[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4393 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 4393

  To improve the provision of health care and other benefits from the 
 Department of Veterans Affairs for veterans who were exposed to toxic 
                  substances, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 30, 2020

  Mr. Tillis introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
  To improve the provision of health care and other benefits from the 
 Department of Veterans Affairs for veterans who were exposed to toxic 
                  substances, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Toxic Exposure in 
the American Military Act of 2020'' or the ``TEAM Act of 2020''
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS EXPOSED TO 
                            TOXIC SUBSTANCES

Sec. 101. Consultation, testing, and treatment for certain veterans who 
                            received hazardous duty pay or were exposed 
                            to toxic substances.
Sec. 102. Permanent reauthorization of authority of Secretary of 
                            Veterans Affairs to prescribe regulations 
                            providing that a presumption of service 
                            connection is warranted for a disease 
                            associated with exposure to a herbicide 
                            agent.
Sec. 103. Presumptions of service connection for diseases associated 
                            with exposure to certain toxic substances.
  TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC SUBSTANCES

Sec. 201. Establishment of Toxic Exposure Review Commission.
Sec. 202. Agreement with National Academies of Sciences, Engineering, 
                            and Medicine concerning the exposure of 
                            humans to toxic substances.
Sec. 203. Analysis of results of consultation, testing, and treatment 
                            of veterans for disabilities related to 
                            exposure to toxic substances.
Sec. 204. Report to evaluate and identify groups at-risk of exposure to 
                            toxic substances.
 TITLE III--IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS 
                REGARDING EXPOSURES TO TOXIC SUBSTANCES

Sec. 301. Publication of list of resources of Department of Veterans 
                            Affairs for veterans exposed to toxic 
                            substances and outreach program for such 
                            veterans and caregivers and survivors of 
                            such veterans.
Sec. 302. Incorporation of toxic exposure questionnaire during primary 
                            care appointments.
Sec. 303. Portal for access by veterans to individual longitudinal 
                            exposure record.
Sec. 304. Training of personnel of Department of Veterans Affairs on 
                            illnesses related to exposure to toxic 
                            substances.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning 
        given that term in section 101(24) of title 38, United States 
        Code.
            (2) Toxic substance.--The term ``toxic substance'' has the 
        meaning given that term in section 1720J(i) of such title, as 
        added by section 101(a).

TITLE I--EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS EXPOSED TO 
                            TOXIC SUBSTANCES

SEC. 101. CONSULTATION, TESTING, AND TREATMENT FOR CERTAIN VETERANS WHO 
              RECEIVED HAZARDOUS DUTY PAY OR WERE EXPOSED TO TOXIC 
              SUBSTANCES.

    (a) In General.--Subchapter II of chapter 17 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 1720J. Consultation, testing, and treatment of veterans for 
              exposure to toxic substances
    ``(a) In General.--The Secretary shall furnish to covered 
veterans--
            ``(1) covered consultation and testing regarding the 
        exposure of those veterans to toxic substances; and
            ``(2) treatment for any illness relating to such exposure 
        diagnosed under subsection (b)(2), subject to approval by the 
        Under Secretary for Health.
    ``(b) Covered Consultation and Testing.--For purposes of this 
section, covered consultation and testing is--
            ``(1) consultation with a primary care physician or other 
        treating physician to determine whether the covered veteran has 
        an illness related to exposure to a toxic substance while 
        serving in the Armed Forces;
            ``(2) diagnosis by such physician of any illness related to 
        exposure to a toxic substance; and
            ``(3) any medical testing necessary to carry out paragraphs 
        (1) and (2), including a referral to a specialist physician.
    ``(c) Covered Veterans.--For purposes of this section, a covered 
veteran is a veteran who--
            ``(1) received hazardous duty incentive pay under section 
        351 of title 37 for more than one day; or
            ``(2) has been identified by the Secretary of Defense to 
        have been possibly exposed, inside or outside the United 
        States, during service in the Armed Forces, to--
                    ``(A) an open burn pit;
                    ``(B) a toxic substance; or
                    ``(C) a site at which members of the Armed Forces 
                were potentially exposed to a toxic substance, as 
                indicated in a database shared by the Department of 
                Defense and the Department of Veterans Affairs.
    ``(d) Consultation.--A covered veteran is eligible under this 
section for three consultations each year unless a treating physician 
for such veteran determines that more consultations are necessary under 
subsection (b)(1).
    ``(e) Provision of Services.--Covered consultation and testing and 
treatment may be provided under this section at facilities of the 
Department or under contract arrangements with the Department for such 
services.
    ``(f) Determinations Relating to Treatment.--(1) When determining 
whether to approve eligibility for treatment under subsection (a)(2), 
the Under Secretary for Health shall give heavy weight to the diagnosis 
by the treating physician under subsection (b)(2).
    ``(2) The Under Secretary shall support any denial of eligibility 
under subsection (a)(2) with specific scientific evidence.
    ``(3) Determinations by the Under Secretary under subsection (a)(2) 
shall be made not later than five business days after a request for 
approval has been made by the treating physician under subsection 
(b)(2).
    ``(g) Information and Training.--The Secretary shall provide 
information and training on eligibility for services under this section 
and the services covered under this section to--
            ``(1) health care providers of the Department;
            ``(2) health care providers providing services under this 
        section under contract arrangements; and
            ``(3) covered veterans.
    ``(h) Copayment.--A covered veteran is not required to pay a 
copayment for covered consultation and testing or treatment under this 
section.
    ``(i) Definitions.--In this section:
            ``(1) The term `open burn pit' has the meaning given that 
        term in section 201(c) of the Dignified Burial and Other 
        Veterans' Benefits Improvement Act of 2012 (Public Law 112-260; 
        38 U.S.C. 527 note).
            ``(2) The term `toxic substance' means a toxicant or a 
        toxin.
            ``(3) The term `toxicant' means any substance that can 
        injure or kill humans, animals, or plants and that is produced 
        by humans or is a by-product of human activities.
            ``(4) The term `toxin' means any substance that can injure 
        or kill humans, animals, or plants and that is produced 
        naturally.
            ``(5) The team `treatment' means any commonly accepted 
        medical treatment practiced by the medical community at 
        large.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
subchapter II of chapter 17 of such title is amended by adding at the 
end the following new item:

``1720J. Consultation, testing, and treatment of veterans for exposure 
                            to toxic substances.''.

SEC. 102. PERMANENT REAUTHORIZATION OF AUTHORITY OF SECRETARY OF 
              VETERANS AFFAIRS TO PRESCRIBE REGULATIONS PROVIDING THAT 
              A PRESUMPTION OF SERVICE CONNECTION IS WARRANTED FOR A 
              DISEASE ASSOCIATED WITH EXPOSURE TO A HERBICIDE AGENT.

    (a) In General.--Section 1116 of title 38, United States Code, is 
amended by striking subsection (e).
    (b) Effective Date.--Subsection (a) of this section and subsections 
(b) through (d) of section 1116 of such title shall take effect on the 
date of the enactment of this Act.

SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR DISEASES ASSOCIATED 
              WITH EXPOSURE TO CERTAIN TOXIC SUBSTANCES.

    (a) In General.--Subchapter II of chapter 11 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 1119. Presumptions of service connection for diseases associated 
              with exposure to certain toxic substances
    ``(a) Presumptions of Service Connection.--(1) For purposes of 
section 1110 of this title, and subject to section 1113 of this title, 
each disease specified in paragraph (2) becoming manifest as specified 
in that paragraph shall be considered to have been incurred in or 
aggravated by service referred to in that paragraph, notwithstanding 
that there is no record of evidence of such disease during the period 
of such service.
    ``(2) A disease specified in this paragraph is any disease that--
            ``(A) the Secretary determines in regulations prescribed 
        under this section warrants a presumption of service connection 
        by reason of having a positive association with exposure to a 
        toxic substance; and
            ``(B) becomes manifest within the period, if any, 
        prescribed in such regulations in a veteran who was exposed to 
        that toxic substance during active military, naval, or air 
        service.
    ``(3)(A) For purposes of this subsection, the Secretary may presume 
that a veteran who has a disease specified in paragraph (2) was exposed 
to the toxic substance for which the Secretary has determined under 
paragraph (2)(A) warrants a presumption of service connection by reason 
of having a positive association with exposure to the toxic substance, 
notwithstanding that there is no record of evidence of such exposure, 
if the Secretary determines based on one or more of the factors set 
forth in subparagraph (B) that a presumption of exposure is warranted.
    ``(B) The factors set forth in this subparagraph are as follows:
            ``(i) The duty location of the veteran.
            ``(ii) The length of service of the veteran.
            ``(iii) Such other factors as the Secretary considers 
        appropriate.
    ``(b) Determinations Relating to Diseases.--(1) Whenever the 
Secretary determines, on the basis of sound medical and scientific 
evidence, that a positive association exists between the exposure of 
humans to a toxic substance and the occurrence of a disease in humans, 
the Secretary shall prescribe regulations providing that a presumption 
of service connection is warranted for that disease for purposes of 
this section.
    ``(2) In making determinations under paragraph (1), the Secretary 
shall take into account--
            ``(A) reports received by the Secretary from the National 
        Academies of Sciences, Engineering, and Medicine under section 
        202(g) of the Toxic Exposure in the American Military Act of 
        2020; and
            ``(B) all other sound medical and scientific information 
        and analyses available to the Secretary.
    ``(3)(A) In evaluating any report, information, or analysis for 
purposes of making such determinations, the Secretary shall consider 
only scientific studies that are valid in accordance with contemporary 
scientific standards.
    ``(B) The Secretary may define the standards described in 
subparagraph (A) for purposes of that subparagraph.
    ``(c) Response to Reports by the National Academies of Sciences, 
Engineering, and Medicine.--(1) Not later than 60 days after the date 
on which the Secretary receives a report from the National Academies of 
Sciences, Engineering, and Medicine under section 202(g) of the Toxic 
Exposure in the American Military Act of 2020, the Secretary shall 
determine whether a presumption of service connection is warranted for 
each disease covered by the report.
    ``(2) If the Secretary determines under paragraph (1) that a 
presumption of service connection is warranted for a disease, the 
Secretary shall, not later than 60 days after making the determination, 
issue proposed regulations setting forth the determination.
    ``(3)(A) If the Secretary makes a determination described in 
subparagraph (B), the Secretary shall, not later than 60 days after 
making the determination, publish in the Federal Register a notice of 
the determination.
    ``(B) A determination described in this subparagraph is a 
determination by the Secretary under paragraph (1) that--
            ``(i) a presumption of service connection is not warranted 
        for a disease; and
            ``(ii)(I) sufficient evidence of an association exists 
        between the exposure of humans to a toxic substance and the 
        occurrence of the disease in humans; or
            ``(II) limited evidence or suggestive evidence of such an 
        association exists.
    ``(C) Any notice published under subparagraph (A) shall include an 
explanation of the scientific basis for the determination described in 
subparagraph (B).
    ``(D) If a disease already presumed to be service connected under 
this section is subject to a determination described in subparagraph 
(B), the Secretary shall, not later than 60 days after publication of 
the notice under subparagraph (A), issue proposed regulations removing 
the presumption of service connection for the disease.
    ``(4) Not later than 180 days after the date on which the Secretary 
issues any proposed regulations under this subsection, the Secretary 
shall issue final regulations.
    ``(d) Removal of Presumption of Service Connection.--Whenever the 
presumption of service connection for a disease under this section is 
removed under subsection (c)--
            ``(1) a veteran who was awarded compensation for the 
        disease on the basis of the presumption before the effective 
        date of the removal of the presumption shall continue to be 
        entitled to receive compensation on that basis; and
            ``(2) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from the disease on the basis of the presumption before that 
        date shall continue to be entitled to receive dependency and 
        indemnity compensation on that basis.
    ``(e) Reference to National Academies of Sciences, Engineering, and 
Medicine.--In the case that the Secretary enters into an agreement with 
another organization as described in section 202(i)(1) of the Toxic 
Exposure in the American Military Act of 2020, any reference in this 
section to the National Academies of Sciences, Engineering, and 
Medicine shall be treated as a reference to the other organization.
    ``(f) Definitions.--In this section:
            ``(1) The term `positive association' means, with respect 
        to an association between exposure to a toxic substance and the 
        occurrence of a disease in humans, that there is credible 
        evidence for the association and such evidence is equal to or 
        outweighs the credible evidence against the association.
            ``(2) The term `toxic substance' has the meaning given that 
        term in section 1720J(i) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 11 of such title is amended by inserting after the item 
relating to section 1118 the following new item:

``1119. Presumptions of service connection for diseases associated with 
                            exposure to certain toxic substances.''.
    (c) Conforming Amendment.--Section 1113 of such title is amended by 
striking ``or 1118'' each place it appears and inserting ``1118, or 
1119''.

  TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC SUBSTANCES

SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW COMMISSION.

    (a) In General.--Subchapter III of chapter 5 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 547. Toxic Exposure Review Commission
    ``(a) Establishment.--There is established within the Department an 
independent commission to be known as the `Toxic Exposure Review 
Commission' (in this section referred to as the `Commission').
    ``(b) Duties.--The Commission shall carry out the following duties:
            ``(1) Collect any relevant public information from the 
        Department of Defense and other sources to identify possible 
        exposures to toxic substances pertaining to active military, 
        naval, or air service.
            ``(2) Hold public meetings to gather relevant information 
        regarding exposure to toxic substances.
            ``(3) Review such information to assess whether to 
        recommend that a study be conducted under section 202(e) of the 
        Toxic Exposure in the American Military Act of 2020.
            ``(4) Recommend, by majority vote, whether such a study 
        should be conducted.
            ``(5) Recommend to the Secretary, by majority vote, whether 
        new, independent studies should be conducted regarding the 
        health outcomes of exposure to toxic substances.
            ``(6) Annually report to Congress on progress regarding the 
        duties set forth in paragraphs (1) through (5).
    ``(c) Membership.--(1)(A) The Commission shall be composed of 9 
members, appointed as follows:
            ``(i) Two members appointed by the Speaker of the House of 
        Representatives.
            ``(ii) Two members appointed by the minority leader of the 
        House of Representatives.
            ``(iii) Two members appointed by the majority leader of the 
        Senate.
            ``(iv) Two members appointed by the minority leader of the 
        Senate.
            ``(v) One member appointed by the Secretary.
    ``(B) The initial members of the Commission shall be appointed 
under subparagraph (A) not later than 180 days after the date of the 
enactment of the Toxic Exposure in the American Military Act of 2020.
    ``(2) In appointing individuals under paragraph (1)(A), the Speaker 
of the House of Representatives, the minority leader of the House of 
Representatives, the majority leader of the Senate, the minority leader 
of the Senate, and the Secretary shall ensure that the following fields 
of experience are represented on the Commission:
            ``(A) The field of respiratory medicine.
            ``(B) The field of endocrinology and metabolic medicine.
            ``(C) The field of hematology.
            ``(D) The field of oncology.
            ``(E) The field of public health.
            ``(F) The field of occupational and environmental health.
    ``(3) In appointing individuals under paragraph (1)(A), the Speaker 
of the House of Representatives, the minority leader of the House of 
Representatives, the majority leader of the Senate, the minority leader 
of the Senate, and the Secretary shall ensure that at least two members 
of the Commission represent an organization recognized by the Secretary 
for the representation of veterans under section 5902 of this title.
    ``(4) In appointing individuals under paragraph (1)(A), the Speaker 
of the House of Representatives, the minority leader of the House of 
Representatives, the majority leader of the Senate, the minority leader 
of the Senate, and the Secretary shall give consideration to including 
in the Commission at least one member who works with survivors of 
illnesses related to exposure to toxic substances and has a background 
in the field of study of exposure to toxic substances.
    ``(d) Meetings.--(1) The Commission shall meet not less frequently 
than twice each year.
    ``(2)(A) Each meeting of the Commission shall be open to the 
public.
    ``(B) All the proceedings, information, and deliberations of the 
Commission shall be available for review by the public.
    ``(e) Chair and Vice Chair.--At the initial meeting of the 
Commission under subsection (d), the Commission shall select a Chair 
and Vice Chair from among the members of the Commission by a majority 
vote of the members of the Commission.
    ``(f) Vacancies.--A vacancy in the Commission shall be filled in 
the same manner as the original appointment, but the individual 
appointed to fill the vacancy shall serve only for the unexpired 
portion of the term for which the individual's predecessor was 
appointed.
    ``(g) Pay.--(1) Members of the Commission shall serve without pay.
    ``(2) Each member of the Commission who is an officer or employee 
of the United States shall serve without compensation in addition to 
that received for service as an officer or employee of the United 
States.
    ``(3) Members shall receive travel expenses, including per diem in 
lieu of subsistence, in accordance with sections 5702 and 5703 of title 
5.
    ``(h) Director of Staff.--(1) The Commission shall appoint a 
Director who--
            ``(A) has not served as an employee of the Department 
        during the one-year period preceding the date of such 
        appointment; and
            ``(B) is not otherwise barred or prohibited from serving as 
        Director under Federal ethics laws and regulations, by reason 
        of post-employment conflict of interest.
    ``(2) The Director shall be paid at the rate of basic pay payable 
for level IV of the Executive Schedule under section 5315 of title 5.
    ``(i) Staff.--(1) Subject to paragraphs (2) and (3), the Director, 
with the approval of the Commission, may appoint and fix the pay of 
additional personnel.
    ``(2) The Director may make such appointments without regard to the 
provisions of title 5 governing appointments in the competitive 
service, and any personnel so appointed may be paid without regard to 
the provisions of chapter 51 and subchapter III of chapter 53 of that 
title relating to classification and General Schedule pay rates, except 
that an individual so appointed may not receive pay in excess of the 
annual rate of basic pay payable for GS-15 of the General Schedule.
    ``(3)(A) Not more than two-thirds of the personnel employed by or 
detailed to the Commission may be on detail from the Department.
    ``(B) Not more than half of the professional analysts of the 
Commission staff may be persons detailed from the Department to the 
Commission.
    ``(4) Subject to paragraph (3), the head of any Federal agency, 
upon the request of the Director, may detail any of the personnel of 
that agency to the Commission to assist the Commission in carrying out 
its duties under this section.
    ``(5) The Commission may secure directly from any Federal agency 
such information as the Commission considers necessary to carry out 
this section. Upon request of the Chair, the head of such agency shall 
furnish such information to the Commission, unless such information is 
classified.
    ``(j) Other Authority.--(1) The Commission may procure by contract, 
to the extent funds are available, the temporary or intermittent 
services of experts or consultants pursuant to section 3109 of title 5.
    ``(2) To the extent funds are available, the Commission may lease 
real property and acquire personal property either of its own accord or 
in consultation with the General Services Administration.
    ``(k) Communications.--(1)(A) Except as provided in subparagraph 
(B), no person may restrict an employee of the Department in 
communicating with the Commission.
    ``(B) Subparagraph (A) does not apply to a communication that is 
unlawful.
    ``(2) All ex parte communications with the Commission shall be made 
part of the public record.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such subchapter is amended by adding at the end the following new item:

``547. Toxic Exposure Review Commission.''.

SEC. 202. AGREEMENT WITH NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, 
              AND MEDICINE CONCERNING THE EXPOSURE OF HUMANS TO TOXIC 
              SUBSTANCES.

    (a) Purpose.--The purpose of this section is to provide for the 
National Academies of Sciences, Engineering, and Medicine (in this 
section referred to as the ``Academies''), an independent nonprofit 
scientific organization with appropriate expertise that is not part of 
the Federal Government, to review and evaluate the available scientific 
evidence regarding associations between diseases and exposure to toxic 
substances.
    (b) Agreement.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        seek to enter into an agreement with the Academies to perform 
        the services covered by this section.
            (2) Timing.--The Secretary shall seek to enter into an 
        agreement described in paragraph (1) not later than 60 days 
        after the date of the enactment of this Act.
    (c) Review of Scientific Evidence.--Under an agreement between the 
Secretary and the Academies under this section, the Academies shall 
review and summarize the scientific evidence, and assess the strength 
thereof, concerning the association between exposure to toxic 
substances during active military, naval, or air service and each 
disease suspected to be associated with such exposure in the human 
population.
    (d) Scientific Determinations Concerning Diseases.--For each 
disease reviewed under subsection (c), the Academies shall determine, 
to the extent that available scientific data permit meaningful 
determinations--
            (1) whether an association exists between exposure to toxic 
        substances and the occurrence of the disease, taking into 
        account the strength of the scientific evidence and the 
        appropriateness of the statistical and epidemiological methods 
        used to detect the association;
            (2) the increased risk of the disease among those exposed 
        to toxic substances during active military, naval, or air 
        service; and
            (3) whether there exists a plausible biological mechanism 
        or other evidence of a causal relationship between the exposure 
        and the occurrence of the disease.
    (e) Scientific Studies.--
            (1) In general.--Under an agreement between the Secretary 
        and the Academies under this section, the Academies shall 
        conduct such scientific studies as the Toxic Exposure Review 
        Commission recommends pursuant to section 547(b)(4) of title 
        38, United States Code, as added by section 201(a).
            (2) Recommendations for additional scientific studies.--
                    (A) In general.--Under an agreement between the 
                Secretary and the Academies under this section, the 
                Academies shall make any recommendations for additional 
                scientific studies to resolve areas of continuing 
                scientific uncertainty relating to the exposure of 
                humans to toxic substances.
                    (B) Considerations.--In making recommendations 
                under subparagraph (A), the Academies shall consider--
                            (i) the scientific information that is 
                        available at the time of the recommendation;
                            (ii) the value and relevance of the 
                        information that could result from additional 
                        studies; and
                            (iii) the cost and feasibility of carrying 
                        out such additional studies.
    (f) Subsequent Reviews.--Under an agreement between the Secretary 
and the Academies under this section, the Academies shall--
            (1) conduct as comprehensive a review as is practicable of 
        the evidence referred to in subsection (c) that became 
        available since the last review of such evidence under this 
        section; and
            (2) make determinations and estimates on the basis of the 
        results of such review and all other reviews conducted for the 
        purposes of this section.
    (g) Reports.--
            (1) Initial report.--
                    (A) In general.--Under an agreement between the 
                Secretary and the Academies under this section, not 
                later than one year after the date of the enactment of 
                this Act, the Academies shall submit to the Secretary, 
                the Committee on Veterans' Affairs of the Senate, and 
                the Committee on Veterans' Affairs of the House of 
                Representatives an initial report on the activities of 
                the Academies under the agreement.
                    (B) Elements.--The report submitted under 
                subparagraph (A) shall include the following:
                            (i) The determinations described in 
                        subsection (d).
                            (ii) A full explanation of the scientific 
                        evidence and reasoning that led to such 
                        determinations.
                            (iii) Any recommendations of the Academies 
                        under subsection (e)(2).
                            (iv) The recommendation described in 
                        subparagraph (C).
                    (C) Recommendation for implementation of analysis 
                of examinations and treatment of veterans for 
                disabilities related to exposure to toxic substances.--
                            (i) In general.--The recommendation 
                        described in this subparagraph is the 
                        recommendation of the Academies as to whether 
                        section 203 should take effect as provided in 
                        subsection (d) of such section.
                            (ii) Considerations.--In making a 
                        recommendation under clause (i), the Academies 
                        shall consider--
                                    (I) the scientific information that 
                                is available at the time of the 
                                recommendation;
                                    (II) the value and relevance of the 
                                information that could result from the 
                                implementation of section 203; and
                                    (III) the cost and feasibility of 
                                such implementation.
                            (iii) Maintenance of clinical data.--If the 
                        Academies recommend that section 203 should 
                        take effect, the Academies shall recommend the 
                        means by which clinical data referred to in 
                        that section could be maintained in the most 
                        scientifically useful way.
            (2) Periodic updates.--Under an agreement between the 
        Secretary and the Academies under this section, not less 
        frequently than once every two years after the date on which 
        the initial report is submitted under paragraph (1)(A), the 
        Academies shall submit to the Secretary, the Committee on 
        Veterans' Affairs of the Senate, and the Committee on Veterans' 
        Affairs of the House of Representatives an updated report on 
        the activities of the Academies under the agreement.
    (h) Limitation on Authority.--The authority to enter into 
agreements under this section shall be effective for a fiscal year to 
the extent that appropriations are available for such purpose.
    (i) Alternative Contract Scientific Organization.--
            (1) In general.--If the Secretary is unable within the time 
        period prescribed in subsection (b)(2) to enter into an 
        agreement with the Academies for the purposes of this section 
        on terms acceptable to the Secretary, the Secretary shall seek 
        to enter into an agreement for the purposes of this section 
        with another appropriate scientific organization that--
                    (A) is not part of the Federal Government;
                    (B) operates as a not-for-profit entity; and
                    (C) has expertise and objectivity comparable to 
                that of the Academies.
            (2) Treatment.--If the Secretary enters into an agreement 
        with another organization as described in paragraph (1), any 
        reference in this section, section 203, and section 1119 of 
        title 38, United States Code, as added by section 102(a), to 
        the National Academies of Sciences, Engineering, and Medicine 
        shall be treated as a reference to the other organization.

SEC. 203. ANALYSIS OF RESULTS OF CONSULTATION, TESTING, AND TREATMENT 
              OF VETERANS FOR DISABILITIES RELATED TO EXPOSURE TO TOXIC 
              SUBSTANCES.

    (a) In General.--The Secretary of Veterans Affairs shall compile 
and analyze, on a continuous basis, all clinical data that--
            (1) is obtained by the Department of Veterans Affairs in 
        connection with consultation, testing, and treatment furnished 
        to veterans by the Department under section 1720J of title 38, 
        United States Code, as added by section 101(a); and
            (2) is likely to be scientifically useful in determining 
        the association, if any, between the disability of a veteran 
        and exposure to a toxic substance.
    (b) Consent of Patients.--Compilation and analysis by the Secretary 
of clinical data of a veteran under subsection (a) shall be conducted, 
and such data shall be used, consistent with the informed consent of 
the veteran and in compliance with all applicable Federal law.
    (c) Annual Report.--Not later than one year after the effective 
date under subsection (d), and annually thereafter, the Secretary shall 
submit to the Committee on Veterans' Affairs of the Senate and the 
Committee on Veterans' Affairs of the House of Representatives a report 
containing--
            (1) the information compiled under subsection (a);
            (2) an analysis of such information;
            (3) a description of the types and incidences of 
        disabilities identified by the Department under such 
        subsection;
            (4) the explanation of the Secretary for the incidence of 
        such disabilities and other explanations for the incidence of 
        such disabilities as the Secretary considers reasonable; and
            (5) the views of the Secretary on the scientific validity 
        of drawing conclusions from the incidence of such disabilities, 
        as evidenced by the data compiled under subsection (a), 
        regarding any association between such disabilities and 
        exposure to a toxic substance.
    (d) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), this 
        section shall take effect on the date that is 90 days after the 
        date on which the report submitted by the National Academies of 
        Sciences, Engineering, and Medicine under section 202(g)(1) is 
        received by the Secretary.
            (2) Exception.--This section shall not take effect if the 
        Secretary, after receiving the report described in paragraph 
        (1) and before the end of the 90-day period described in such 
        paragraph--
                    (A) determines that it is not feasible or cost-
                effective to carry out this section or that carrying 
                out this section would not make a material contribution 
                to the body of scientific knowledge concerning the 
                health effects in humans of herbicide exposure; and
                    (B) notifies the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives of that determination and 
                the reasons therefor.

SEC. 204. REPORT TO EVALUATE AND IDENTIFY GROUPS AT-RISK OF EXPOSURE TO 
              TOXIC SUBSTANCES.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, and every two years thereafter, the Secretary of 
Defense shall submit to the appropriate committees of Congress and, 
subject to applicable Federal privacy laws, make available to the 
public a report evaluating and identifying the groups of members of the 
Armed Forces and former members of the Armed Forces who are at-risk of 
exposure to toxic substances.
    (b) Existing Data.--The Secretary shall use data from existing 
record and tracking systems to develop each report under subsection 
(a).
    (c) Use of Capabilities of National Artificial Intelligence 
Institute.--In developing each report under subsection (a), the 
Secretary shall use the capabilities of the National Artificial 
Intelligence Institute of the Department of Veterans Affairs to 
interpret the veteran population data within the Individual 
Longitudinal Exposure Record of the Department, including data compiled 
under--
            (1) the Million Veteran Program of the Department;
            (2) health records of veterans; and
            (3) benefits records of veterans.
    (d) Elements of Report.--Each report submitted under subsection (a) 
shall--
            (1) identify groups at a high-risk for illnesses relating 
        to exposure to toxic substances and recommend an outreach 
        strategy for those groups; and
            (2) determine the viability of correlating the Individual 
        Longitudinal Exposure Record and health records maintained by 
        the Veterans Health Administration, including with respect to 
        participation of a veteran in the Million Veteran Program of 
        the Department, to provide more data to epidemiologists of the 
        Department.
    (e) Appropriate Committees of Congress Defined.--In this section, 
the term ``appropriate committees of Congress'' means--
            (1) the Committee on Armed Services and the Committee on 
        Veterans' Affairs of the Senate; and
            (2) the Committee on Armed Services and the Committee on 
        Veterans' Affairs of the House of Representatives.

 TITLE III--IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS 
                REGARDING EXPOSURES TO TOXIC SUBSTANCES

SEC. 301. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF VETERANS 
              AFFAIRS FOR VETERANS EXPOSED TO TOXIC SUBSTANCES AND 
              OUTREACH PROGRAM FOR SUCH VETERANS AND CAREGIVERS AND 
              SURVIVORS OF SUCH VETERANS.

    (a) Publication of List of Resources.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, and annually thereafter, the 
        Secretary of Veterans Affairs shall publish a list of resources 
        of the Department of Veterans Affairs for--
                    (A) veterans provided disability compensation under 
                chapter 11 of title 38, United States Code, relating to 
                exposure to toxic substances;
                    (B) veterans eligible for consultation, testing, 
                and treatment under section 1720J of such title, as 
                added by section 101(a);
                    (C) caregivers of veterans described in 
                subparagraph (A) or (B) who are participating in the 
                program of comprehensive assistance for family 
                caregivers under section 1720G(a) of such title; and
                    (D) survivors of veterans described in subparagraph 
                (A) or (B) (or who would be described in any such 
                subparagraph were the veteran alive) who are receiving 
                death benefits under the laws administered by the 
                Secretary.
            (2) Update.--The Secretary shall periodically update the 
        list published under paragraph (1).
    (b) Outreach.--The Secretary shall develop, with input from the 
community, an informative outreach program for veterans on illnesses 
that may be related to exposure to toxic substances, including outreach 
with respect to benefits and support programs.

SEC. 302. INCORPORATION OF TOXIC EXPOSURE QUESTIONNAIRE DURING PRIMARY 
              CARE APPOINTMENTS.

    (a) In General.--The Secretary of Veterans Affairs shall 
incorporate a clinical questionnaire to help determine potential 
exposure to toxic substances 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 exposure of 
veterans to toxic substances while serving in the Armed Forces.
    (b) Determination of Questions.--The questions included in the 
questionnaire required under subsection (a) shall be determined by the 
Secretary with input from medical professionals.

SEC. 303. PORTAL FOR ACCESS BY VETERANS TO INDIVIDUAL LONGITUDINAL 
              EXPOSURE RECORD.

    (a) In General.--The Secretary of Veterans Affairs shall establish 
a portal through which a veteran may access documents and information 
with respect to the veteran contained in the Individual Longitudinal 
Exposure Record of the Department of Veterans Affairs.
    (b) Elements of Portal.--The portal established under subsection 
(a) shall--
            (1) present documents and information with respect to a 
        veteran contained in the Individual Longitudinal Exposure 
        Record of the veteran in a printable, read-only format; and
            (2) be hosted on an internet website of the Department that 
        is commonly used by veterans.

SEC. 304. TRAINING OF PERSONNEL OF DEPARTMENT OF VETERANS AFFAIRS ON 
              ILLNESSES RELATED TO EXPOSURE TO TOXIC SUBSTANCES.

    (a) In General.--The Secretary of Veterans Affairs shall ensure 
that personnel of the Department of Veterans Affairs, including 
personnel involved with establishing disability ratings under the laws 
administered by the Secretary, and non-Department health care personnel 
who provide care to veterans under the laws administered by the 
Secretary are appropriately trained to identify, treat, and assess the 
impact of illnesses related to exposure to toxic substances.
    (b) Elements of Training.--The training required under subsection 
(a) shall--
            (1) provide veterans and personnel with specific education 
        with respect to illnesses related to exposure to toxic 
        substances;
            (2) inform disability raters of secondary effects that can 
        be attributed to exposure to toxic substances; and
            (3) inform personnel of how to probe for additional 
        information regarding exposures to different toxicants.
    (c) Toxicant Defined.--In this section, the term ``toxicant'' has 
the meaning given that term in section 1720J(i) of title 38, United 
States Code, as added by section 101(a).
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