117 HR 3967 IH: Honoring our Promise to Address Comprehensive Toxics Act of 2021
U.S. House of Representatives
2021-06-17
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EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; references to title 38, United States Code; table of contents(a)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 CodeExcept 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)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 veteransSec. 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 processSec. 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 veteransSec. 301. Short title.Sec. 302. Presumptions of toxic exposure.Sec. 303. Medical nexus examinations for toxic exposure risk activities.Title IV—Presumptions of service connectionSec. 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 mattersSec. 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 veteransSec. 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 mattersSec. 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.<enum>I</enum><header>Expansion of health care eligibility for toxic exposed veterans</header><section id="H70A5E6CAE41943CEAA0E7B081C5C69EA"><enum>101.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>Conceding Our Veterans’ Exposures Now And Necessitating Training Act</short-title></quote> or the <quote><short-title>COVENANT Act</short-title></quote>.</text></section><section id="H146F3BAE43744C10B32073152A9D5727"><enum>102.</enum><header>Definitions relating to toxic exposed veterans</header><subsection id="H3717EA5663BD49D4AD9F8A167FCA16BC" commented="no"><enum>(a)</enum><header>In general</header><text><external-xref legal-doc="usc" parsable-cite="usc/38/1710">Section 1710(a)(2)(F)</external-xref> is amended by striking <quote>who was exposed to a toxic substance, radiation, or other conditions, as provided in subsection (e)</quote> and inserting <quote>in accordance with subsection (e), who is a toxic exposed veteran</quote>.</text></subsection><subsection id="H64DC41CF7DD54A28AA87D24F633738D5"><enum>(b)</enum><header>Definitions of toxic exposure and toxic exposed veteran</header><text><external-xref legal-doc="usc" parsable-cite="usc/38/101">Section 101</external-xref> is amended by adding at the end the following new paragraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H414B83483986461DAB77C441E1EF5DC4"><paragraph id="H42214E61219B4923BD3D4F9B4DBB61D8" indent="up1"><enum>(37)</enum><text>The term <term>toxic exposure</term> includes the following:</text><subparagraph id="H6642FBC86A4545B08D67F96DCBEA77BF"><enum>(A)</enum><text>A toxic exposure risk activity, as defined in <external-xref legal-doc="usc" parsable-cite="usc/38/1710">section 1710(e)(4)</external-xref> of this title.</text></subparagraph><subparagraph id="H11D5064719964449815515683BF36B30" commented="no"><enum>(B)</enum><text>An exposure to a substance, chemical, or airborne hazard specified in section 1119(b)(2).</text></subparagraph></paragraph><paragraph id="H89E7DA1FAF5741D899B4D40C41CF9C2A" indent="up1"><enum>(38)</enum><text>The term <term>toxic exposed veteran</term> means a veteran described in <external-xref legal-doc="usc" parsable-cite="usc/38/1710">section 1710(e)(1)</external-xref> of this title.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H44611F04BB594017BD6494D93C639C73"><enum>(c)</enum><header>Definition of toxic exposure risk activity</header><text><external-xref legal-doc="usc" parsable-cite="usc/38/1710">Section 1710(e)(4)</external-xref> is amended by adding at the end the following new subparagraph:</text><quoted-block style="USC" id="H191C3E63027E4F089728497179DF4B87" display-inline="no-display-inline"><subparagraph id="HFFFED7E2FEFD41CA926C0F21B63C4024" indent="up1"><enum>(C)</enum><text>The term <term>toxic exposure risk activity</term> means any activity—</text><clause id="HD1367E8566B94F858FEFB77F1F7A74BF"><enum>(i)</enum><text>that requires a corresponding entry in the Individual Longitudinal Exposure Record of the Department for the veteran who carried out the activity; or</text></clause><clause id="H4AA0C8938C6342839A073D4E7D66771D" commented="no" display-inline="no-display-inline"><enum>(ii)</enum><text>that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H358B9E1396204BF293F337178725533B"><enum>103.</enum><header>Expansion of health care for specific categories of toxic exposed veterans</header><subsection id="H269CB0CF17C34606AE247A2CA97B61C0"><enum>(a)</enum><header>In general</header><text>Section 1710(e), as amended by section 102(c), is further amended—</text><paragraph id="H66C6692895A948E8AAF98D610EBEADBB"><enum>(1)</enum><text>in paragraph (1), by adding at the end the following new subparagraphs: </text><quoted-block style="OLC" display-inline="no-display-inline" id="H91131B849E3749D1B860421085C05D8C"><subparagraph id="HEA3D920E3AA34D2BB44368C1007C8723" indent="up2"><enum>(G)</enum><text display-inline="yes-display-inline">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.</text></subparagraph><subparagraph id="H13E02FE6B2134C97904DE5F29E70A8B9" indent="up2"><enum>(H)</enum><text>Subject to paragraph (2), a covered veteran (as defined in <external-xref legal-doc="usc" parsable-cite="usc/38/1119">section 1119(c)</external-xref> of this title) is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="H85446E73FF7D452B9994DCD949684E05"><enum>(2)</enum><text>in paragraph (2)(B)—</text><subparagraph id="HACD68FA7DAE64AE68EFC1660B42274FC"><enum>(A)</enum><text>by striking <quote>or (F)</quote> and inserting <quote>(F), (G), or (H)</quote>; and</text></subparagraph><subparagraph id="H3C5191ADE0104F66895ECF97C643B8D4"><enum>(B)</enum><text>by striking <quote>service or testing</quote> and inserting <quote>service, testing, or activity</quote>.</text></subparagraph></paragraph></subsection><subsection id="HEAA8CE0F8A5D45A19623E3FA8D4B5AAE"><enum>(b)</enum><header>Resource assessment and report</header><paragraph id="HA94EE5F8B275461A919C97D70B57283F"><enum>(1)</enum><header>Initial assessment and report</header><text>Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—</text><subparagraph id="H657C779843A04F888776B45290357F5F"><enum>(A)</enum><text display-inline="yes-display-inline">complete an assessment to determine—</text><clause id="HDFD66789F0974CB38F4D17D2C26E0844"><enum>(i)</enum><text>the personnel and material resources necessary to implement the amendments made by subsection (a); and</text></clause><clause id="H200E3F0B7A564D20B7778E22385C8DED"><enum>(ii)</enum><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of such title, disaggregated by priority group specified in <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705(a)</external-xref> of such title; and</text></clause></subparagraph><subparagraph id="HD28DD0F0506042C8B44C0BE9D5B2BD91"><enum>(B)</enum><text display-inline="yes-display-inline">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).</text></subparagraph></paragraph><paragraph id="HE4287E2C7EFC4DCF9B194652BEDB362F"><enum>(2)</enum><header>Subsequent reports</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection><subsection id="H5A4228B715C741D4BF63EFF81D99CF62" commented="no"><enum>(c)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall take effect on the date that is the earlier of the following:</text><paragraph id="H45BB538C2A4848B782D44E488D36BD98" commented="no"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="H63C8E3C007A74D58BC23B157BDE97D78" commented="no"><enum>(2)</enum><text>The date that is 18 months after the date of the enactment of this Act.</text></paragraph></subsection></section><enum>II</enum><header>Toxic exposure presumption process</header><section id="HE1696333928E40AD8048C319688E17C0"><enum>201.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>Fairly Assessing Service-related Toxic Exposure Residuals Presumptions Act</short-title></quote> or the <quote><short-title>FASTER Presumptions Act</short-title></quote>.</text></section><section section-type="subsequent-section" id="H838BBA3A96E54645B8BD6F763C2DD6F6"><enum>202.</enum><header>Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure</header><subsection id="H78504F0E57F24811AA0CAD9858BE5B00"><enum>(a)</enum><header>Advisory committees, panels, and boards</header><paragraph id="H05A4452E679A4B76A2C87C09B174B14F"><enum>(1)</enum><header>Establishment</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc-chapter/38/11">Chapter 11</external-xref> is amended by adding at the end the following new subchapter:</text><quoted-block style="USC" display-inline="no-display-inline" id="HD52927FDF7224F4D8867366A52270953"><subchapter id="H84A7E280A36E4A229BF2AD347A7A8293"><enum>VII</enum><header>Research and determinations relating to presumptions of service connection based on toxic exposure</header><section id="HA3DC59D3C655467EA96F4C7FE4C724A8"><enum>1171.</enum><header>Procedures to determine presumptions of service connection based on toxic exposure; definitions</header><subsection id="H1A58DC5008674A76B107DE945F41743C"><enum>(a)</enum><header>Procedures</header><text display-inline="yes-display-inline">The Secretary shall determine whether to establish, or to remove, presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby—</text><paragraph commented="no" id="HD7D1FF8CDBEA4893A2EB96D7CE4B5FD4"><enum>(1)</enum><text display-inline="yes-display-inline">the Formal Advisory Committee on Toxic Exposure under <external-xref legal-doc="usc" parsable-cite="usc/38/1172">section 1172</external-xref> of this title—</text><subparagraph commented="no" id="H94A5D41123E74F648B97391DC6821845"><enum>(A)</enum><text display-inline="yes-display-inline">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;</text></subparagraph><subparagraph commented="no" id="H7ED6D3D8E619447090DA2D2C241F82EC"><enum>(B)</enum><text display-inline="yes-display-inline">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 </text></subparagraph><subparagraph commented="no" id="H7B77C72BB078478FADF9B7474A70EE18"><enum>(C)</enum><text>provides to the Secretary recommendations regarding which cases of possible toxic exposure described in subparagraph (A) the Science Review Board should review;</text></subparagraph></paragraph><paragraph id="H9C87582B5E7147EA9CBC534F2A974A3A"><enum>(2)</enum><text>the Science Review Board under <external-xref legal-doc="usc" parsable-cite="usc/38/1173">section 1173</external-xref> of this title—</text><subparagraph id="H1A232C16074F46FFBAF52889F80F18DA"><enum>(A)</enum><text>reviews cases of possible toxic exposure nominated by the Secretary;</text></subparagraph><subparagraph id="HB7B79C4951AE42A8B07B7A6DD52E5B6F"><enum>(B)</enum><text>reviews research nominated by the Secretary;</text></subparagraph><subparagraph id="H35640E6871814C3B84EBFC6298E287A4"><enum>(C)</enum><text>develops recommendations for new research; and</text></subparagraph><subparagraph id="HEE919ACE644149C9AA37BFD753AD3BF6"><enum>(D)</enum><text>determines the strength of evidence supporting positive association between toxic exposure and an illness;</text></subparagraph></paragraph><paragraph commented="no" id="H528FE8487ED048509A14528802D9641A"><enum>(3)</enum><text>the Working Group under <external-xref legal-doc="usc" parsable-cite="usc/38/1174">section 1174</external-xref> 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</text></paragraph><paragraph id="H997496559B9C45C49A0EEED193ED6621"><enum>(4)</enum><text>the Secretary prescribes regulations under <external-xref legal-doc="usc" parsable-cite="usc/38/1175">section 1175</external-xref> of this title.</text></paragraph></subsection><subsection id="HFEAD0592ED614A909E2697BA320F5785"><enum>(b)</enum><header>Illness defined</header><text display-inline="yes-display-inline">In this subchapter, the term <term>illness</term> includes a disease or other condition affecting the health of an individual. </text></subsection><subsection id="H1D038458E87D483C8CA315800DB09C38"><enum>(c)</enum><header>Nonapplication of sunset requirements</header><text display-inline="yes-display-inline">Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an entity established under this subchapter.</text></subsection></section><section id="HC21E347579C54E6ABB4A32B3BB8374A1"><enum>1172.</enum><header>Formal Advisory Committee on Toxic Exposure</header><subsection id="H1BA99083740C4DB79B294ACB787F1E22"><enum>(a)</enum><header>Establishment</header><paragraph commented="no" display-inline="yes-display-inline" id="HD42954E84E644F36A3060D07D5AFB50E"><enum>(1)</enum><text display-inline="yes-display-inline">There is in the Veterans Health Administration of the Department the Formal Advisory Committee on Toxic Exposure (in this section referred to as the <quote>Committee</quote>).</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFADB98FB8BE24EA49974E7473AD89E49" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HB85662ACBF4E4D62B033291ACEFBC284"><enum>(A)</enum><text>The Committee shall be composed of nine members appointed as follows:</text><clause id="HB3CBF9D15BAE4597A1028FFAC32CD58A" display-inline="no-display-inline" indent="up1"><enum>(i)</enum><text>Five members shall be appointed by the Secretary.</text></clause><clause id="H8F0F4033AC8D4FD3B8907D711361F502" display-inline="no-display-inline" indent="up1"><enum>(ii)</enum><text>One member shall be appointed by the Speaker of the House of Representatives.</text></clause><clause id="HC4367921C8D24249A563EA8089022FC8" display-inline="no-display-inline" indent="up1"><enum>(iii)</enum><text>One member shall be appointed by the minority leader of the House of Representatives.</text></clause><clause id="HA21CCCD5C99F4AA2BBC5FF531C1D3832" display-inline="no-display-inline" indent="up1"><enum>(iv)</enum><text>One member shall be appointed by the majority leader of the Senate.</text></clause><clause id="HE269553DAAD546D9AE661A31AE59A9EC" display-inline="no-display-inline" indent="up1"><enum>(v)</enum><text>One member shall be appointed by the minority leader of the Senate.</text></clause></subparagraph><subparagraph id="HB94A804C464F4CA69BD6DEB00A116FBC" display-inline="no-display-inline" indent="up1"><enum>(B)</enum><text>The members appointed under subparagraph (A) shall meet the following criteria:</text><clause id="HDA84798FF1294F66A80F9196B22585C4" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">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.</text></clause><clause id="H9000F3CE213849F8974889F48F1CC30F" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause><clause id="HE1E8252CAF4345EDABC58E79164DD76B" commented="no"><enum>(iii)</enum><text display-inline="yes-display-inline">At least one member shall be appointed from among individuals who are representatives of disabled veterans.</text></clause><clause id="HECFC9591F7C14EE4B6BB7DB905F4631D" commented="no"><enum>(iv)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph></paragraph><paragraph commented="no" id="H79B1220133AC49D4A5E1EC666813285D" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">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.</text></paragraph><paragraph commented="no" id="H79EAF51BF9A04D949E174FCB2B507C38" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">Each member of the Committee shall be appointed for a two-year term, and may serve not more than three successive terms.</text></paragraph><paragraph commented="no" id="H72354AC42FEC42798B3580133DE5627A" indent="up1"><enum>(5)</enum><text display-inline="yes-display-inline">A vacancy in the Committee shall be filled in the manner in which the original appointment was made.</text></paragraph></subsection><subsection id="HCE32EA46341C4F4D8C6923B233D5BA61"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="H16BFA7CE62BC424CA58C6D9A9A8E8082"><enum>(c)</enum><header>Assessments</header><paragraph commented="no" display-inline="yes-display-inline" id="H0F8DF530948B445795AB50F5F2655CB4"><enum>(1)</enum><text display-inline="yes-display-inline">The Committee shall assess cases of the toxic exposure of veterans and their dependents that occurred during active military, naval, or air service.</text></paragraph><paragraph display-inline="no-display-inline" id="H8E7E24A45D3F42FD8B1D1A5E871D470E" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph><paragraph commented="no" id="H47B4B38E305B4A48B042F5C5006162B3" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">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.</text></paragraph><paragraph id="HFB3D8B10A6854E3692CA216CB9A4E745" indent="up1" commented="no"><enum>(4)</enum><text display-inline="yes-display-inline">The Committee shall on a periodic basis assess the Individual Longitudinal Exposure Record to ensure the accuracy of data collected. </text></paragraph></subsection><subsection id="HA0CF3CE73FFB4ADBB91C213DF334823F"><enum>(d)</enum><header>Research recommendations</header><paragraph commented="no" display-inline="yes-display-inline" id="H78147FB747984219BA33858DC9CBD1DF"><enum>(1)</enum><text>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 <external-xref legal-doc="usc" parsable-cite="usc/38/1173">section 1173</external-xref> of this title.</text></paragraph><paragraph id="H8F7F7DB21EA240D39C8143FCDD6DF56B" indent="up1" commented="no"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection><subsection id="H032DB447B5784E988BD6394E4AEFADC8"><enum>(e)</enum><header>Input</header><paragraph commented="no" display-inline="yes-display-inline" id="HB642D59F38FB4987A62FBF117E5F40DA"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="H409BD5CA1B51465E91FC3E9DBCC3F41C" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">The persons described in this paragraph are persons who may be affected by the actions of the Committee, including—</text><subparagraph id="HB9C7A6226CF74CDE830C608466323FCB"><enum>(A)</enum><text>veterans, the families of veterans, veterans service organizations and representatives, researchers, and other members of the general public; and</text></subparagraph><subparagraph id="HC2B7C01FAD794FCE92A2F665A0B82A70"><enum>(B)</enum><text>departments and agencies of the Federal Government.</text></subparagraph></paragraph></subsection><subsection id="H2F0D2DA7F93B489B98231B04E6B649C2"><enum>(f)</enum><header>Reports by the Committee</header><text>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—</text><paragraph id="HFE9FC8502FDC4C73AA2A6F6A13678497"><enum>(1)</enum><text>recommendations for research under subsection (d), if any; and</text></paragraph><paragraph id="H0E9D8A76796D4D8B942714261D08A0BD"><enum>(2)</enum><text> 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.</text></paragraph></subsection><subsection id="H683ABF31B7A142CAB53B732E7DCB8A00"><enum>(g)</enum><header>Responses by Secretary</header><text display-inline="yes-display-inline">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—</text><paragraph id="HF062D25C1C5B4E45BB26EE2E4025A62E"><enum>(1)</enum><text>the findings and opinions of the Secretary with respect to the report most recently submitted under subsection (f); and</text></paragraph><paragraph id="HF9B2491A234048E1A048EE8C3AADAB42"><enum>(2)</enum><text>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.</text></paragraph></subsection></section><section id="HC4204C4E0A4A4609B0F901190CE576EF"><enum>1173.</enum><header>Science Review Board</header><subsection id="HC031656782284D7DB0F54C3934942836"><enum>(a)</enum><header>Establishment</header><paragraph commented="no" display-inline="yes-display-inline" id="HDE1D39583C5B4E0BBB9DB16AAD8D3F2F"><enum>(1)</enum><text display-inline="yes-display-inline">There is in the Veterans Health Administration of the Department the Science Review Board (in this section referred to as the <quote>Board</quote>).</text></paragraph><paragraph id="H3BF54EF6FB6641D7B29CA42A82709184" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H5736EEE8BCE044CC8DCAACF35DCCE6D9"><enum>(A)</enum><text display-inline="yes-display-inline">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.</text></subparagraph><subparagraph id="HAD3C9E5E2A5D446EABE0C4F9BD80297D" indent="up1" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">An individual may not concurrently serve on the Board and the Formal Advisory Committee on Toxic Exposure under <external-xref legal-doc="usc" parsable-cite="usc/38/1172">section 1172</external-xref> of this title.</text></subparagraph><subparagraph id="HA95D53D07693472C8A62FE2A4127B9D1" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">The Secretary shall determine the number, terms of service, and pay and allowances of members of the Board appointed by the Secretary.</text></subparagraph></paragraph></subsection><subsection commented="no" id="H4A1B783AAC6B46239230EB2C1EAB1389"><enum>(b)</enum><header>Duties</header><paragraph commented="no" display-inline="yes-display-inline" id="H787212D22264429997D74BE5AC17F2A9"><enum>(1)</enum><text display-inline="yes-display-inline">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—</text><subparagraph commented="no" id="H9FDE0645D37A43AB8F0FB606B420E503" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">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</text></subparagraph><subparagraph commented="no" id="H2EB01B2A52D549E294A19932FF4B380C" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph><paragraph commented="no" id="HD1919BFA1DD24D7F920714D4C69449B1" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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:</text><subparagraph commented="no" id="H36A611459CBD4EA0BA3ADD78C7010FF4"><enum>(A)</enum><text display-inline="yes-display-inline">The <quote>sufficient</quote> category, where the evidence is sufficient to conclude that a positive association exists.</text></subparagraph><subparagraph commented="no" id="H57166CC8E87544629039DD6FC02B0257"><enum>(B)</enum><text display-inline="yes-display-inline">The <quote>equipoise and above</quote> 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.</text></subparagraph><subparagraph commented="no" id="HF109194F7A534E4E8FC42F74A7AF5A1E"><enum>(C)</enum><text display-inline="yes-display-inline">The <quote>below equipoise</quote> 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.</text></subparagraph><subparagraph commented="no" id="HF245ECE9E265498994F635A63A45CCC8"><enum>(D)</enum><text display-inline="yes-display-inline">The <quote>against</quote> category, where the evidence suggests the lack of a positive association.</text></subparagraph></paragraph><paragraph commented="no" id="H25E3B7C7ADED4F23B4CB3C20EE7C60ED" indent="up1"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="H7962AB4DC86143D9A0DB0BA2D0D207D2"><enum>(A)</enum><text>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.</text></subparagraph><subparagraph commented="no" id="HAB7DFF95D3374A3186864C06824A9AEE" indent="up1"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="H24053D24058D414BBFD401A2D34DDB68"><enum>(i)</enum><text display-inline="yes-display-inline">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.</text></clause><clause commented="no" indent="up1" id="H31601A4262E8465AAF806BFA457C5216"><enum>(ii)</enum><text display-inline="yes-display-inline">In calculating the service-attributable fraction of illness, the Board shall consider the dose-response relationships.</text></clause></subparagraph></paragraph><paragraph commented="no" id="HF17A4ACAEDDA4CFCA071DD5BDEBFAF6C" indent="up1"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HC1972AFADAF44C86925DAD1DCCA1162E"><enum>(A)</enum><text>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.</text></subparagraph><subparagraph id="HEC5CEF8C2E8241999B5330DD012FA000" indent="up1" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph></subsection><subsection commented="no" id="H40A2E46B195146C8800FAE2CAD09BAFE"><enum>(c)</enum><header>Reports</header><paragraph commented="no" display-inline="yes-display-inline" id="HC1DF97355DB24F4CABFC97E06FB8F387"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text></paragraph><paragraph id="H9A9EA2AE2A544D799B998A39908DA97D" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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).</text></paragraph></subsection><subsection display-inline="no-display-inline" commented="no" id="HB922EF09220649A1BFF2713E7E7553DF"><enum>(d)</enum><header>Responses from the Secretary</header><paragraph commented="no" display-inline="yes-display-inline" id="HF7428C79BCFB470EA3E741F6030112E2"><enum>(1)</enum><text>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.</text></paragraph><paragraph display-inline="no-display-inline" commented="no" indent="up1" id="H1073FA96BE67404395A6BC79EA44C510"><enum>(2)</enum><text>Each report submitted under paragraph (1) of this subsection shall include, with respect to a report received under subsection (c)(1), the following:</text><subparagraph id="H5488FBC4D9AF4D3E87A56C1A19745277"><enum>(A)</enum><text>The findings and opinions of the Secretary with respect to the report received under subsection (c)(1).</text></subparagraph><subparagraph id="HE34679C9473E485B9AF8283202E93E37"><enum>(B)</enum><text>Whether the Secretary intends to nominate to the Working Group, established under <external-xref legal-doc="usc" parsable-cite="usc/38/1174">section 1174(a)</external-xref> 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. </text></subparagraph></paragraph></subsection></section><section id="H9A15C78D20AA447693901526E7084C89"><enum>1174.</enum><header>Working group on presumptions of service connection</header><subsection id="H9D9F8D27009546A6AB8CFD0F2DD310F2"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">The Secretary shall establish a working group (in this section referred to as the <quote>Working Group</quote>) to—</text><paragraph id="HA47B422A2A5A4EEAAADDE53B61B8AC53"><enum>(1)</enum><text>evaluate—</text><subparagraph id="H8CBD3FF5E1E547AAA2B1B06F3BD7AED3"><enum>(A)</enum><text>the conclusions of the Science Review Board contained in each report submitted under <external-xref legal-doc="usc" parsable-cite="usc/38/1173">section 1173(c)(1)</external-xref> of this title; and</text></subparagraph><subparagraph id="H4BB70667BF5A4C42973FAA37C579F9EA" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">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</text></subparagraph></paragraph><paragraph commented="no" id="H637470EFD8A343FA893A2AE6D9FB8119"><enum>(2)</enum><text display-inline="yes-display-inline">develop and submit to the Secretary a recommendation with respect to whether—</text><subparagraph commented="no" id="HE33B11D9F4974A0F8252C1B277B3F8C8"><enum>(A)</enum><text>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</text></subparagraph><subparagraph commented="no" id="HB9B023FAFEAB44D9A2798F45C25F2CEA"><enum>(B)</enum><text>to modify an existing presumption of service connection described in subparagraph (B) of such paragraph.</text></subparagraph></paragraph></subsection><subsection id="H67AD0C87E0E8490AA9B1C2EE3606F85A"><enum>(b)</enum><header>Recommendations</header><paragraph commented="no" display-inline="yes-display-inline" id="H6254F9E90172496E8381BCA6D3F8DEF5"><enum>(1)</enum><text display-inline="yes-display-inline">In making a recommendation under subsection (a)(2), the Working Group shall—</text><subparagraph id="H5DA8F6640E1B4454A921125E0E869896" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/38/1173">section 1173(b)(2)</external-xref> of this title, weigh such evidence heavily in favor of establishing a presumption of service connection;</text></subparagraph><subparagraph id="H5FFD650777404F3D8502F79B4DE72A36" indent="up1"><enum>(B)</enum><text>take into consideration such factors as may be determined appropriate by the Secretary; and</text></subparagraph><subparagraph id="H043B5629DBBE49E3AFF0104D4CBD5E3F" indent="up1"><enum>(C)</enum><text>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.</text></subparagraph></paragraph><paragraph display-inline="no-display-inline" id="H71779D59262546E5B47347169D79C8AD" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection><subsection id="H2CC013251BA14C58ABC52E0AE20A22F5"><enum>(c)</enum><header>Report</header><text>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.</text></subsection></section><section id="HE3C0E8CEBC624DDE836B9EBE7A6178BD"><enum>1175.</enum><header>Regulations regarding presumptions of service connection based on toxic exposure</header><subsection id="HCB78C327783542259C2E179B9F772883"><enum>(a)</enum><header>Action upon Working Group recommendation</header><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/38/1174">section 1174(a)(2)</external-xref> of this title—</text><paragraph id="HD383C8F166BC447EA6E972383A26AFFD"><enum>(1)</enum><text display-inline="yes-display-inline">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</text></paragraph><paragraph id="H3874BB0172F642B7A37597C3BAB98561"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection><subsection id="HEDC00FB533C64094BF5752253FA0534C"><enum>(b)</enum><header>Final regulation</header><text display-inline="yes-display-inline">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.</text></subsection><subsection commented="no" id="H9A52E312700E4F5EB4F663E6F4C3E738"><enum>(c)</enum><header>Removal of presumption</header><paragraph commented="no" display-inline="yes-display-inline" id="HBF797BF2FF3D44C29DCA55AFD8970AF4"><enum>(1)</enum><text>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).</text></paragraph><paragraph commented="no" id="H67C26A3B729547AC9A017FE0A3DB4A8D" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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)—</text><subparagraph commented="no" id="H37A629C253194B7B832625FF80DC79FA"><enum>(A)</enum><text display-inline="yes-display-inline">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</text></subparagraph><subparagraph commented="no" id="H436679AD874046D18C69BA5DC7917DBF"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph></subsection></section></subchapter><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="HF5EB5F9AA4E8486680BCD6E306D38896"><enum>(2)</enum><header>Clerical amendment</header><text>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:</text><quoted-block style="USC" display-inline="no-display-inline" id="H36BFC1A33BD54ED4A90818EF042B6D41"><toc regeneration="no-regeneration"><toc-entry level="subchapter">Subchapter VII—Research and determinations relating to presumptions of service connection based on toxic exposure </toc-entry><toc-entry level="section">1171. Procedures to determine presumptions of service connection based on toxic exposure; definitions. </toc-entry><toc-entry level="section">1172. Formal Advisory Committee on Toxic Exposure. </toc-entry><toc-entry level="section">1173. Science Review Board. </toc-entry><toc-entry level="section">1174. Working group on presumptions of service connection. </toc-entry><toc-entry level="section">1175. Regulations regarding presumptions of service connection based on toxic exposure.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H00E71B9CE3CA48B29CB2B53A2CFB6F76"><enum>(b)</enum><header>Conforming amendments</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc-chapter/38/11">Chapter 11</external-xref> is amended—</text><paragraph id="H82A75257085F4200B3EBF7385D688542"><enum>(1)</enum><text>in section 1116—</text><subparagraph id="H04CB6A6F7D994929972A69D947A3430E"><enum>(A)</enum><text>by striking subsections (b), (c), (d), and (e);</text></subparagraph><subparagraph commented="no" id="HEF4A9E3907944A22B703C798D065615D"><enum>(B)</enum><text>by inserting after subsection (a) the following new subsection (b):</text><quoted-block style="USC" display-inline="no-display-inline" id="H1FDCF1173E054184AFE1BEBCF4FA74D0"><subsection commented="no" id="HE4D6D7858E614048911410544B857012"><enum>(b)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="public-law" parsable-cite="pl/102/4">Public Law 102–4</external-xref>).</text></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph id="H5FF992836C614BE6BC9EAF9DFEF912FE"><enum>(C)</enum><text>by redesignating subsection (f) as subsection (c);</text></subparagraph></paragraph><paragraph commented="no" id="HF80901B995D24E6AA366F50875C2F85E"><enum>(2)</enum><text>in section 1116B(b)(2)(A), by inserting <quote>pursuant to subchapter VII of this chapter,</quote> before <quote>the Secretary determines</quote>; and</text></paragraph><paragraph commented="no" id="HF185CE311FA3457C9FF438FA7B91ACBE"><enum>(3)</enum><text>in section 1118—</text><subparagraph commented="no" id="H3B4C3E4A3C154480AACEE84F58763BF2"><enum>(A)</enum><text>by striking subsections (b) through (e); and</text></subparagraph><subparagraph commented="no" id="H77C9BFBC98674689A82770AD1E0C5B24"><enum>(B)</enum><text>by inserting after subsection (a) the following new subsection (b):</text><quoted-block style="USC" display-inline="no-display-inline" id="H1FA1A639D0F94813B37C5EC95FF863EF"><subsection commented="no" id="H91068F5A62444DFC9A16579188243B4A"><enum>(b)</enum><text display-inline="yes-display-inline">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.</text></subsection><after-quoted-block>. </after-quoted-block></quoted-block></subparagraph></paragraph></subsection></section><section commented="no" id="H86CBA15A97A54AC4B83854A0BF9D3833"><enum>203.</enum><header>Reevaluation of claims for compensation involving presumptions of service connection</header><subsection commented="no" id="H5337BDFD712E43F69FF6E278C3582522"><enum>(a)</enum><header>In general</header><text>Subchapter VI of chapter 11 is amended by adding at the end the following new section:</text><quoted-block style="USC" display-inline="no-display-inline" id="HFA3487B962D440D088A4C4FAF57B5D09"><section commented="no" id="HD789332FC42A48F99D8A73E361071950"><enum>1167.</enum><header>Reevaluation of compensation determinations pursuant to changes in presumptions of service connection</header><subsection commented="no" id="H18014EEEDC0C46A8B6BD7ECA7784E577"><enum>(a)</enum><header>Reevaluation</header><text display-inline="yes-display-inline">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—</text><paragraph commented="no" id="H14509581FAC14448846E96FE84F34480"><enum>(1)</enum><text display-inline="yes-display-inline">identify all claims for compensation under this chapter that—</text><subparagraph commented="no" id="HDA12105A2C6446E69BCE172070911188"><enum>(A)</enum><text display-inline="yes-display-inline">were submitted to the Secretary;</text></subparagraph><subparagraph commented="no" id="HC5E7EADB221E4682AE441AD7FA497CA0"><enum>(B)</enum><text>were evaluated and denied by the Secretary before the date on which such provision of law went into effect; and</text></subparagraph><subparagraph commented="no" id="HB8CD4BA9A36E4D19BD289755120983F3"><enum>(C)</enum><text>might have been evaluated differently had the establishment or modification been applicable to the claim;</text></subparagraph></paragraph><paragraph commented="no" id="H5F328B057CDF4DAAA44FFA98C45C97AD"><enum>(2)</enum><text>allow for the reevaluation of such claims at the election of the veteran; and</text></paragraph><paragraph id="HB0C14D2DDC034AFFA8E99DB5DEFF2422"><enum>(3)</enum><text>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).</text></paragraph></subsection><subsection id="H2B5A7F32114E4F2D8149AE48198FD9AC"><enum>(b)</enum><header>Outreach</header><text display-inline="yes-display-inline">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:</text><paragraph id="HCE9ACA1B70BE438DB4B4564F78626FD1" display-inline="no-display-inline"><enum>(1)</enum><text>The Secretary shall publish on the internet website of the Department a notice that such veterans may elect to have a claim so reevaluated.</text></paragraph><paragraph id="H2F70BCFEC37940FFADBB5AA178731A4D" display-inline="no-display-inline"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection commented="no" id="H04A8025D8F044C2B9AD664D1C978A558"><enum>(c)</enum><header>Relation to other laws</header><text display-inline="yes-display-inline">The Secretary shall carry out subsection (a) to the degree that doing so does not conflict with any other provision of law.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" id="H6837B6294AE9499C999214D99E8E80FC"><enum>(b)</enum><header>Clerical amendment</header><text>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:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H168C48B46A47456CBA7106E1D27D3C31"><toc><toc-entry level="section" bold="off">1167. Reevaluation of compensation determinations pursuant to changes in presumptions of service connection.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H6BDE3B30C92241DA943C2EF42F372E58" commented="no"><enum>(c)</enum><header>Application</header><text display-inline="yes-display-inline">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.</text></subsection></section><enum>III</enum><header>Improving the establishment of service connection process for toxic exposed veterans</header><section id="HBBB12652AB24417CA7171DB2E957DC55"><enum>301.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>Veterans Burn Pits Exposure Recognition Act</short-title></quote>. </text></section><section id="H69E4CBDE06DF4A808862E1219BCAE3E3"><enum>302.</enum><header>Presumptions of toxic exposure</header><subsection id="HA25583B557AB4CA48FFCC95BDF11134A"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter II of chapter 11 is amended by adding at the end the following new section:</text><quoted-block style="USC" display-inline="no-display-inline" id="H0248630EBA114F348B1C03593CC05BF7"><section id="H7963564E7A5D420F94EA57AB59D45425"><enum>1119.</enum><header>Presumptions of toxic exposure</header><subsection id="H6A82A5A687994029B3BC9B5F69D66325"><enum>(a)</enum><header>Consideration of Individual Longitudinal Exposure Record required</header><text>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—</text><paragraph id="H25A73BD1B7EC498FABDC57ACF9CF7258"><enum>(1)</enum><text>the Individual Longitudinal Exposure Record of the veteran; and</text></paragraph><paragraph id="HF63D8D1D989D4E36BF2840520FC8694D" commented="no"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="H8D665E9080754A3D92B6B907F5BEA23D"><enum>(b)</enum><header>Presumption of specific toxic exposure for members who served in certain locations</header><paragraph commented="no" display-inline="yes-display-inline" id="H4ACE16AED3FE4B06968CCC6A6BF28749"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="H0AA1C526EB4D481382B3D5DBD5F19986" changed="not-changed" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HAE0C81A5371C4B9F8B473C829E78B347" changed="not-changed"><enum>(A)</enum><text>Subject to subparagraph (B), the substances, chemicals, and airborne hazards listed in this paragraph are as follows:</text><clause id="HA95F801C9FA644CFA020180BA8D111C4" changed="not-changed" indent="up1"><enum>(i)</enum><text>Particulate matter, including the following:</text><subclause id="H29B8C663A4E34FCAB2C251684055A72C" changed="not-changed"><enum>(I)</enum><text>PM-10.</text></subclause><subclause id="HB4469B517C2E4157BF2A3AAEB498ABA3" changed="not-changed"><enum>(II)</enum><text>PM-2.5.</text></subclause></clause><clause id="H35EF445AA133435AB685E7A4AED2F59C" changed="not-changed" indent="up1"><enum>(ii)</enum><text>Polycyclic aromatic hydrocarbons (PAHs), including the following:</text><subclause id="H24529A0EF270412996A929E81A4280DC" changed="not-changed"><enum>(I)</enum><text>Acenaphthene.</text></subclause><subclause id="H5B8B9394FC4A49F0A17B3D743438FCB4" changed="not-changed"><enum>(II)</enum><text>Acenaphthylene.</text></subclause><subclause id="H60D6CC4C80444B56B178C66022350CDB" changed="not-changed"><enum>(III)</enum><text>Anthracene.</text></subclause><subclause id="HD1826623CBF542B094F42AB98A668E4C" changed="not-changed"><enum>(IV)</enum><text>Benzo(a)anthracene.</text></subclause><subclause id="HF797FFE3624F4CD69193A9C986A66384" changed="not-changed"><enum>(V)</enum><text>Benzo(a)pyrene.</text></subclause><subclause id="H9A458186F9564B0A9375DE59463AB095" changed="not-changed"><enum>(VI)</enum><text>Benzo(b)fluoranthene.</text></subclause><subclause id="H5543692154174AFE9AA957C29A7FEA78" changed="not-changed"><enum>(VII)</enum><text>Benzo(g,h,i)perylene.</text></subclause><subclause id="HEB7B860E6CA4472AB25F8A34BC5E9FA7" changed="not-changed"><enum>(VIII)</enum><text>Benzo(k)fluoranthene.</text></subclause><subclause id="HED101C1299B44DEB9682549D6C266B9A" changed="not-changed"><enum>(IX)</enum><text>Chrysene.</text></subclause><subclause id="H1918A5636FCB413CB1C377A34638FAAA" changed="not-changed"><enum>(X)</enum><text>Dibenz(a,h)anthracene.</text></subclause><subclause id="H1360D54001814D938BD07C90D6E6F208" changed="not-changed"><enum>(XI)</enum><text>Fluoranthene.</text></subclause><subclause id="HC8A6C03F589749BB8C3B8CDE36EDCA01" changed="not-changed"><enum>(XII)</enum><text>Fluorene.</text></subclause><subclause id="H2FBD430148FA4026A2A388DBB1CAB516" changed="not-changed"><enum>(XIII)</enum><text>Indeno(1,2,3-cd)pyrene.</text></subclause><subclause id="HD9402012AF0F4CE199CAEDFFFCC14A0D" changed="not-changed"><enum>(XIV)</enum><text>Naphthalene.</text></subclause><subclause id="H8FBC336E291B4E46B511C255224EA99A" changed="not-changed"><enum>(XV)</enum><text>Phenanthrene.</text></subclause><subclause id="H76B74F69483F425893CFC2D7E6995EE3" changed="not-changed"><enum>(XVI)</enum><text>Pyrene.</text></subclause></clause><clause id="HC7D4A2DB2BF745D38C134DFF746E6F89" changed="not-changed" indent="up1"><enum>(iii)</enum><text>Volatile organic compounds (VOCs), including the following:</text><subclause id="H76E91EC91E82427DB6A9C06AD3A32E0B" changed="not-changed"><enum>(I)</enum><text>Acetone.</text></subclause><subclause id="H749E3AE3FE48487B9B38736C0AFEA61E" changed="not-changed"><enum>(II)</enum><text>Acrolein.</text></subclause><subclause id="HF5559B0512034A7995560FCF5A48DCD9" changed="not-changed"><enum>(III)</enum><text>Benzene.</text></subclause><subclause id="H4EE2B901185F417799068A66E79E9B39" changed="not-changed"><enum>(IV)</enum><text>Carbon Disulfide.</text></subclause><subclause id="HD0AF0E978B8040B480545CF191ED6D9C" changed="not-changed"><enum>(V)</enum><text>Chlorodifluoromethane.</text></subclause><subclause id="H06D864D229D84114B9F996ADFF4F4EA1" changed="not-changed"><enum>(VI)</enum><text>Chloromethane.</text></subclause><subclause id="H60764E2C13F94C5E8501EFC67ACCCCFB" changed="not-changed"><enum>(VII)</enum><text>Ethylbenzene.</text></subclause><subclause id="H284D656B59544C4CB20CD4745D8FE771" changed="not-changed"><enum>(VIII)</enum><text>Hexachlorobutadiene.</text></subclause><subclause id="HC2BD3A2E0E8843E3AF4A875F957B1FEB" changed="not-changed"><enum>(IX)</enum><text>Hexane.</text></subclause><subclause id="H52426D686214417CBB80E95648BD88F8" changed="not-changed"><enum>(X)</enum><text>m/p-Xylene.</text></subclause><subclause id="HC24EAF277B3A4BBE9D3A2CF446948826" changed="not-changed"><enum>(XI)</enum><text>Methylene Chloride.</text></subclause><subclause id="HB4FC4B33314340588441D314EEC1DD38" changed="not-changed"><enum>(XII)</enum><text>Pentane.</text></subclause><subclause id="H5498FA488CCD4ED68AAB9539212977E5" changed="not-changed"><enum>(XIII)</enum><text>Propylene.</text></subclause><subclause id="HDB740CF2B5DA470EB973C9036257EB86" changed="not-changed"><enum>(XIV)</enum><text>Styrene.</text></subclause><subclause id="H377AC46533694A3783ED336C47DE3C81" changed="not-changed"><enum>(XV)</enum><text>Toluene.</text></subclause></clause><clause id="HCA9FD5C7BABF4AA09A736E8AC5124843" changed="not-changed" indent="up1"><enum>(iv)</enum><text>Toxic organic halogenated dioxins and furans (dioxins), including the following:</text><subclause id="H50E13FC71B634AF7AC55188A5000B0BC" changed="not-changed"><enum>(I)</enum><text>1,2,3,4,6,7,8 HPCDD.</text></subclause><subclause id="H24643A6E32644FA280518276C495BF8E" changed="not-changed"><enum>(II)</enum><text>1,2,3,4,6,7,8 HPCDF.</text></subclause><subclause id="H41562B20FBFF48FCB62519B3C94E7F8E" changed="not-changed"><enum>(III)</enum><text>1,2,3,4,7,8,9 HPCDF.</text></subclause><subclause id="HC6EF3516A18D4353AE5582F57C5FFAF4" changed="not-changed"><enum>(IV)</enum><text>1,2,3,4,7,8 HXCDD.</text></subclause><subclause id="HC98B6A11442C42FC81441AD7F23A414B" changed="not-changed"><enum>(V)</enum><text>1,2,3,6,7,8 HXCDD.</text></subclause><subclause id="H8770E5C46CD44CFEACCCB0DEF0689040" changed="not-changed"><enum>(VI)</enum><text>1,2,3,7,8,9 HXCDD.</text></subclause><subclause id="H0846948A9BD74FAAB7265563DF8F14CE" changed="not-changed"><enum>(VII)</enum><text>1,2,3,4,7,8 HXCDF.</text></subclause><subclause id="H6DFFF0C4730745009553DA6820295CC6" changed="not-changed"><enum>(VIII)</enum><text>1,2,3,6,7,8 HXCDF.</text></subclause><subclause id="H2CA4B3C29FA540B3B6984E598958B488" changed="not-changed"><enum>(IX)</enum><text>1,2,3,7,8,9 HXCDF.</text></subclause><subclause id="H6F34E6AA6530452185C93542AD96756E" changed="not-changed"><enum>(X)</enum><text>1,2,3,7,8 PECDD.</text></subclause><subclause id="HC29B1D91BED0455597D64895004F2BAD" changed="not-changed"><enum>(XI)</enum><text>1,2,3,7,8 PECDF.</text></subclause><subclause id="HCADC3E139F354E76BD8FBAD10E408D86" changed="not-changed"><enum>(XII)</enum><text>2,3,4,6,7,8 HXCDF.</text></subclause><subclause id="H907C4F947184467988EE081BF036A0CF" changed="not-changed"><enum>(XIII)</enum><text>2,3,4,7,8 PECDF.</text></subclause><subclause id="HEC069EABF1A44856993DE13BC229342E" changed="not-changed"><enum>(XIV)</enum><text>2,3,7,8 TCDD.</text></subclause><subclause id="H2BE435E94B8E4BD1B46683EEE99FD0A5" changed="not-changed"><enum>(XV)</enum><text>2,3,7,8 TCDF.</text></subclause><subclause id="H1F507CA5B4644695BA4DAB5E7C2C25B7" changed="not-changed"><enum>(XVI)</enum><text>Octachlorodibenzodioxin.</text></subclause><subclause id="HD2C1EEDA16F341D9B5225DC33C7BBA5A" changed="not-changed"><enum>(XVII)</enum><text>Octachlorodibenzofuran.</text></subclause></clause><clause id="H2FB47250629243E4A4E99CB27C612063" changed="not-changed" indent="up1"><enum>(v)</enum><text>Such other substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate.</text></clause></subparagraph><subparagraph id="HB69AC34992424D9AA639CD1EF7D1CA61" changed="not-changed" indent="up1" commented="no"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="H8AB80714E57D40088B53952E9535CE04" changed="not-changed"><enum>(i)</enum><text>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.</text></clause><clause id="HA8FF7BEBEB1E4A718F2C4FAF3BDD0F01" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph></paragraph></subsection><subsection id="H1F864DB67B784EF7AAF97261DE1D84B5"><enum>(c)</enum><header>Definitions</header><text>In this section:</text><paragraph id="H3C7EC88A51F04664A4F62043B570DD7A"><enum>(1)</enum><text>The term <quote>covered veteran</quote> means any veteran who—</text><subparagraph id="HB3A4D4E76E1349EEAF3C6381DA622E58"><enum>(A)</enum><text display-inline="yes-display-inline">on or after August 2, 1990, performed active military, naval, or air service while assigned to a duty station in—</text><clause id="H48EAA853B8914A7EBCF0E5A387ABDE1F"><enum>(i)</enum><text>Bahrain;</text></clause><clause id="HE98635DEE2654BE1A2CE32518C9DA76D"><enum>(ii)</enum><text>Iraq;</text></clause><clause id="HDD7950165E7740349B352CBDDC35A177"><enum>(iii)</enum><text>Kuwait;</text></clause><clause id="HF6BE425272E9441685D37A9A7C26AD4B"><enum>(iv)</enum><text>Oman;</text></clause><clause id="H854B430F77D34E11B36F1A88F176F6EC"><enum>(v)</enum><text>Qatar;</text></clause><clause id="H8218C63FED3344AB80BB16F5B0F60D95"><enum>(vi)</enum><text>Saudi Arabia; </text></clause><clause id="HF073EDA40DF44B5290B7FD6E27D979DF"><enum>(vii)</enum><text>Somalia; or</text></clause><clause id="H7C947BAFE65440AE9264A11386038CC0"><enum>(viii)</enum><text>United Arab Emirates; or</text></clause></subparagraph><subparagraph id="HE2B6523BAE8941E3ACDABD7DB678BC1E"><enum>(B)</enum><text display-inline="yes-display-inline">on or after September 11, 2001, performed active military, naval, or air service while assigned to a duty station in—</text><clause id="HC64D12E46FDD4B219654B7E77AD8018D"><enum>(i)</enum><text>Afghanistan;</text></clause><clause id="H4FC4A14AC4484C01A4714B54CB3E74DB"><enum>(ii)</enum><text>Djibouti;</text></clause><clause id="H59A0788E95484893B04106FA23E2D11A"><enum>(iii)</enum><text>Egypt;</text></clause><clause id="H2C0C3C903C924F0EB60507BC192423CA"><enum>(iv)</enum><text>Jordan;</text></clause><clause id="H53250E55255040B5AAA82065636743FF"><enum>(v)</enum><text>Lebanon;</text></clause><clause id="HDAFD0C0A9C7D418A90D20EB308562AB0"><enum>(vi)</enum><text>Syria;</text></clause><clause id="HA57988C982634D9BB474A673D848A895"><enum>(vii)</enum><text>Yemen;</text></clause><clause id="HC0E9078A58294D2E976E4DA99D3597E0"><enum>(viii)</enum><text>Uzbekistan;</text></clause><clause id="H160559BE89AE4D4AB1456DD87DAD4A91"><enum>(ix)</enum><text>the Philippines; or</text></clause><clause id="HA1C7A9609BB547E2BC1FB8066862C958"><enum>(x)</enum><text>any other country determined relevant by the Secretary.</text></clause></subparagraph></paragraph><paragraph id="HA7E0C78B7D3B428E81526F8CC8D611CB"><enum>(2)</enum><text>The term <term>Individual Longitudinal Exposure Record</term> 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.</text></paragraph><paragraph id="H08750A277A5E40C7BFB0602BAC29E8EE"><enum>(3)</enum><text>The term <term>toxic exposure risk activity</term> has the meaning given such term in section 1710(e)(4) of this title.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H19A47053276F45DF95F85571A1B56399"><enum>(b)</enum><header>Clerical amendment</header><text>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: </text><quoted-block style="USC" id="HDB21AC29169446AB903DEB0CB9D688B8"><toc><toc-entry level="section" idref="H7963564E7A5D420F94EA57AB59D45425">1119. Presumptions of toxic exposure.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H8BD5792381AC4533957C986D33A72B52"><enum>303.</enum><header>Medical nexus examinations for toxic exposure risk activities</header><subsection id="HD8ABF43ACF1041F681BA7741D9B84714"><enum>(a)</enum><header>In general</header><text>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:</text><quoted-block style="USC" display-inline="no-display-inline" id="HC5431C4D866141C9BDD6BC9258637CA3"><section id="H3C9418DB211D4B5C900804519D4E2E26"><enum>1168.</enum><header>Medical nexus examinations for toxic exposure risk activities</header><subsection id="H0DA93F682DD6448484442ADAEED21804" changed="not-changed"><enum>(a)</enum><header>Medical examinations and medical opinions</header><paragraph commented="no" display-inline="yes-display-inline" id="HEDE1242864AB4CEDB61ACA48956C097F" changed="not-changed"><enum>(1)</enum><text>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—</text><subparagraph changed="not-changed" id="HE5151AD899754AE9A0761DF483DC71BE" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">provide the veteran with a medical examination under section 5103A(d) of this title; and</text></subparagraph><subparagraph changed="not-changed" indent="up1" id="H9E218CFB2C5D4BAEB37137155DA5C987"><enum>(B)</enum><text>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.</text></subparagraph></paragraph><paragraph id="H707E6B2E6F6E49C3BBB9D9F2F905B4FC" indent="up1" changed="not-changed"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="HF6DCFAC73135417891C06A94BDCC1FB9" commented="no"><enum>(b)</enum><header>Exception</header><text>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.</text></subsection><subsection id="H43D47017765345FEB978DB2D0FF5ACF1"><enum>(c)</enum><header>Toxic exposure risk activity defined</header><text>In this section, the term <term>toxic exposure risk activity</term> has the meaning given such term in section 1710(e)(4) of this title. </text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H05779A58EEBC4C6097E9259C8204A369" changed="not-changed"><enum>(b)</enum><header>Clerical amendment</header><text>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: </text><quoted-block style="USC" id="HB5A127CF8BA74FDBA11F0E94500DBD6C"><toc><toc-entry level="section">1168. Medical nexus examinations for toxic exposure risk activities.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><enum>IV</enum><header>Presumptions of service connection</header><section id="HBFAB89FF1131416A86F83BA13E6B1184"><enum>401.</enum><header>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</header><subsection id="H8C5FA93F452B46EDAA7A0CE0A76C2BF8"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This section may be cited as the <quote><short-title>Mark Takai Atomic Veterans Healthcare Parity Act</short-title></quote>. </text></subsection><subsection id="H610816A7B0AA40909A60D869C857F6DC"><enum>(b)</enum><header>Enewetak Atoll</header><text display-inline="yes-display-inline">Section 1112(c)(3)(B) is amended by adding at the end the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H0C76B6F35AFD43AEB9CAF259620DABA5"><clause id="H0FD48D0EA46B491D99511BBD5114BB57" indent="up1"><enum>(v)</enum><text>Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H244446B4787C41108655556C4F2D3929"><enum>402.</enum><header>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</header><subsection id="H7200D1006D6C4764B1211FB72F22D24F"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This section may be cited as the <quote><short-title>Palomares Veterans Act</short-title></quote>.</text></subsection><subsection id="H6710A37174E7435596F599637BA6C3C1"><enum>(b)</enum><header>Palomares</header><text display-inline="yes-display-inline">Section 1112(c)(3)(B), as amended by section 401, is further amended by adding at the end the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H4591BA4FCDF6488E9E6785457FFB3219"><clause id="H565EF8A318834CD9832056BA16E0E503" indent="up1"><enum>(vi)</enum><text>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.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H92C96E8CD54F48978A5B611AFE0713F5"><enum>403.</enum><header>Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations</header><subsection id="HA12C025FB5C6417D8B1A8DDED63E1342"><enum>(a)</enum><header>Short title</header><text>This section may be cited as the <quote><short-title>Veterans Agent Orange Exposure Equity Act</short-title></quote>. </text></subsection><subsection id="H9D17032FF4714B83BF96F2C3DEEF0B42"><enum>(b)</enum><header>In general</header><text>Section 1116, as amended by section 202, is further amended—</text><paragraph id="HD44D94B58AFA413D8D7A111775525F14"><enum>(1)</enum><text>by striking <quote>, 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</quote> each place it appears and inserting <quote>performed covered service</quote>;</text></paragraph><paragraph id="H2E1F32BFD5FA41D787BB3A0BB241062F"><enum>(2)</enum><text>by striking <quote>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</quote> each place it appears and inserting <quote>performed covered service</quote>; and</text></paragraph><paragraph id="HCB68D67414DA495C896E77E865B179BE"><enum>(3)</enum><text>by adding at the end the following new subsection:</text><quoted-block style="OLC" display-inline="no-display-inline" id="HC21A038A134042DBBDEBFC859DBCA79D"><subsection id="HCD645794608C43928E75582ADEF56B74"><enum>(d)</enum><text>In this section, the term <term>covered service</term> means active military, naval, or air service—</text><paragraph id="HC2EB3F17216E4C9D8B8999997CC5215F"><enum>(1)</enum><text>performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975;</text></paragraph><paragraph id="H87827395B1F24D30A875CBDD2905EBE9"><enum>(2)</enum><text>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;</text></paragraph><paragraph id="HBC71A9EEF5194ACB8B1FE4D0CFA75B51"><enum>(3)</enum><text>performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969;</text></paragraph><paragraph id="H413A092A2C464F4E864078F9DDA5F0A0"><enum>(4)</enum><text>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</text></paragraph><paragraph id="HAAF553EA85F44D02BB411732C9D35733"><enum>(5)</enum><text>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.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H95054713AE0547D58843F83CE7E21A90"><enum>(c)</enum><header>Eligibility for hospital care and medical services</header><text>Section 1710(e)(4), as amended by section 103, is further amended by striking subparagraph (A) and inserting the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H8C03C8D8239E4C7E8F25223672C55F10"><subparagraph id="H8E5FB6C727D945B29305DE4F9275D695" indent="up1"><enum>(A)</enum><text>The term <term>Vietnam-era herbicide-exposed veteran</term> means a veteran who—</text><clause id="H435B62E5F02B4A4EA3DA28F9F535CCC5"><enum>(i)</enum><text>performed covered service, as defined in section 1116(d) of this title; or</text></clause><clause id="H2EE2C2D652D847A3AE3FF6AAEE0FBF2C"><enum>(ii)</enum><text>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.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="HFDB8D46A8DB34779A77813F2C9640AE6"><enum>(d)</enum><header>Clerical amendments</header><paragraph id="H0B8FA72E2F06489FA8E17341C91DA6FE"><enum>(1)</enum><header>Section heading</header><text>The heading for section 1116 is amended by striking <quote><header-in-text style="USC" level="section">the Republic of Vietnam</header-in-text></quote> and inserting <quote><header-in-text style="USC" level="section">certain locations</header-in-text></quote>.</text></paragraph><paragraph id="HA3A0709005E5452AB255B092BE382229"><enum>(2)</enum><header>Table of sections</header><text>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:</text><quoted-block style="OLC" display-inline="no-display-inline" id="HA3E431C6AA8F4D83ABF5BF4022360A0F"><toc><toc-entry level="section" bold="off">1116. Presumptions of service connection for diseases associated with exposure to certain herbicide agents; presumption of exposure for veterans who served in certain locations.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section><section id="HAC1A1447E073487AA25459E7FD00D88A"><enum>404.</enum><header>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</header><subsection id="H562762C76D064FE5B681346FE6321C59"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This section may be cited as the <quote><short-title>Fair Care for Vietnam Veterans Act</short-title></quote>. </text></subsection><subsection id="HFC61514DC2F94207A18A0E514564F4E4"><enum>(b)</enum><header>Additional diseases</header><text display-inline="yes-display-inline">Section 1116(a)(2), as amended by section 9109 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 (<external-xref legal-doc="public-law" parsable-cite="pl/116/283">Public Law 116–283</external-xref>), is further amended by adding at the end the following new subparagraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H61919D0330784350B7B3DE09DFD8E923"><subparagraph id="H6BC1363AA4AC473AA08878B1A7F3DC6E" indent="up1"><enum>(L)</enum><text>Hypertension.</text></subparagraph><subparagraph id="H01C146272FCF44BBB29FD62216066768" indent="up1"><enum>(M)</enum><text>Monoclonal gammopathy of undetermined significance.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="HA58EDBF760E7411DA066560AFDA23882"><enum>405.</enum><header>Improving compensation for disabilities occurring in Persian Gulf War veterans</header><subsection id="H6B22AEDA831F4452BCA0B243A82253DE"><enum>(a)</enum><header>Reduction in threshold of eligibility</header><text>Subsection (a)(1) of section 1117 is amended by striking <quote>became manifest—</quote> and all that follows through the period at the end and inserting <quote>became manifest to any degree at any time.</quote>.</text></subsection><subsection id="H525B46B81FEC43FEAECA45F37CCD02A0"><enum>(b)</enum><header>Permanent extension of period of eligibility</header><text display-inline="yes-display-inline">Such section is further amended—</text><paragraph id="H4DB7E1BC708E4BC7858E2A7D29F73A0E"><enum>(1)</enum><text>by striking subsection (b);</text></paragraph><paragraph id="H4623FD2697214B2ABC915BF9E11E1F18"><enum>(2)</enum><text>by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and</text></paragraph><paragraph id="H3DD9EEB98566430A923929B0AF643C0E"><enum>(3)</enum><text display-inline="yes-display-inline">in subsection (a)(2)(C), by striking <quote>under subsection (d)</quote> and inserting <quote>under subsection (c)</quote>.</text></paragraph></subsection><subsection id="HCC257EA519DE4EBFBE1A53CE00E58EE7"><enum>(c)</enum><header>Establishing singular disability-Based questionnaire</header><text>Such section is further amended by inserting after subsection (c) (as redesignated by subsection (b)) the following new subsection (d):</text><quoted-block style="OLC" display-inline="no-display-inline" id="H7FFA96424DA640F7B81C63EAD3C5C711"><subsection id="H88C0690048DB425D9C9C823280112BA7"><enum>(d)</enum><text display-inline="yes-display-inline">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.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H6A9A068D425949DE862B47A5BABFC814"><enum>(d)</enum><header>Expansion of definition of Persian Gulf veteran</header><text>Subsection (f) of such section is amended by inserting <quote>, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan,</quote> after <quote>operations</quote>.</text></subsection><subsection id="HE0D8989559F24358997A207C47A94056"><enum>(e)</enum><header>Training</header><text>Such section is further amended by adding at the end the following new subsection:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H94E867B3872C438393294BC5032E98D3"><subsection id="H55925BFCCC194DDAB7FD3D60DC9AAFAE"><enum>(i)</enum><paragraph commented="no" display-inline="yes-display-inline" id="HFE177E76C777443189944C20880C0192"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="H43E7FE32DB6C481FA4F21EDCDDDADF74" indent="up1"><enum>(2)</enum><text>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).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H30DC28BEA8B643BE92C589F10B10C45D"><enum>406.</enum><header>Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins</header><subsection id="H1AE536A4EB8C41C9A55C233F38F64E3D"><enum>(a)</enum><header>Short title</header><text>This section may be cited as the <quote><short-title>Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act</short-title></quote>. </text></subsection><subsection id="H83697D89B1154D289B88DD3513ECFBD1"><enum>(b)</enum><header>In general</header><text>Subchapter II of chapter 11, as amended by section 303(a), is further amended by inserting after section 1119 the following new section: </text><quoted-block id="HE7C97CB710F04AB58D9E7EFB049E9FFA" display-inline="no-display-inline" style="USC" act-name=""><section id="H45444FFD028144C3B794C48E50770F43" section-type="subsequent-section"><enum>1120.</enum><header>Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins</header><subsection id="H3D69B49465E6481D85A904D0C95C9165"><enum>(a)</enum><header>Presumption of service connection</header><text>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.</text></subsection><subsection id="H071000DE1E124044BCB8A139869DE459"><enum>(b)</enum><header>Diseases specified</header><text display-inline="yes-display-inline">The diseases specified in this subsection are the following:</text><paragraph id="H6D26F106152547269CA406B573FCAB07"><enum>(1)</enum><text display-inline="yes-display-inline">Asthma that was diagnosed after service of the covered veteran as specified in subsection (c). </text></paragraph><paragraph id="HB4BFF599F9DD46DBBD829F615DD41D0C"><enum>(2)</enum><text display-inline="yes-display-inline">The following types of cancer:</text><subparagraph commented="no" display-inline="no-display-inline" id="H04EC2269A97D49D4B59F04D42D6B63E6"><enum>(A)</enum><text>Head cancer of any type.</text></subparagraph><subparagraph id="H2279960654B74BABAF5C0839573A5BA5" display-inline="no-display-inline"><enum>(B)</enum><text>Neck cancer of any type.</text></subparagraph><subparagraph id="H90F929F0E1E249A8B29A73C02BA5713D" display-inline="no-display-inline"><enum>(C)</enum><text>Respiratory cancer of any type.</text></subparagraph><subparagraph id="H5A994F9DD1834D1A916D521C19885620" display-inline="no-display-inline"><enum>(D)</enum><text>Gastrointestinal cancer of any type.</text></subparagraph><subparagraph id="H6AABEB39E34541B6AC30A2152747A700" display-inline="no-display-inline"><enum>(E)</enum><text>Reproductive cancer of any type.</text></subparagraph><subparagraph id="HDDCC5D3352DA40939129F727E911810D" display-inline="no-display-inline"><enum>(F)</enum><text>Lymphoma cancer of any type.</text></subparagraph><subparagraph id="H00688FB5C1D140999A05D2CD37F27673" display-inline="no-display-inline"><enum>(G)</enum><text>Lymphomatic cancer of any type.</text></subparagraph><subparagraph id="HE79A8721BBB545C69E859BB68B2B1743" display-inline="no-display-inline"><enum>(H)</enum><text>Kidney cancer.</text></subparagraph><subparagraph id="HF82C41BD907D43B5A59A4390EFE4D66B" display-inline="no-display-inline"><enum>(I)</enum><text>Brain cancer.</text></subparagraph><subparagraph id="H49B0F69EFC2F4963A40D15EC0C064F94" display-inline="no-display-inline"><enum>(J)</enum><text>Melanoma.</text></subparagraph><subparagraph id="HCD4E69DE02C2454ABEA6A84C96020DF2"><enum>(K)</enum><text display-inline="yes-display-inline">Pancreatic cancer.</text></subparagraph></paragraph><paragraph id="H99544DDC52EC4783960D2B948E56B327"><enum>(3)</enum><text>Chronic bronchitis.</text></paragraph><paragraph id="H44AE923643D8443AAA30B62438D7D819"><enum>(4)</enum><text display-inline="yes-display-inline">Chronic obstructive pulmonary disease.</text></paragraph><paragraph id="H2578687BCA5D4CEB966EEC516C90D060"><enum>(5)</enum><text>Constrictive bronchiolitis or obliterative bronchiolitis.</text></paragraph><paragraph id="H4BACEACF17E0450AB845879272C2E9FB"><enum>(6)</enum><text>Emphysema.</text></paragraph><paragraph id="H88F6C2836AF44C4888F252F394D19499"><enum>(7)</enum><text>Granulomatous disease.</text></paragraph><paragraph id="H2F1C0B5104544812B983D7DEF224D766"><enum>(8)</enum><text>Interstitial lung disease.</text></paragraph><paragraph id="H12350C91EB7D45219C3F3D42344235FC"><enum>(9)</enum><text>Pleuritis. </text></paragraph><paragraph id="HA042AF4C699743128AE87BC5B753363F"><enum>(10)</enum><text>Pulmonary fibrosis.</text></paragraph><paragraph id="HD454C1AE80BB43FBB059B4AB7357C6A1"><enum>(11)</enum><text>Sarcoidosis.</text></paragraph><paragraph id="HCED6E7E3E81B4A4E92D225AA3604CC3B"><enum>(12)</enum><text display-inline="yes-display-inline">Chronic sinusitis.</text></paragraph><paragraph id="HD2519F530F26426C90772EFE96BDB65C"><enum>(13)</enum><text display-inline="yes-display-inline">Chronic rhinitis.</text></paragraph><paragraph id="H4DFDD845D43E4CC6956A8D67DDA9739E"><enum>(14)</enum><text>Glioblastoma.</text></paragraph><paragraph id="HA52526B9C5694CBF884B21299B949D3E"><enum>(15)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection><subsection id="H4BB5CB8E81A74794A1AA542E48698A7C"><enum>(c)</enum><header>Covered veteran defined</header><text>In this section, the term <quote>covered veteran</quote> has the meaning given that term in section 1119(c) of this title.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H73F6EE7E51A74B1D8C12ABE4D32284BC"><enum>(c)</enum><header>Clerical amendment</header><text>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:</text><quoted-block style="OLC" display-inline="no-display-inline" id="HBCD0416522694BDCAA38B7B00BF94CA9"><toc><toc-entry level="section" bold="off">1120. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H69BA336237564BDF833578A14E3A008E" commented="no" display-inline="no-display-inline"><enum>(d)</enum><header>Conforming amendment</header><text>Section 1113 is amended by striking <quote>or 1118</quote> each place it appears and inserting <quote>1118, or 1120</quote>.</text></subsection></section><enum>V</enum><header>Research matters</header><section id="H6A310042DFEE445A9A4E96DCB524D1E8"><enum>501.</enum><header>Coordination by Department of Veterans Affairs of toxic exposure research</header><subsection id="H26B32EFA6BD64AA5B3A4EB62F573FBA6"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter II of chapter 73 is amended by adding at the end the following new section:</text><quoted-block style="USC" display-inline="no-display-inline" id="HD2F7D76685FC45F387419D86D57E5737"><section id="HC4543600C83D4D03AE5674A763E8BE40"><enum>7330D.</enum><header>Coordination of toxic exposure research</header><subsection id="H15103416D692495CB674790F878EC694"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="HF4EE84AFB6944909867AAC2C5629185C"><enum>(b)</enum><header>Strategic plan</header><text>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.</text></subsection><subsection id="H7EF0B7A1351F4C62813752AE74F8AEE2"><enum>(c)</enum><header>Report</header><text display-inline="yes-display-inline">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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="H51FEBB6761CA45E3B8641592289ADECE"><enum>(b)</enum><header>Clerical amendment</header><text>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:</text><quoted-block style="USC" id="H4844FAD0BCB64E07B3E3F89E5603E4C1"><toc><toc-entry level="section" idref="HC4543600C83D4D03AE5674A763E8BE40">7330D. Coordination of toxic exposure research.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="H3E7CAE1B2B4D49D2A9783F43FFB6B33C"><enum>502.</enum><header>Data collection, analysis, and report on treatment of veterans for illnesses related to toxic exposure</header><subsection id="HDA8224A5DD744E19B3B3B74ACB8AFC4C"><enum>(a)</enum><header>In general</header><text>The Secretary of Veterans Affairs shall compile and analyze, on a continuous basis, all clinical data that—</text><paragraph id="HAF6365AAC76B4C07B391040DE100A699"><enum>(1)</enum><text>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 </text></paragraph><paragraph id="HB1D634C8CBD348A1BF53DD38F7E334E9" commented="no"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="H477C1EC012304DB6B94CA08BC7D86C70" commented="no"><enum>(b)</enum><header>Consent of patients</header><text>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.</text></subsection><subsection id="HE141203343EC4190B980EECC3738C0DE"><enum>(c)</enum><header>Annual report</header><text>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—</text><paragraph id="HA6F46D242D17432488EDEF571E361A0B"><enum>(1)</enum><text>any data compiled under subsection (a);</text></paragraph><paragraph id="H9F1A5A3A8F6246858E1397F0B62C25A7"><enum>(2)</enum><text>an analysis of any such data;</text></paragraph><paragraph id="HD06BEF28AA2E4FDE8EB9F25D35985D7A" commented="no"><enum>(3)</enum><text>a description of the types and incidences of illnesses identified by the Secretary pursuant to such subsection;</text></paragraph><paragraph id="H9D575410539D4D5EBCF50D42361F88AC"><enum>(4)</enum><text>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</text></paragraph><paragraph id="H453EE20FF8AE4A658F6D48D5F3A3D74A" commented="no" display-inline="no-display-inline"><enum>(5)</enum><text>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.</text></paragraph></subsection><subsection display-inline="no-display-inline" commented="no" id="H1509C8915341419CA9D73BC27EBC2140"><enum>(d)</enum><header>Definitions</header><text>In this section:</text><paragraph id="H738344F9A49947079CEBABAD8221DF9B"><enum>(1)</enum><text>The term <term>toxic exposure</term> has the meaning given that term in section 101 of title 38, United States Code.</text></paragraph><paragraph id="H54211FE4507943329E9F95D967C50066"><enum>(2)</enum><text>The term <quote>illness</quote> has the meaning given that term in section 1171 of such title, as added by section 202.</text></paragraph></subsection></section><section id="H4FBA8C483F534B37B6891E4E89A5775D"><enum>503.</enum><header>Studies related to veterans who served in Southwest Asia and certain other locations</header><subsection id="H7B1FDA3B5FF749ECB4050920A0F66672"><enum>(a)</enum><header>Analysis on mortality in covered veterans</header><paragraph id="H7F3F0A711D4E4876A57854F4A01BAB1E"><enum>(1)</enum><header>Analysis</header><text display-inline="yes-display-inline">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.</text></paragraph><paragraph id="HD6FA37D1CE10405C8DF74FBB422310AF"><enum>(2)</enum><header>Elements</header><text display-inline="yes-display-inline">The analysis under paragraph (1) shall include, to the extent practicable, the following:</text><subparagraph id="H5614FEBE543840F689B0558F9BE90E30"><enum>(A)</enum><text display-inline="yes-display-inline">Metrics of airborne exposures.</text></subparagraph><subparagraph id="H79118ABAA07543D28117134C2E3208A7"><enum>(B)</enum><text>The location and timing of any deployments of the veteran.</text></subparagraph><subparagraph id="H8DD1E49F2EE4462F98A40696F967A601"><enum>(C)</enum><text>The military occupational specialty of the veteran.</text></subparagraph><subparagraph id="H6AFF902E3D20417D96BD5E0901FC98A6"><enum>(D)</enum><text>The Armed Force in which the veteran served.</text></subparagraph><subparagraph id="H929939AEF31F4C30BCD12B60F0ED968C"><enum>(E)</enum><text>The preexisting health status of the veteran, including with respect to asthma.</text></subparagraph><subparagraph id="H3233E76327B24A08AEC65145114EA3CD"><enum>(F)</enum><text>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.</text></subparagraph></paragraph></subsection><subsection id="H549A07B38C6A437C9651564E1B871BFB"><enum>(b)</enum><header>Epidemiological study</header><text display-inline="yes-display-inline">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—</text><paragraph id="H5896CCBAAEDB4A6E81A3F800AE4A37FB"><enum>(1)</enum><text display-inline="yes-display-inline">the use of improved spatio-temporal estimates of ambient air pollution exposures that leverage advances in retrospective exposure assessment; and</text></paragraph><paragraph id="H3D49703220C541BAB4BC2E3AC2BF51CC"><enum>(2)</enum><text display-inline="yes-display-inline">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—</text><subparagraph id="H2631C5EAC5E445DBA686C2F046552F81"><enum>(A)</enum><text display-inline="yes-display-inline">personal information, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity;</text></subparagraph><subparagraph id="HD5186696B0F24F41B6FA7E14D7CB5B15"><enum>(B)</enum><text>deployment history, including locations, periods, and number of deployments;</text></subparagraph><subparagraph id="HDBA318F94AAB4EAA938BE99617EB381A"><enum>(C)</enum><text>biospecimen data; and</text></subparagraph><subparagraph id="HC67DF922721345A5987E25C778610014"><enum>(D)</enum><text>supplementary health status and outcomes data, including imaging and physiological parameters.</text></subparagraph></paragraph></subsection><subsection id="H3421A0C0405040B9B4216B5F8FF0C058"><enum>(c)</enum><header>Toxicology study</header><paragraph id="H4A88C689A9B7480F962BD34EC5F14827"><enum>(1)</enum><header>Study</header><text display-inline="yes-display-inline">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.</text></paragraph><paragraph id="HCC289239105B4907AF4BA572B89AFD48"><enum>(2)</enum><header>Elements</header><text display-inline="yes-display-inline">The study under paragraph (1) shall include—</text><subparagraph id="HE57302DEBB0E44309F2F5262032F8245"><enum>(A)</enum><text display-inline="yes-display-inline">an analysis of results for mechanistic markers and clinically relevant outcomes; and</text></subparagraph><subparagraph id="H239D5BDBDB5343BB9402BFF4B5A16D9D"><enum>(B)</enum><text display-inline="yes-display-inline">a validation of any serum, tissue, or other biomarkers of toxic exposure, susceptibility, or effect with respect to the subjects of the study.</text></subparagraph></paragraph></subsection><subsection id="H17A2040C0268465A92BD44E0264D73CC" commented="no"><enum>(d)</enum><header>Covered veteran defined</header><text>In this section, the term <term>covered veteran</term> has the meaning given that term in section 1119(c) of title 38, United States Code, as added by section 302.</text></subsection></section><section id="H674673E7C92A438AB7F5BA3DA40F87F3"><enum>504.</enum><header>Study on health trends of post 9/11 veterans</header><subsection id="HF67F842D13524EFF85F27AB5A144B390"><enum>(a)</enum><header>Study</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="HBC09908A5FC843718D5A3663DEC8AE11"><enum>(b)</enum><header>Report</header><text display-inline="yes-display-inline">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).</text></subsection></section><section id="H0942CF7B0C71428981BA716349A4ECED"><enum>505.</enum><header>Study on cancer rates among veterans</header><subsection id="HA603A3ED9E284DB79FC2C00E794A01E0"><enum>(a)</enum><header>Study</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="H1F527F29B6B944229C70116DB6C0872F"><enum>(b)</enum><header>Elements</header><text>The study under subsection (a) shall assess, with respect to each veteran included in the study, the following:</text><paragraph id="HFF1EE5AF483A46B2BCB2C3492C083C7D"><enum>(1)</enum><text>The age of the veteran.</text></paragraph><paragraph id="H9650ABFA3C424B57A7E7ABDDE94A6811"><enum>(2)</enum><text>The period of service and length of service of the veteran in the Armed Forces.</text></paragraph><paragraph id="HA7DD001060FB480BA08EECC7776C9E08"><enum>(3)</enum><text>Any military occupational speciality of the veteran.</text></paragraph><paragraph id="HC5053EC8EAA14962A9F3FBDF9A0E3BAE"><enum>(4)</enum><text>The gender of the veteran.</text></paragraph><paragraph id="H82915E0F67FF43A58C2443DC872C955B" commented="no" display-inline="no-display-inline"><enum>(5)</enum><text>Any type of cancer that the veteran has.</text></paragraph></subsection><subsection id="HC29D66CED7D3458988EA80629F0A31E9"><enum>(c)</enum><header>Report</header><text display-inline="yes-display-inline">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).</text></subsection></section><section id="H8D2ECA1C61B24FCDA22B0715A395E57C"><enum>506.</enum><header>Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities</header><subsection id="H9B5545C35214492A99845825AAB5F711"><enum>(a)</enum><header>Study</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="H2697335CC252442AA8A2111C5070600F"><enum>(b)</enum><header>Elements</header><text display-inline="yes-display-inline">The study under subsection (a) shall include—</text><paragraph id="H8030036358E140BE8FC0B5DD4DBD058E"><enum>(1)</enum><text>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;</text></paragraph><paragraph id="HD055D8B6F8EB4C14BF09B8D146889C29"><enum>(2)</enum><text display-inline="yes-display-inline">an assessment of the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection;</text></paragraph><paragraph id="HA4A729A3B14541DBA02D312EE1B3BB14"><enum>(3)</enum><text>an estimate of the resources required to furnish such care and services;</text></paragraph><paragraph id="HDF3CC1F528B549C0ACFEDAF1D36F0B48"><enum>(4)</enum><text>an assessment of any stress or other effect furnishing such care and services would have on the claims and appeals system of the Department;</text></paragraph><paragraph id="H0D95A757BB0841C4B358CD0C4D5D3F01"><enum>(5)</enum><text>an estimate of the number of qualifying dependents who would be eligible for such care and services; and</text></paragraph><paragraph id="H37084FE6F7E44F65AD7DD39805F8CCA8"><enum>(6)</enum><text display-inline="yes-display-inline">an assessment of the feasibility of adjudicating claims for such care and services.</text></paragraph></subsection><subsection id="H79236C59252B4688AC82B95151BAE773"><enum>(c)</enum><header>Phased-In application</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="H9D07A122741645F5A14418EBD3D780EF"><enum>(d)</enum><header>Review of toxic exposure cases regarding liability of Department of Defense</header><text>In conducting the study under subsection (a), the Secretary shall—</text><paragraph id="H7B1DD06ACDC24A098F1CBDAE2C7125A6"><enum>(1)</enum><text>review known cases of toxic exposure on military installations of the Department of Defense located in the United States;</text></paragraph><paragraph id="HA2FA93DCEC4945898E08525C3D96C0EC"><enum>(2)</enum><text>analyze the liability of the Department of Defense in each such case; and</text></paragraph><paragraph id="HDFFD9394A30E4EAABAE4EDD4634031F5"><enum>(3)</enum><text>assess whether the Secretary of Defense should provide care and services relating to such toxic exposures under the TRICARE program.</text></paragraph></subsection><subsection id="HCA3CB53E259044F5A8E05E9D85619FB1"><enum>(e)</enum><header>Report</header><text>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).</text></subsection><subsection id="HD4AD04BC61A44113882EF6127EFC334C"><enum>(f)</enum><header>Definitions</header><text>In this section:</text><paragraph id="H1EB723C6B37945FBB83070E84AC2E292"><enum>(1)</enum><text display-inline="yes-display-inline">The terms <quote>hospital care</quote> and <quote>medical services</quote> have the meanings given those terms in section 1701 of title 38, United States Code.</text></paragraph><paragraph id="HAEDE7E93A2B741A6B7F8404E42756D79"><enum>(2)</enum><text display-inline="yes-display-inline">The term <quote>illness</quote> has the meaning given that term in section 1171 of such title, as added by section 202.</text></paragraph><paragraph id="H0F7A5290852A4949A840353F792D5773"><enum>(3)</enum><text>The term <quote>qualifying dependent</quote> means—</text><subparagraph id="HF858AFA8595B4E1FAFCA5969AF8EC794"><enum>(A)</enum><text display-inline="yes-display-inline">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;</text></subparagraph><subparagraph id="H42007D980C2A4EDA8C8F89BF803DBFA3"><enum>(B)</enum><text>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</text></subparagraph><subparagraph id="HFDDB073DBD914E63B270FB371F60B1AC"><enum>(C)</enum><text>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.</text></subparagraph></paragraph><paragraph id="H72E81E3A884C4992B139C4EC787FA4C5"><enum>(4)</enum><text display-inline="yes-display-inline">The term <quote>toxic exposure</quote> has the meaning given that term in section 101 of such title, as added by section 102(b).</text></paragraph><paragraph id="H627BC2717CC4471EAE80BD5C543DF287"><enum>(5)</enum><text display-inline="yes-display-inline">The term <quote>toxic exposure risk activity</quote> has the meaning given that term in section 1710(e)(4) of such title, as added by section 103(a)(3).</text></paragraph><paragraph id="H473F913BE949474A99C85CF01845D845"><enum>(6)</enum><text display-inline="yes-display-inline">The term <quote>TRICARE program</quote> has the meaning given that term in section 1072 of such title.</text></paragraph></subsection></section><enum>VI</enum><header>Improvement of resources and training regarding toxic exposed veterans</header><section id="H91021006F1EC423F97E24AA18AD2BC3F"><enum>601.</enum><header>Short title; definitions</header><subsection id="H823C937F6B8E4C3497BCB473A12B53CD"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This title may be cited as the <quote><short-title>Toxic Exposure in the American Military Act</short-title></quote> or the <quote><short-title>TEAM Act</short-title></quote>. </text></subsection><subsection id="HBB34393D9B5842C5B7B4D1C0B6C8F9D2"><enum>(b)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this title, the terms <term>active military, naval, or air service</term>, <term>toxic exposure</term>, and <term>toxic exposed veteran</term> have the meanings given those terms in section 101 of title 38, United States Code.</text></subsection></section><section id="HF4488A77F990479F9AD00EC04AC74CD7"><enum>602.</enum><header>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</header><subsection id="HBBCF2540C7FB4B9BA7AF005380F07233"><enum>(a)</enum><header>Publication of list of resources</header><paragraph id="HDC70FDE81BDB4E72B8E5E15811ECA836"><enum>(1)</enum><header>In general</header><text>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—</text><subparagraph id="H595505519C6F4CE6AFEF5FE56F972454"><enum>(A)</enum><text>toxic exposed veterans, including with respect to—</text><clause id="HCD226E4E910D4E3B8B2B975ADFC481E0"><enum>(i)</enum><text>disability compensation under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code; and</text></clause><clause id="HF02E4E24B378413E85C0DCF083CE10D3"><enum>(ii)</enum><text>hospital care, medical services, and nursing home care under section 1710(a)(2)(F) of such title;</text></clause></subparagraph><subparagraph id="H651CDD92748148C0BD2F4B470D1C4B32"><enum>(B)</enum><text display-inline="yes-display-inline">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</text></subparagraph><subparagraph id="H551674CA2FAA4A6E93089B8813A3963A"><enum>(C)</enum><text display-inline="yes-display-inline">survivors of toxic exposed veterans who are receiving death benefits under the laws administered by the Secretary.</text></subparagraph></paragraph><paragraph id="H015554D025C84825B958253B71F97188"><enum>(2)</enum><header>Update</header><text>The Secretary shall periodically update the list published under paragraph (1).</text></paragraph></subsection><subsection id="HD1E8693020DB4E32873CAFBFF3F2BB85" commented="no" display-inline="no-display-inline"><enum>(b)</enum><header>Outreach</header><text>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.</text></subsection></section><section id="H68AC9369C67F4259BF8F516559FEE65E"><enum>603.</enum><header>Incorporation of toxic exposure questionnaire during primary care appointments</header><subsection id="HCAFB1156829946439F416F11061ECCAE"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="H55317DDB65A840BCB338402F018D87CA" commented="no" display-inline="no-display-inline"><enum>(b)</enum><header>Determination of questions</header><text>The questions included in the questionnaire required under subsection (a) shall be determined by the Secretary with input from medical professionals. </text></subsection></section><section id="HB575517BFCB6404F84D7306CB4DD0A30"><enum>604.</enum><header>Training for personnel of the Department of Veterans Affairs with respect to toxic exposed veterans</header><subsection id="H68FEDE70BCEC4A838BE0111FB4011C81"><enum>(a)</enum><header>Health care personnel</header><text>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.</text></subsection><subsection id="H175FCA765D0B4D95A03BC4731E9DF03A"><enum>(b)</enum><header>Benefits personnel</header><paragraph id="H04CF7A55CF0547718677FC705F3F3875"><enum>(1)</enum><header>Standard claims processor training curriculum</header><subparagraph id="H8102F94A39CC4E29A3BE818279FEEB0B"><enum>(A)</enum><header>Curriculum</header><text display-inline="yes-display-inline">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.</text></subparagraph><subparagraph id="H400434268AE14B6DB5A1DC1634D01E5F"><enum>(B)</enum><header>Matters included</header><text>The Secretary shall ensure that the training under subparagraph (A) includes the following explanations with respect to claims relating to toxic exposure:</text><clause id="H01D3765E92104698A7A92D703C34FD98"><enum>(i)</enum><text>A lack of a presumption of service connection is not by itself sufficient to determine that service connection does not exist.</text></clause><clause id="H0AB4BCE674244921BFA1C2F62F91F7A7"><enum>(ii)</enum><text>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.</text></clause><clause id="HC92042D658CB4D9494C51C168DB877B7"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph><subparagraph id="H33198425AEA74FC1AFE596351D063517"><enum>(C)</enum><header>Provision of training</header><text display-inline="yes-display-inline">The Secretary shall—</text><clause id="HDEB0BF491F0344BCB713810EF8D7296F"><enum>(i)</enum><text>provide training under subparagraph (A) to each employee described in such subparagraph not less frequently than annually; and</text></clause><clause id="HD91A899E97F54CA6A860FB98924A725C"><enum>(ii)</enum><text>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.</text></clause></subparagraph></paragraph><paragraph id="H8CFA574919E549E89428595657C8C4AA"><enum>(2)</enum><header>Standard medical examiner training curriculum</header><subparagraph id="H818A9CA3B03A4079B4CE012C5AE441F1"><enum>(A)</enum><header>Curriculum</header><text display-inline="yes-display-inline">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.</text></subparagraph><subparagraph id="H58E3F6E3B7D64B87B5585231F27CE4C3"><enum>(B)</enum><header>Standardized approach</header><text>The Secretary shall ensure that the curriculum established under subparagraph (A)—</text><clause id="H30454611374B4D76925C2D42116C98A8"><enum>(i)</enum><text>provides a standardized approach to conducting and providing examinations and opinions in accordance with such section 1168; and</text></clause><clause id="H0F1743E6DA0146AAACE18C8F11E2D6EE"><enum>(ii)</enum><text>instructs medical providers to consider, when conducting an examination or providing an opinion—</text><subclause id="H058A2264558744068D925FFD23E4D4C3"><enum>(I)</enum><text>relevant medical and scientific literature;</text></subclause><subclause id="HB12CB947E0F7492EA0FF460135B53E1A"><enum>(II)</enum><text>the proximity, intensity, and frequency of exposure of the individual to the identified toxic exposure;</text></subclause><subclause id="HA118418624194A8D8A6698A55176B6F1"><enum>(III)</enum><text>medically unexplained chronic multisymptom illnesses; and</text></subclause><subclause id="HCB3C34311EFF474B8BFB750899E1BDFC"><enum>(IV)</enum><text>all competent and credible evidence of record.</text></subclause></clause></subparagraph></paragraph></subsection></section><enum>VII</enum><header>Registries, records, and other matters</header><section id="H20F5FA24428141738F0DDD4665E75FAD"><enum>701.</enum><header>Registry of individuals exposed to per- and polyfluoroalkyl substances on military installations</header><subsection id="HBEADADBD83B148148B8E8820247D96BE"><enum>(a)</enum><header>Establishment of registry</header><paragraph id="HA9ADF9D6EABA460A9289843061628AED"><enum>(1)</enum><header>In general</header><text>Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—</text><subparagraph id="HAFB11658FC7C422AAFB0B9CE241A799D"><enum>(A)</enum><text>establish and maintain a registry for eligible individuals who may have been exposed to per- and polyfluoroalkyl substances (in this section referred to as <quote>PFAS</quote>) due to the environmental release of aqueous film-forming foam (in this section referred to as <quote>AFFF</quote>) on military installations to meet the requirements of military specification MIL–F–24385F;</text></subparagraph><subparagraph id="H8FD1503ACD9F4E14BAF8DB35CFABD1FF"><enum>(B)</enum><text>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;</text></subparagraph><subparagraph id="HCE97093B7A4D4D5ABB9296E0DD4259BF"><enum>(C)</enum><text>develop a public information campaign to inform eligible individuals about the registry, including how to register and the benefits of registering; and</text></subparagraph><subparagraph id="H085D0A8501C84AABBEFF77D2B20202F1"><enum>(D)</enum><text>periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to PFAS.</text></subparagraph></paragraph><paragraph id="HAE9946AB829D4C878E498D454B4B684D"><enum>(2)</enum><header>Coordination</header><text>The Secretary of Veterans Affairs shall coordinate with the Secretary of Defense in carrying out paragraph (1).</text></paragraph></subsection><subsection id="HF3AE86D4843E4F848DA96DEB990EC1DC"><enum>(b)</enum><header>Reports</header><paragraph id="H21365515DEDA45E49D33CFA7DC48D343"><enum>(1)</enum><header>Initial report</header><text>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:</text><subparagraph id="HF7FDE3CAF47C486098BD1653B91A0CD2"><enum>(A)</enum><text>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.</text></subparagraph><subparagraph id="HFEFDEEEDCDC1428297C6D14B95515B5D"><enum>(B)</enum><text>Recommendations to improve the collection and maintenance of such information.</text></subparagraph><subparagraph id="H2AB7C18180FE480F98FFB6308E8E9D95"><enum>(C)</enum><text>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.</text></subparagraph></paragraph><paragraph id="HEE85BC2A18E84A3AAF3B134B5AE45894"><enum>(2)</enum><header>Followup report</header><text>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:</text><subparagraph id="HB66A49ED114C476BA18554E268F9D654"><enum>(A)</enum><text>An update to the initial report submitted under paragraph (1).</text></subparagraph><subparagraph id="H0AC89DDD1C254A3EB48320609D2749C1"><enum>(B)</enum><text>An assessment of whether and to what degree the content of the registry established under subsection (a) is current and scientifically up to date.</text></subparagraph></paragraph><paragraph id="HD3EBF3BD2FF840CEB61F42172EC3943B"><enum>(3)</enum><header>Independent scientific organization</header><text>The Secretary of Veterans Affairs shall enter into an agreement with an independent scientific organization to prepare the reports under paragraphs (1) and (2).</text></paragraph></subsection><subsection id="H7E28A3C1200A47119E1C17BCE47E31F2"><enum>(c)</enum><header>Recommendations for additional exposures To be included</header><text>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).</text></subsection><subsection commented="no" display-inline="no-display-inline" id="H9D1E8B0D9BEA4390B8495B37F825E000"><enum>(d)</enum><header>Eligible individual defined</header><text>In this section, the term <term>eligible individual</term> 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.</text></subsection></section><section id="H3D3881BD6D4A4427B6704FA6BE195BC9"><enum>702.</enum><header>Fort McClellan Health Registry</header><subsection id="H38966EB8F2F3436982E4A749519D1B36"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">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 <quote>Registry</quote>).</text></subsection><subsection id="H45594FEEE2C448D7B19568FA2E337F98"><enum>(b)</enum><header>Contents</header><text display-inline="yes-display-inline">Except as provided in subsection (c), the Registry shall include the following information:</text><paragraph id="H0D90B50E589643059BCA1693AA2EAF9A"><enum>(1)</enum><text display-inline="yes-display-inline">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—</text><subparagraph id="HE35ECC6C7DEF4F0FA4F710746ECF21F7"><enum>(A)</enum><text>applies for care or services from the Department of Veterans Affairs under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code;</text></subparagraph><subparagraph id="HAEBCEA5A7D1A414C9069A7E4718DC7C3"><enum>(B)</enum><text>files a claim for compensation under chapter 11 of such title on the basis of any disability which may be associated with such service;</text></subparagraph><subparagraph id="HD9562B138AE6428EAFB5884E0D3A2415"><enum>(C)</enum><text>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;</text></subparagraph><subparagraph id="HB85DD59D46634D959865C8BA313A354D"><enum>(D)</enum><text>requests from the Secretary a health examination under subsection (d); or</text></subparagraph><subparagraph id="HA2EC7B159F5A4DF6B5A73B9960CB6DFD"><enum>(E)</enum><text>receives from the Secretary a health examination similar to the health examination referred to in subparagraph (D) and requests inclusion in the Registry.</text></subparagraph></paragraph><paragraph id="H9EAAE6614A4C4E5AAC7DB76F40406697"><enum>(2)</enum><text>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—</text><subparagraph id="H1147E5B8149F4A388532BA426557A04D"><enum>(A)</enum><text>grants to the Secretary permission to include such information in the Registry; or</text></subparagraph><subparagraph id="HC5EFE4B4ED824382BBCE2DA58C04715D"><enum>(B)</enum><text>at the time the individual is listed in the Registry, is deceased.</text></subparagraph></paragraph></subsection><subsection id="HBB9D3754DF4C496D8A9E03462BB6E4AC"><enum>(c)</enum><header>Individuals submitting claims or making requests before date of enactment</header><text>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.</text></subsection><subsection id="H9A9D72EC344645CFA347D12B8F720C37"><enum>(d)</enum><header>Examinations</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="H1B9A5CB788AF4C08BA3048C11F8B90C8"><enum>(e)</enum><header>Outreach</header><paragraph id="H1F22ED67814C4333BE12F1973FFA76AF"><enum>(1)</enum><header>Ongoing outreach to individuals listed in Registry</header><text>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.</text></paragraph><paragraph display-inline="no-display-inline" id="H592804B937034822ACFCB5B28D48981D"><enum>(2)</enum><header>Examination outreach</header><text>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).</text></paragraph></subsection><subsection id="HB080A5E1611B43E293B1033266C38886"><enum>(f)</enum><header>Consultation</header><text>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.</text></subsection></section><section id="H859B00D948B24A1CB9D535471E692B9B" section-type="subsequent-section"><enum>703.</enum><header>Independent study on Individual Longitudinal Exposure Record</header><subsection id="H6BFB7F77876044D3937E157E02DE13A5"><enum>(a)</enum><header>In general</header><text>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—</text><paragraph id="HAF61D7D5DA6E411FBDE0B1555B0A4805"><enum>(1)</enum><text>the quality of the location data, occupational and environmental exposure data, and health surveillance data; and</text></paragraph><paragraph id="H820609E85B8748268DD3257FBB57F8D1"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="HCC88632B8E2A43AE81F92FE3B79E8933"><enum>(b)</enum><header>Independent research entity</header><text>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).</text></subsection><subsection id="HA9A7B9D2424245108948149492F1D9DB"><enum>(c)</enum><header>Toxic exposure defined</header><text>In this section, the term <term>toxic exposure</term> has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b).</text></subsection></section><section id="HB5DE44D756D8428C87877775843DB26C"><enum>704.</enum><header>Biannual report on Individual Longitudinal Exposure Record</header><subsection id="H13413962187B49A2ABD6DCC80F77C033"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="HA8AA11E77F7D4165AA6A55869DEC13C2"><enum>(b)</enum><header>Elements</header><text>Each report required by subsection (a) shall include, for the period covered by the report, the following:</text><paragraph id="H8C30485948704C2DB01D9819902DCD29"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="H0DEDE411ED5E4D2B977FAE463B8A0427"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="H5737678E517D4EC398AAC1F970A11A88"><enum>(c)</enum><header>Definitions</header><text>In this section:</text><paragraph id="H73C37ACA4C9340CA83FB7384CF3297E4"><enum>(1)</enum><header>Appropriate committees of Congress</header><text>The term <term>appropriate committees of Congress</term> means—</text><subparagraph id="HADE880916A684A57BC17037B8F2969EF"><enum>(A)</enum><text>the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and</text></subparagraph><subparagraph id="HE860CB48F34E492E9B8C76EF2626AD86"><enum>(B)</enum><text>the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives.</text></subparagraph></paragraph><paragraph id="H690524117702441F983A7C4C4710F7CB"><enum>(2)</enum><header>Toxic exposure</header><text>The term <term>toxic exposure</term> has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b).</text></paragraph></subsection></section><section id="HB0AA9DE6882D4A17A8FD9A543649DCB3"><enum>705.</enum><header>Correction of exposure records by members of the Armed Forces and veterans</header><subsection id="H08E18A34CF0E417BA00F22FFBAE07892"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="H7D9AB90C74A9450A97761D416C69AED7"><enum>(b)</enum><header>Evidence</header><paragraph id="HCF4F574C8338453CA26B99BFC738E0EA"><enum>(1)</enum><header>Provision of evidence</header><text display-inline="yes-display-inline">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.</text></paragraph><paragraph id="HA04BCB5BFBE141CFA19E18CC900CABBD"><enum>(2)</enum><header>Benefit of the doubt</header><text display-inline="yes-display-inline">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.</text></paragraph><paragraph id="H4B6F8E14AB9140689CE3FABB30ADAEC3"><enum>(3)</enum><header>Regulations</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs, in consultation with the Secretary of Defense, shall prescribe by regulation the evidence considered necessary under paragraph (1).</text></paragraph></subsection><subsection id="H4761922A3CA6474BB379305A0B7FCE89"><enum>(c)</enum><header>Toxic exposure defined</header><text>In this section, the term <term>toxic exposure</term> has the meaning given that term in section 101(37) of title 38, United States Code, as added by section 102(b).</text></subsection></section>