission are scientists or health care
professionals--
``(A) of whom--
``(i) one has a background in the field of
respiratory medicine;
``(ii) one has a background in the field of
endocrinology and metabolic medicine;
``(iii) one has a background in hematology;
``(iv) one has a background in oncology; and
``(v) one has a background in occupational and
environmental health; and
``(B) who are not officials or employees of the Federal
Government.
``(3) In appointing individuals under paragraph (1)(A), the
majority leader of the Senate, the minority leader of the Senate, the
Speaker of the House of Representatives, the minority leader of the
House of Representatives, and the Secretary shall jointly ensure that
at least two members of the Commission represent an organization
recognized by the Secretary for the representation of veterans under
section 5902 of this title.
``(4) In appointing individuals under paragraph (1)(A), the
majority leader of the Senate, the minority leader of the Senate, the
Speaker of the House of Representatives, the minority leader of the
House of Representatives, and the Secretary shall jointly give
consideration to including in the Commission at least one member who
works with survivors of illnesses relating to toxic exposures and has a
background in the field of study of toxic exposures.
``(e) Meetings.--(1) The Commission shall meet not less frequently
than twice each year.
``(2)(A) Each meeting of the Commission shall be open to the
public.
``(B) All the proceedings, information, and deliberations of the
Commission shall be available for review by the public.
``(C) Meetings of the Commission may be carried out through the use
of telephonic or other appropriate telecommunication technology if the
Commission determines that such technology will allow the members to
communicate simultaneously.
``(f) Chairperson and Vice Chair.--At the initial meeting of the
Commission under subsection (e), the Commission shall select a
chairperson and vice chairperson from among the members of the
Commission by a majority vote of the members of the Commission.
``(g) Period of Appointment; Vacancies.--(1) A member of the
Commission shall be appointed for a term that may not exceed four
years.
``(2) The Secretary shall ensure that terms of members of the
Commission are staggered so that no such terms end on the same date.
``(3) A vacancy in the Commission shall be filled in the same
manner as the original appointment, but the individual appointed to
fill the vacancy shall serve only for the unexpired portion of the term
for which the individual's predecessor was appointed.
``(4) In appointing the initial members of the Commission, each
official who is authorized to appoint two members of the Commission
shall appoint--
``(A) one member whose term expires after two years; and
``(B) one member whose term expires after four years.
``(h) Pay.--(1) Members of the Commission shall serve without pay.
``(2) Each member of the Commission who is an officer or employee
of the United States shall serve without compensation in addition to
that received for service as an officer or employee of the United
States.
``(3) Members shall receive travel expenses, including per diem in
lieu of subsistence, in accordance with sections 5702 and 5703 of title
5.
``(i) Director of Staff.--(1) The Commission shall appoint a
Director who--
``(A) has not served as an employee of the Department
during the one-year period preceding the date of such
appointment; and
``(B) is not otherwise barred or prohibited from serving as
Director under Federal ethics laws and regulations, by reason
of post-employment conflict of interest.
``(2) The Director shall be paid at the rate of basic pay payable
for level IV of the Executive Schedule under section 5315 of title 5.
``(j) Staff.--(1) Subject to paragraphs (2) and (3), the Director,
with the approval of the Commission, may appoint and fix the pay of
additional personnel.
``(2) The Director may make such appointments without regard to the
provisions of title 5 governing appointments in the competitive
service, and any personnel so appointed may be paid without regard to
the provisions of chapter 51 and subchapter III of chapter 53 of that
title relating to classification and General Schedule pay rates, except
that an individual so appointed may not receive pay in excess of the
annual rate of basic pay payable for GS-15 of the General Schedule.
``(3)(A) Not more than two-thirds of the personnel employed by or
detailed to the Commission may be on detail from the Department.
``(B) Not more than half of the professional analysts of the
Commission staff may be persons detailed from the Department to the
Commission.
``(4) Subject to paragraph (3), the head of any Federal agency,
upon the request of the Director, may detail any of the personnel of
that agency to the Commission to assist the Commission in carrying out
its duties under this section.
``(5) The Commission may secure directly from any Federal agency
such information as the Commission considers necessary to carry out
this section. Upon request of the chairperson of the Commission, the
head of such agency shall furnish such information to the Commission,
unless such information is classified.
``(k) Other Authority.--(1) The Commission may procure by contract,
to the extent funds are available, the temporary or intermittent
services of experts or consultants pursuant to section 3109 of title 5.
``(2) To the extent funds are available, the Commission may lease
real property and acquire personal property either of its own accord or
in consultation with the General Services Administration.
``(l) Communications.--(1)(A) Except as provided in subparagraph
(B), no person may restrict an employee of the Department in
communicating with the Commission.
``(B) Subparagraph (A) does not apply to a communication that is
unlawful.
``(2) All ex parte communications with the Commission shall be made
part of the public record.
``(m) Responses by Secretary.--In response to each report submitted
to the Secretary by the Commission under subsection (c)(1), the
Secretary shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives and make available to the public a report on--
``(1) the findings and opinions of the Secretary with
respect to the report most recently submitted under subsection
(c)(1);
``(2) whether the Secretary intends to nominate for review
under an agreement with the National Academies of Sciences,
Engineering, and Medicine under section 1173 of this title the
review recommended by the Committee in the report, and if not,
an explanation of why, including citations and sources; and
``(3) whether the Secretary intends to follow any other
recommendation made by the Commission.
``Sec. 1173. Science review agreement
``(a) Purpose.--The purpose of this section is to provide for the
National Academies of Sciences, Engineering, and Medicine (in this
section referred to as the `Academies'), an independent nonprofit
scientific organization with appropriate expertise that is not part of
the Federal Government, to review and evaluate the available scientific
evidence regarding associations between illnesses and toxic exposures.
``(b) Agreement.--(1) The Secretary shall seek to enter into a 10-
year agreement with the Academies to perform the services covered by
this section.
``(2) The Secretary shall seek to enter into an agreement described
in paragraph (1) not later than 60 days after the date of the enactment
of the Comprehensive and Overdue Support for Troops of War Act of 2021.
``(3) An agreement under this section may be extended in five-year
or 10-year increments.
``(c) Review of Scientific Evidence.--Under an agreement between
the Secretary and the Academies under this section, the Academies shall
review and summarize the scientific evidence, and assess the strength
thereof, concerning the association between toxic exposures during
active military, naval, or air service and each illness suspected to be
associated with such exposure in the human population.
``(d) Scientific Determinations Concerning Illnesses.--For each
illness reviewed under subsection (c), the Academies shall determine,
to the extent that available scientific data permit meaningful
determinations--
``(1) whether an association exists between a toxic
exposure and the occurrence of the illness, taking into account
the strength of the scientific evidence and the appropriateness
of the statistical and epidemiological methods used to detect
the association;
``(2) the increased risk of the illness among those subject
to toxic exposures during active military, naval, or air
service; and
``(3) whether there exists a plausible biological mechanism
or other evidence of a causal relationship between the toxic
exposure and the occurrence of the illness.
``(e) Cooperation of Federal Agencies.--The head of each relevant
Federal agency, including the Secretary of Defense, shall cooperate
fully with the Academies in performing the services covered by this
section.
``(f) Recommendations for Additional Scientific Studies.--(1) Under
an agreement between the Secretary and the Academies under this
section, the Academies shall make any recommendations for additional
scientific studies to resolve areas of continuing scientific
uncertainty relating to toxic exposures.
``(2) In making recommendations under paragraph (1), the Academies
shall consider--
``(A) the scientific information that is available at the
time of the recommendation;
``(B) the value and relevance of the information that could
result from additional studies; and
``(C) the cost and feasibility of carrying out such
additional studies.
``(g) Reports.--(1) Under an agreement between the Secretary and
the Academies under this section, for each review conducted under
subsection (c), the Academies shall submit to the Secretary, the
Committee on Veterans' Affairs of the Senate, and the Committee on
Veterans' Affairs of the House of Representatives an initial report on
the activities of the Academies under the agreement.
``(2) The report submitted under paragraph (1) shall include the
following:
``(A) The determinations described in subsection (d).
``(B) A full explanation of the scientific evidence and
reasoning that led to such determinations.
``(C) Any recommendations of the Academies under subsection
(f).
``(h) Alternative Contract Scientific Organization.--(1) If the
Secretary is unable to enter into an agreement with the Academies for
the purposes of this section on terms acceptable to the Secretary, the
Secretary shall seek to enter into an agreement for the purposes of
this section with another appropriate scientific organization that--
``(A) is not part of the Federal Government;
``(B) operates as a not-for-profit entity; and
``(C) has expertise and objectivity comparable to that of
the Academies.
``(2) If the Secretary enters into an agreement with another
organization as described in paragraph (1), any reference in this
subchapter to the National Academies of Sciences, Engineering, and
Medicine shall be treated as a reference to the other organization.
``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')--
``(1) to evaluate the conclusions of the National Academies
of Sciences, Engineering, and Medicine contained in each report
submitted under section 1173(g) of this title; and
``(2) to develop and submit to the Secretary a
recommendation within 60 days of the Secretary's receipt of a
report under section 1173(g) of this title with respect to
whether--
``(A) to establish a presumption of service
connection between each toxic exposure and illness
covered by a report described in paragraph (1); or
``(B) to modify an existing presumption of service
connection covered by a report described in paragraph
(1).
``(b) Recommendations.--(1) In making a recommendation under
subsection (a)(2), the Working Group shall, 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 additional research, studies, or
reports.
``(2) In making a recommendation under subsection (a)(2), the
Working Group shall consider only the positive association between a
toxic exposure and an illness.
``(3) Concurrent with the submittal of a recommendation to the
Secretary under subsection (a)(2), the Working Group shall submit to
the Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a description of such
recommendation.
``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, and all materials the
Secretary relied upon for the determination.
``(b) Final Regulation.--Not later than 90 days after the date on
which the Secretary issues any proposed regulations under subsection
(a)(1), the Secretary shall issue final regulations. Such regulations
shall be effective on the date of issuance.
``(c) Removal of Presumption.--(1) The Secretary may issue
regulations to remove an illness from a presumption of service
connection previously established pursuant to a regulation issued under
subsection (b).
``(2) Whenever an illness is removed from regulations pursuant to
paragraph (1), or the periods or 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 adding at the end 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. Toxic Exposure Review Commission.
``1173. Science review agreement.
``1174. Working group on presumptions of service connection.
``1175. Regulations regarding presumptions of service connection based
on toxic exposure.''.
(b) Establishment of Working Group.--Not later than 120 days after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall establish the working group required by section 1174(a)
of title 38, United States Code, as added by subsection (a).
(c) Conforming Amendments.--Chapter 11 of title 38, United States
Code, 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 Comprehensive and Overdue
Support for Troops of War 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 Comprehensive and Overdue
Support for Troops of War 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. 202. TECHNICAL CORRECTIONS.
(a) In General.--Subchapter VI of chapter 11 of title 38, United
States Code, is amended--
(1) by redesignating section 1165 as section 1166; and
(2) by redesignating the section 1164 that was added by
section 5501(a)(1) of the Johnny Isakson and David P. Roe, M.D.
Veterans Health Care and Benefits Improvement Act of 2020
(Public Law 116-315) as section 1165.
(b) Conforming Clerical Amendments.--The table of sections at the
beginning of such chapter is amended by striking the items relating to
the section 1164 that was added by section 5501(a)(1) of the Johnny
Isakson and David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (Public Law 116-315) and section 1165 and
inserting the following new items:
``1165. Specialized teams to evaluate claims involving military sexual
trauma.
``1166. Choice of sex of medical examiner for certain disabilities.''.
TITLE III--REFORMS TO THE SERVICE CONNECTION PROCESS FOR TOXIC EXPOSURE
VETERANS
SEC. 301. PRESUMPTIONS OF TOXIC EXPOSURE.
(a) In General.--Subchapter II of chapter 11 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1119. Presumptions of toxic exposure
``(a) Presumption of Toxic Exposure.--Except as provided in section
1120 of this title, if a veteran submits to the Secretary a claim for
compensation for a service-connected disability under section 1110 of
this title with indication of a toxic exposure that occurred during
active military, naval, or air service, the Secretary shall presume
that the veteran was subject to such toxic exposure--
``(1) if the Individual Longitudinal Exposure Record of the
veteran includes evidence of the toxic exposure; or
``(2) in a case in which the Individual Longitudinal
Exposure Record of the veteran does not indicate that the
veteran was subject to the claimed toxic exposure during active
military, naval, or air service, if credible evidence of the
facts, places, and circumstances of the service of the veteran
in the active military, naval, or air service, including
evidence of the veteran's unit assignments, military specialty,
or date and location of service, shows the veteran was subject
to the claimed toxic exposure during such service.
``(b) Role of Lay Statements.--In a case described in subsection
(a)(2), the Secretary shall accept as credible evidence under such
subsection a lay statement by the veteran or another that is consistent
with the other credible evidence of the facts, places, and
circumstances of the veteran's service in the active military, naval,
or air service.''.
(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 1118 the following new item:
``1119. Presumptions of toxic exposure.''.
(c) Conforming Amendment.--Section 1113 of such title is amended by
striking ``or 1118'' each place it appears and inserting ``1118, or
1119''.
SEC. 302. PRESUMPTION OF EXPOSURE TO AIRBORNE HAZARDS AND SUBSTANCES
FROM BURN PITS.
(a) In General.--Subchapter II of chapter 11 of title 38, United
States Code, as amended by section 301(a), is further amended by adding
at the end the following new section:
``Sec. 1120. Presumption of exposure to certain airborne hazards and
substances from participation in contingency operations
``(a) In General.--For purposes of section 1110 and chapter 17 of
this title, any veteran described in subsection (b) shall be presumed
to have been exposed to the substances, chemicals, and hazards listed
in subsection (c), unless there is affirmative evidence to establish
that the veteran was not exposed to any such substances, chemicals, or
hazards during that service.
``(b) Veterans Described.--(1) A veteran described in this
paragraph is any veteran who--
``(A) during active military, naval, or air service, was
deployed in support of a contingency operation while so serving
and as part of such deployment served in a covered location
during a corresponding period set forth under paragraph (2); or
``(B) on or after August 2, 1990, was awarded any of the
following:
``(i) The Afghanistan Campaign Medal.
``(ii) The Armed Forces Expeditionary Medal.
``(iii) The Global War On Terrorism Expeditionary
Medal.
``(iv) The Inherent Resolve Campaign Medal.
``(v) The Iraqi Campaign Medal.
``(vi) The Southwest Asia Service Medal.
``(2)(A) The covered locations and corresponding periods set forth
under this subsection are as follows:
``(i) Iraq and the 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.
``(ii) The Southwest Asia Theater of operations, other than
Iraq, and 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:
``(I) Kuwait.
``(II) Saudi Arabia.
``(III) Oman.
``(IV) Qatar.
``(iii) Afghanistan and the period beginning on September
11, 2001, and ending on such date as the Secretary determines
burn pits are no longer used in Afghanistan.
``(iv) Djibouti and the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Djibouti.
``(v) Syria and the period beginning on September 11, 2001,
and ending on such date as the Secretary determines burn pits
are no longer used in Syria.
``(vi) Jordan and the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Jordan.
``(vii) Egypt and the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Egypt.
``(viii) Lebanon and the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Lebanon.
``(ix) Yemen and the period beginning on September 11,
2001, and ending on such date as the Secretary determines burn
pits are no longer used in Yemen.
``(x) Such other locations as are 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) and corresponding periods set forth in such registry.
``(xi) Such other locations and corresponding periods as
the Secretary, in collaboration with the Secretary of Defense,
may determine appropriate in a report the Secretary of Veterans
Affairs shall submit to Congress not later than two years after
the date of the enactment of the Veterans Burn Pits Exposure
Recognition Act of 2021 and not less frequently than once every
two years thereafter.
``(B) A location set forth under this paragraph shall not include
any body of water around or any airspace above such location.
``(c) Substances, Chemicals, and Airborne Hazards.--(1) Subject to
paragraph (2), the substances, chemicals, and airborne hazards listed
in this subsection are as follows:
``(A) Particulate matter, including the following:
``(i) PM-10.
``(ii) PM-2.5.
``(B) Polycyclic aromatic hydrocarbons (PAHs), including
the following:
``(i) Acenaphthene.
``(ii) Acenaphthylene.
``(iii) Anthracene.
``(iv) Benzo(a)anthracene.
``(v) Benzo(a)pyrene.
``(vi) Benzo(b)fluoroanthene.
``(vii) Benzo(g,h,i)perylene.
``(viii) Benzo(k)fluoroanthene.
``(ix) Chrysene.
``(x) Dibenz(a,h)anthracene.
``(xi) Fluoranthene.
``(xii) Fluorene.
``(xiii) Indeno(1,2,3-cd)pyrene.
``(xiv) Naphthalene.
``(xv) Phenanthrene.
``(xvi) Pyrene.
``(C) Volatile organic compounds (VOCs), including the
following:
``(i) Acetone.
``(ii) Acrolein.
``(iii) Benzene.
``(iv) Carbon Disulfide.
``(v) Chlorodifluoromethane.
``(vi) Chloromethane.
``(vii) Ethylbenzene.
``(viii) Hexane.
``(ix) Hexachlorobutadiene.
``(x) m/p-Xylene.
``(xi) Methylene Chloride.
``(xii) Pentane.
``(xiii) Propylene.
``(xiv) Styrene.
``(xv) Toluene.
``(D) 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) 1,2,3,4,7,8 HXCDF.
``(vi) 1,2,3,6,7,8 HXCDD.
``(vii) 1,2,3,6,7,8 HXCDF.
``(viii) 1,2,3,7,8,9 HXCDD.
``(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.
``(E) Such other substances, chemicals, and airborne
hazards as the Secretary, in collaboration with the Secretary
of Defense, may add under paragraph (2).
``(2) The Secretary may add to or remove from the list under
paragraph (1) as the Secretary determines appropriate in a report the
Secretary shall submit to Congress not later than two years after the
date of the enactment of the Comprehensive and Overdue Support for
Troops of War Act of 2021, and not less frequently than once every two
years thereafter.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 11 of such title, as amended by section 301(b), is further
amended by inserting after the item relating to section 1119 the
following new item:
``1120. Presumption of exposure to certain airborne hazards and
substances from participation in
contingency operations.''.
(c) Conforming Amendment.--Section 1113 of such title, as amended
by section 301, is amended by striking ``or 1119'' each place it
appears and inserting ``1119, or 1120''.
SEC. 303. MEDICAL NEXUS EXAMINATIONS FOR TOXIC EXPOSURES.
(a) In General.--Subchapter VI of chapter 11 of title 38, United
States Code, as amended by title II of this Act, is further amended by
adding at the end the following new section:
``Sec. 1168. Medical nexus examinations for toxic exposures
``(a) In General.--Except as provided in subsection (c), if a
covered veteran submits to the Secretary a claim for compensation for a
service-connected disability under section 1110 of this title relating
to a toxic exposure or exposure to a substance, chemical, or hazard
listed in section 1120(c) of this title during active military, naval,
or air service, and such evidence is not sufficient to establish a
service connection for the disability, the Secretary shall--
``(1) provide the veteran with a medical examination of the
claimed disability relating to such exposure;
``(2) provide the veteran the option to have the
examination provided under paragraph (1) conducted by a
specialist in the field of medicine which covers the
specifically claimed disability; and
``(3) request a medical opinion, as part of the medical
examination provided under paragraph (1), as to whether it is
at least as likely as not that there is a nexus between the
claimed disability and the exposure.
``(b) Covered Veterans.--For purposes of this section, a covered
veteran is--
``(1) a veteran presumed under section 1119(a) of this
title to have been subject to a toxic exposure; or
``(2) a veteran presumed under subsection (a) of section
1120 of this title to have been exposed to a substance,
chemical, or hazard listed in subsection (c) of such section.
``(c) Exception.--Subsection (a) shall not apply in a case in which
a covered veteran claims a disability that is clearly unrelated to the
claimed exposure.
``(d) Considerations in Provision of Medical Opinions.--When
providing the Secretary with a medical opinion requested under
subsection (a)(3), the examiner shall consider the total potential
exposure through all applicable military deployments, and the
synergistic, combined effect of all applicable toxic exposure risk
activities.''.
(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 exposures.''.
TITLE IV--EXPANSION OF PRESUMPTIONS OF SERVICE CONNECTION FOR FORGOTTEN
VETERANS
SEC. 401. MARK TAKAI ATOMIC VETERANS HEALTHCARE PARITY ACT OF 2021.
Section 1112(c)(3)(B) of title 38, United States Code, 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.
Section 1112(c)(3)(B) of title 38, United States Code, 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) In General.--Section 1116 of title 38, United States Code, as
amended by section 201, 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, Kompon 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.''.
(b) Eligibility for Hospital Care and Medical Services.--Section
1710(e)(4) is amended by amending subparagraph (A) to read as follows:
``(A) The term `Vietnam-era herbicide-exposed veteran'
means a veteran who--
``(i) performed covered service, as defined in
section 1116(c) 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.''.
(c) Clerical Amendments.--
(1) Section heading.--The heading for section 1116 is
amended by striking and ``the Republic of Vietnam'' and
inserting ``certain locations''.
(2) Table of sections.--The table of sections at the
beginning of chapter 11 of such title 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 THE
REPUBLIC OF VIETNAM.
Section 1116(a)(2) of title 38, United States Code, 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 of title 38, United States Code, is amended by striking
``became manifest--'' and all that follows through the period at the
end and inserting ``became manifest to a degree of 10 percent or more
at any time.''.
(b) Permanent Extension of Period of Eligibility.--
(1) In general.--Such section is amended by striking
subsection (b).
(2) Conforming amendments.--Such section, as amended by
paragraph (1), is further amended--
(A) by redesignating subsections (c) and (d) as
subsections (b) and (c), respectively; and
(B) in subsection (a)(2)(C), by striking ``under
subsection (d)'' and inserting ``under subsection
(c)''.
(c) Establishing Singular Disability Based Questionnaire.--Such
section, as amended by subsection (b), is further amended by inserting
after subsection (c) the following new subsection (d):
``(d) The Secretary shall develop a Disability Benefits
Questionnaire (DBQ), or successor questionnaire, such that if a Persian
Gulf veteran presents with any one symptom associated with Gulf War
Illness, use of such questionnaire is mandatory for health care
personnel of the Department for the identification of Gulf War
Illness.''.
(d) Training.--Such section is 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) In General.--Subchapter II of chapter 11 of title 38, United
States Code, as amended by section 302(a), is further amended by
inserting after section 1120 the following new section:
``Sec. 1120A. 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 (c) 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) Covered Veterans.--For purposes of this section, a covered
veteran is a veteran presumed under subsection (a) of section 1120 of
this title to have been exposed to a substance, chemical, or hazard
listed in subsection (c) of such section.
``(c) Diseases Specified.--The diseases specified in this
subsection are the following:
``(1) Asthma that was diagnosed after--
``(A) a deployment described in subparagraph (A) of
section 1120(b)(1) of this title; or
``(B) a period of service for which a medal set
forth under subparagraph (B) of such section was
awarded.
``(2) Chronic obstructive pulmonary disease.
``(3) Chronic bronchitis.
``(4) Constrictive bronchiolitis or obliterative
bronchiolitis.
``(5) Emphysema.
``(6) Pleuritis.
``(7) Pulmonary fibrosis.
``(8) Interstitial lung disease.
``(9) Sarcoidosis.
``(10) Respiratory cancer of any type.
``(11) Glioblastoma.
``(12) Rhinitis.
``(13) Sinusitis.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 11 of title 38, United States Code, as amended by section
302(b), is further amended by inserting after the item relating to
section 1120 the following new item:
``1120A. Presumption of service connection for certain diseases
associated with exposure to burn pits and
other toxins.''.
(c) Conforming Amendment.--Section 1113 of such title, as amended
by section 302, is further amended by striking ``or 1120'' each place
it appears and inserting ``1120, or 1120A''.
TITLE V--STRENGTHENING FEDERAL RESEARCH ON TOXIC EXPOSURES
SEC. 501. COORDINATION BY DEPARTMENT OF VETERANS AFFAIRS OF 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. Coordination of toxic exposure research
``(a) In General.--The Secretary shall coordinate all research
activities undertaken 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 described in such subsection are collaborative, transparent,
and highly coordinated.
``(c) Report.--Not later than one year after the date of the
enactment of the Comprehensive and Overdue Support for Troops of War
Act of 2021, and annually thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on all
research activities described in subsection (a) undertaken 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. COLLECTION, ANALYSIS, AND REPORT ON TREATMENT OF VETERANS FOR
MEDICAL CONDITIONS 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 Department of Veterans Affairs in
connection with hospital care, medical services, and nursing
home care furnished under section 1710(a)(2)(F) of title 38,
United States Code; and
(2) is likely to be scientifically useful in determining
the association, if any, between the medical condition of a
veteran and a toxic exposure.
(b) Consent of Patients.--Compilation and analysis by the Secretary
of clinical data of a veteran under subsection (a) shall be conducted,
and such data shall be used, 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 Senate and the
Committee on Veterans' Affairs of the House of Representatives a report
containing--
(1) the data compiled under subsection (a);
(2) an analysis of such data;
(3) a description of the types and incidences of medical
conditions identified by the Department under such subsection;
(4) the explanation of the Secretary for the incidence of
such medical conditions and other explanations for the
incidence of such conditions as the Secretary considers
reasonable; and
(5) the views of the Secretary on the scientific validity
of drawing conclusions from the incidence of such medical
conditions, as evidenced by the data compiled under subsection
(a), regarding any association between such conditions and a
toxic exposure.
(d) 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.
SEC. 503. STUDIES RELATING TO VETERANS WHO SERVED IN SOUTHWEST ASIA.
(a) Analysis.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in coordination with the Secretary of Defense, shall conduct an
updated analysis of total and respiratory disease mortality in
covered veterans.
(2) Elements.--The analysis required by paragraph (1) shall
include, to the extent practicable, the following:
(A) Metrics of airborne exposures.
(B) The location and timing of deployments.
(C) The military occupational specialty.
(D) The Armed Force in which the veteran served.
(E) Pre-existing health status, including with
respect to asthma.
(F) Relevant personal information, including
cigarette and e-cigarette smoking history, diet, sex,
gender, age, race, and ethnicity.
(b) Epidemiological Study.--Not later than 180 days after the date
of the enactment of this Act, the Secretary shall conduct an
epidemiological study of covered veterans that uses the following:
(1) Improved spatio-temporal estimates of ambient air
pollution exposures using advances in retrospective exposure
assessment.
(2) Detailed information on the study subjects obtained
through medical records, administrative data, and other
existing sources, that include--
(A) personal characteristics, including cigarette
and e-cigarette smoking history, diet, sex, gender,
age, race, and ethnicity;
(B) deployment history, including locations,
periods, and number of deployments;
(C) biospecimen data; and
(D) supplementary health status and outcomes data,
including imaging and physiological parameters.
(c) Toxicology Study.--
(1) In general.--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 exposures
of healthy, young members of the Armed Forces, as well as
potentially susceptible members, with preexisting health
conditions.
(2) Elements.--The study required under paragraph (1)
shall--
(A) analyze the study results for mechanistic
markers and clinically relevant outcomes; and
(B) validate serum, tissue, and other biomarkers of
exposure, susceptibility, or effect.
(d) Covered Veteran Defined.--In this section, the term ``covered
veteran'' means any veteran who--
(1) on or after August 2, 1990, served on active duty in--
(A) Bahrain;
(B) Iraq;
(C) Kuwait;
(D) Oman;
(E) Qatar;
(F) Saudi Arabia;
(G) Somalia; or
(H) the United Arab Emirates; or
(2) on or after September 11, 2001, served on active duty
in--
(A) Afghanistan;
(B) Djibouti;
(C) Egypt;
(D) Jordan;
(E) Lebanon;
(F) Syria; or
(G) Yemen.
SEC. 504. STUDY ON HEALTH TRENDS OF POST 9/11 VETERANS.
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.
SEC. 505. STUDY ON CANCER RATES AMONG VETERANS.
(a) In General.--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 required by 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) The military occupational speciality or specialties of
the veteran.
(4) The gender of the veteran.
(5) The type or types of cancer that the veteran has.
TITLE VI--IMPROVING SUPPORT TO TOXIC EXPOSURE VETERANS
SEC. 601. DEFINITIONS.
In this title, the terms ``active military, naval, or air
service'', ``toxic exposure'', and ``toxic exposure 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 EXPOSURE 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 exposure veterans;
(B) families and caregivers of toxic exposure
veterans; and
(C) survivors of toxic exposure veterans (or who
would be toxic exposure veterans were the veterans
alive) 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 EXPOSURE 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 exposure 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) In general.--The Secretary shall establish a training
program 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.
(2) Annual training.--Training provided to processors under
paragraph (1) shall be provided not less frequently than
annually.
SEC. 605. SFC HEATH ROBINSON BURN PIT TRANSPARENCY ACT.
(a) Short Title.--This section may be cited as the ``SFC Heath
Robinson Burn Pit Transparency Act''.
(b) Quarterly Notifications.--
(1) 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.
(2) Elements.--Each report submitted under paragraph (1)
shall include, with respect to each reported case of burn pit
exposure of a covered veteran included in the report, the
following:
(A) Notice of the case, including the medical
facility at which the case was reported.
(B) 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 that the covered
veteran reported as being a location at which
the veteran was exposed to toxic airborne
chemicals and fumes from an open burn pit;
(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.
(3) Protection of information.--The Secretary shall ensure
that the reports submitted under paragraph (1) do not include
the identity of covered veterans or contain other personally
identifiable data.
(c) Annual Report on Cases.--
(1) 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:
(A) The total number of covered veterans.
(B) 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.
(C) A comprehensive list of--
(i) the conditions for which covered
veterans seek treatment; and
(ii) the locations that the covered
veterans reported as being locations at which
the veterans were exposed to toxic airborne
chemicals and fumes from open burn pits.
(D) 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.
(E) The total number of covered veterans who died
after seeking care for an illness relating to exposure
to an open burn pit.
(F) Any updates or trends with respect to the
information described in subparagraphs (A), (B), (C),
(D), and (E) that the Secretary determines appropriate.
(2) Matters included in first report.--The Secretary shall
include in the first report under paragraph (1) information
specified in subsection (b)(2) 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.
(d) 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--
(1) the processing of reported cases of burn pit exposure;
and
(2) 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.
(e) Definitions.--In this section:
(1) 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).
(2) The term ``appropriate congressional committees''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Armed Services of the Senate; and
(B) The Committee on Veterans' Affairs and the
Committee on Armed Services of the House of
Representatives.
(3) 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.
(4) 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).
(5) 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.
TITLE VII--STRENGTHENING RECORD-KEEPING OF TOXIC EXPOSURES BY
DEPARTMENT OF DEFENSE
SEC. 701. DEFINITIONS.
In this title:
(1) Individual longitudinal exposure record.--The term
``Individual Longitudinal Exposure Record'' has the meaning
given that term in section 101(40) of title 38, United States
Code, as added by section 101(b).
(2) Toxic exposure.--The term ``toxic exposure'' has the
meaning given that term in section 101(37) of such title, as so
added.
SEC. 702. 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 evaluate--
(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 experienced by the member
during service in the Armed Forces will be accurately reflected
in the Individual Longitudinal Exposure Record of the member.
(b) Independent Research Entity Described.--An independent research
entity described in this subsection is a federally funded research and
development center with appropriate expertise and analytical capability
to carry out the study required under subsection (a).
SEC. 703. 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 of Defense 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 exposures that may not be
fully captured by the current systems of the Department of
Defense for environmental and occupational 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.
(c) Appropriate Committees of Congress Defined.--In this section,
the term ``appropriate committees of Congress'' means--
(1) the Committee on Armed Services and the Committee on
Veterans' Affairs of the Senate; and
(2) the Committee on Armed Services and the Committee on
Veterans' Affairs of the House of Representatives.
SEC. 704. CORRECTION OF TOXIC EXPOSURE RECORDS.
(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) In general.--To update a record under subsection (a), a
member of the Armed Forces or veteran, as the case may be, must
provide such evidence as the Secretary of Defense and the
Secretary of Veterans Affairs jointly consider sufficient.
(2) Regulations.--The Secretary of Veterans Affairs shall
prescribe by regulation the evidence considered sufficient
under paragraph (1).
Calendar No. 145
117th CONGRESS
1st Session
S. 3003
_______________________________________________________________________
A BILL
To improve health care and benefits for veterans exposed to toxic
substances, and for other purposes.
_______________________________________________________________________
October 19, 2021
Read twice and placed on the calendar