II 111th CONGRESS 1st Session S. 642 IN THE SENATE OF THE UNITED STATES March 19, 2009 Mr. Bayh (for himself, Mr. Merkley, Mr. Byrd, Mr. Dorgan, Mr. Wyden, and Mr. Lugar) introduced the following bill; which was read twice and referred to the Committee on Armed Services A BILL To require the Secretary of Defense to establish registries of members and former members of the Armed Forces exposed in the line of duty to occupational and environmental health chemical hazards, to amend title 38, United States Code, to provide health care to veterans exposed to such hazards, and for other purposes.

1.

Short title

This Act may be cited as the Health Care for Members of the Armed Forces Exposed to Chemical Hazards Act of 2009.

2.

Establishment of registries of members and former members of the Armed Forces exposed in line of duty to occupational and environmental health chemical hazards

(a)

Establishment

For each occupational and environmental health chemical hazard of particular concern, the Secretary of Defense shall establish and administer a registry of members and former members of the Armed Forces who were exposed in the line of duty to such hazard on or after September 11, 2001. (b)

Registration

For every member and former member of the Armed Forces who was exposed in the line of duty to a hazard described in subsection (a), the Secretary shall— (1)register such member or former member in such registry; and (2)collect such information about such member or former member as the Secretary considers appropriate for purposes of establishing and administering such registry. (c)

Notification

In the case that the Secretary learns that a member or former member of the Armed Forces may have been exposed in the line of duty to a hazard described in subsection (a), the Secretary shall— (1)notify of such exposure— (A)such member or former member; (B)the commanding officer of the unit to which such member or former member belonged at the time of such exposure; and (C)in the case of a member of the National Guard, the Adjutant General of the State concerned; and (2)inform such member or former member that such member or former member may be included in the registry required by subsection (a) for such hazard. (d)

Examination

Not later than 30 days after the date on which the Secretary becomes aware of an exposure of a member or former member of the Armed Forces to a hazard described in subsection (a) and annually thereafter, the Secretary shall provide such member or former member— (1)a complete physical and medical examination; (2)consultation and counseling with respect to the results of such physical and examination; and (3)a copy of the documentation of such exposure in the member's or former member's medical record maintained by the Department of Defense. (e)

Occupational and environmental health chemical hazard of particular concern defined

In this section, the term occupational and environmental health chemical hazard of particular concern means an occupational and environmental health chemical hazard that the Secretary of Defense determines is of particular concern after considering appropriate guidelines and standards for exposure, including the following: (1)The military exposure guidelines specified in the January 2002 Chemical Exposure Guidelines for Deployed Military Personnel, United States Army Center for Health Promotion and Preventive Medicine Technical Guide 230 (or any successor technical guide that establishes military exposure guidelines for the assessment of the significance of field exposures to occupational and environmental health chemical hazards during deployments). (2)Occupational and environmental health chemical exposure standards promulgated by the Occupational Safety and Health Administration.

3.

Scientific review of association of incidents of exposure to occupational and environmental health chemical hazards with health consequences

(a)

Agreement

(1)

In general

The Secretary of Defense shall seek to enter into an agreement with the Institute of Medicine of the National Academies for the Institute of Medicine to perform the services covered by this section. (2)

Timing

The Secretary shall seek to enter into the agreement described in paragraph (1) not later than two months after the date of the enactment of this Act. (b)

Review of scientific evidence

Under an agreement between the Secretary of Defense and the Institute of Medicine under this section, the Institute of Medicine shall, for each incident of exposure involving one or more members of the Armed Forces reported in a registry established under section 2(a) to an occupational and environmental health chemical hazard of particular concern, review and summarize the scientific evidence, and assess the strength thereof, concerning the association between the exposure to such hazard and acute and long-term health consequences of such exposure. (c)

Scientific determinations concerning health consequences

(1)

In general

For each incident of exposure reviewed under subsection (b), the Institute of Medicine shall determine (to the extent that available scientific data permit meaningful determinations)— (A)whether a statistical association with the acute and long-term health consequences exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association; and (B)whether there exists a plausible biological mechanism or other evidence of a causal relationship between the occupational and environmental health chemical hazard and the health consequences. (2)

Discussion and reasoning

The Institute of Medicine shall include in its reports under subsection (f) a full discussion of the scientific evidence and reasoning that led to its conclusions under this subsection. (d)

Recommendations for additional scientific studies

(1)

In general

The Institute of Medicine shall make any recommendations it has for additional scientific studies to resolve areas of continuing scientific uncertainty relating to exposure to occupational and environmental health chemical hazards of particular concern. (2)

Considerations

In making recommendations for further study, the Institute of Medicine shall consider the following: (A)The scientific information that is currently available. (B)The value and relevance of the information that could result from additional studies. (e)

Subsequent reviews

The agreement under subsection (a) shall require the Institute of Medicine— (1)to conduct periodically as comprehensive a review as is practicable of the evidence referred to in subsection (b) that has become available since the last review of such evidence under this section; and (2)to make its determinations and estimates on the basis of the results of such review and all other reviews conducted for the purposes of this section. (f)

Reports

(1)

Reports to Congress

(A)

In general

The agreement under subsection (a) shall require the Institute of Medicine to submit, not later than the end of the 18-month period beginning on the date of the enactment of this Act and not less frequently than once every two years thereafter, to the appropriate committees of Congress a report on the activities of the Institute of Medicine under the agreement. (B)

Contents

The report described in subparagraph (A) shall include the following: (i)The determinations and discussion referred to in subsection (c). (ii)Any recommendations of the Institute of Medicine under subsection (d). (2)

Reports to Secretary of Defense

The agreement under subsection (a) shall require the Institute of Medicine, in the case that the Institute of Medicine makes any conclusive determination under subsection (c)(1) with respect to any incident of exposure studied under subsection (b), to submit, not later than 30 days after the date of such determination, to the Secretary of Defense a report describing such determination. (g)

Notice to members and former members of the Armed Forces

The Secretary of Defense shall notify members and former members of the Armed Forces listed in a registry established under section 2(a) for exposure to an occupational and environmental health chemical hazard of particular concern of— (1)any conclusive determinations made with respect to such exposure under subsection (c)(1); and (2)any other significant developments in research on the health consequences of exposure to such hazard. (h)

Limitation on authority

The agreement under this section shall be effective for a fiscal year to the extent that appropriations are available to carry out the agreement. (i)

Sunset

This section shall cease to be effective 10 years after the last day of the fiscal year in which the Institute of Medicine submits to the Secretary of Defense the first report under subsection (f). (j)

Alternative contract scientific organization

(1)

In general

If the Secretary of Defense is unable within the time period prescribed in subsection (a)(2) to enter into an agreement described in subsection (a)(1) with the Institute of Medicine on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate scientific organization that— (A)is not part of the Government; (B)operates as a not-for-profit entity; and (C)has expertise and objectivity comparable to that of the Institute of Medicine. (2)

Treatment

If the Secretary enters into an agreement with another organization as described in paragraph (1), any reference in this section to the Institute of Medicine shall be treated as a reference to the other organization. (k)

Definitions

In this section: (1)

Appropriate committees of Congress

The term appropriate committees of Congress means— (A)the Committee on Armed Services, the Committee on Veterans' Affairs, and the Committee on Appropriations of the Senate; and (B)the Committee on Armed Services, the Committee on Veterans' Affairs, and the Committee on Appropriations of the House of Representatives. (2)

Occupational and environmental health chemical hazard of particular concern

The term occupational and environmental health chemical hazard of particular concern means an occupational and environmental health chemical hazard that the Secretary of Defense determines is of particular concern after considering appropriate guidelines and standards for exposure, including the following: (A)The military exposure guidelines specified in the January 2002 Chemical Exposure Guidelines for Deployed Military Personnel, United States Army Center for Health Promotion and Preventive Medicine Technical Guide 230 (or any successor technical guide that establishes military exposure guidelines for the assessment of the significance of field exposures to occupational and environmental health chemical hazards during deployments). (B)Occupational and environmental health chemical exposure standards promulgated by the Occupational Safety and Health Administration.

4.

Revision in authorities for provision of health care for certain veterans exposed to occupational and environmental health chemical hazards

(a)

Authorized inpatient care

Section 1710(e) of title 38, United States Code, is amended— (1)in paragraph (1), by adding at the end the following: (F)A veteran who was exposed in the line of duty to an occupational and environmental health chemical hazard of particular concern is eligible (subject to paragraph (2)) for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disability, notwithstanding that there is insufficient medical evidence to conclude that such disability may be associated with such exposure. ; (2)in paragraph (2), by adding at the end the following: (C)In the case of a veteran described in paragraph (1)(F), hospital care, medical services, and nursing home care may not be provided under subsection (a)(2)(F) with respect to— (i)a disability that is found, in accordance with guidelines issued by the Under Secretary for Health, to have resulted from a cause other than an exposure described in paragraph (1)(F); or (ii)a health effect for which the National Academy of Sciences, in a report issued in accordance with section 3 of the Health Care for Members of the Armed Forces Exposed to Chemical Hazards Act of 2009, has determined that there is limited or suggestive evidence of the lack of a positive association between occurrence of the health consequences in humans and exposure to an occupational and environmental health chemical hazard of particular concern. ; and (3)in paragraph (4), by adding at the end the following: (C)The term occupational and environmental health chemical hazard of particular concern means an occupational and environmental health chemical hazard that the Secretary of Defense determines is of particular concern after considering appropriate guidelines and standards for exposure, including the following: (i)The military exposure guidelines specified in the January 2002 Chemical Exposure Guidelines for Deployed Military Personnel, United States Army Center for Health Promotion and Preventive Medicine Technical Guide 230 (or any successor technical guide that establishes military exposure guidelines for the assessment of the significance of field exposures to occupational and environmental health chemical hazards during deployments). (ii)Occupational and environmental health chemical exposure standards promulgated by the Occupational Safety and Health Administration. . (b)

Technical amendment

Section 1710(e)(4) of such title is amended in the matter before subparagraph (A) by striking For purposes of this subsection— and inserting In this subsection:.