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

<DOC>





                                                       Calendar No. 602
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 (for himself, Mrs. Blackburn, Ms. McSally, and Mrs. Capito) 
introduced the following bill; which was read twice and referred to the 
                     Committee on Veterans' Affairs

                            December 8, 2020

                Reported by Mr. Moran, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (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''</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents for this Act 
is as follows:</DELETED>

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

<DELETED>Sec. 101. Consultation, testing, and treatment for certain 
                            veterans who received hazardous duty pay or 
                            were exposed to toxic substances.
<DELETED>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.
<DELETED>Sec. 103. Presumptions of service connection for diseases 
                            associated with exposure to certain toxic 
                            substances.
  <DELETED>TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC 
                               SUBSTANCES

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

<DELETED>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.
<DELETED>Sec. 302. Incorporation of toxic exposure questionnaire during 
                            primary care appointments.
<DELETED>Sec. 303. Portal for access by veterans to individual 
                            longitudinal exposure record.
<DELETED>Sec. 304. Training of personnel of Department of Veterans 
                            Affairs on illnesses related to exposure to 
                            toxic substances.

<DELETED>SEC. 2. DEFINITIONS.</DELETED>

<DELETED>    In this Act:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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).</DELETED>

 <DELETED>TITLE I--EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS 
                 EXPOSED TO TOXIC SUBSTANCES</DELETED>

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

<DELETED>    (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:</DELETED>
<DELETED>``Sec. 1720J. Consultation, testing, and treatment of veterans 
              for exposure to toxic substances</DELETED>
<DELETED>    ``(a) In General.--The Secretary shall furnish to covered 
veterans--</DELETED>
        <DELETED>    ``(1) covered consultation and testing regarding 
        the exposure of those veterans to toxic substances; 
        and</DELETED>
        <DELETED>    ``(2) treatment for any illness relating to such 
        exposure diagnosed under subsection (b)(2), subject to approval 
        by the Under Secretary for Health.</DELETED>
<DELETED>    ``(b) Covered Consultation and Testing.--For purposes of 
this section, covered consultation and testing is--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) diagnosis by such physician of any illness 
        related to exposure to a toxic substance; and</DELETED>
        <DELETED>    ``(3) any medical testing necessary to carry out 
        paragraphs (1) and (2), including a referral to a specialist 
        physician.</DELETED>
<DELETED>    ``(c) Covered Veterans.--For purposes of this section, a 
covered veteran is a veteran who--</DELETED>
        <DELETED>    ``(1) received hazardous duty incentive pay under 
        section 351 of title 37 for more than one day; or</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(A) an open burn pit;</DELETED>
                <DELETED>    ``(B) a toxic substance; or</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(2) The Under Secretary shall support any denial of 
eligibility under subsection (a)(2) with specific scientific 
evidence.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) health care providers of the 
        Department;</DELETED>
        <DELETED>    ``(2) health care providers providing services 
        under this section under contract arrangements; and</DELETED>
        <DELETED>    ``(3) covered veterans.</DELETED>
<DELETED>    ``(h) Copayment.--A covered veteran is not required to pay 
a copayment for covered consultation and testing or treatment under 
this section.</DELETED>
<DELETED>    ``(i) Definitions.--In this section:</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) The term `toxic substance' means a toxicant 
        or a toxin.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) The term `toxin' means any substance that 
        can injure or kill humans, animals, or plants and that is 
        produced naturally.</DELETED>
        <DELETED>    ``(5) The team `treatment' means any commonly 
        accepted medical treatment practiced by the medical community 
        at large.''.</DELETED>
<DELETED>    (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:</DELETED>

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

<DELETED>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.</DELETED>

<DELETED>    (a) In General.--Section 1116 of title 38, United States 
Code, is amended by striking subsection (e).</DELETED>
<DELETED>    (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.</DELETED>

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

<DELETED>    (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:</DELETED>
<DELETED>``Sec. 1119. Presumptions of service connection for diseases 
              associated with exposure to certain toxic 
              substances</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(2) A disease specified in this paragraph is any disease 
that--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(B) The factors set forth in this subparagraph are as 
follows:</DELETED>
        <DELETED>    ``(i) The duty location of the veteran.</DELETED>
        <DELETED>    ``(ii) The length of service of the 
        veteran.</DELETED>
        <DELETED>    ``(iii) Such other factors as the Secretary 
        considers appropriate.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(2) In making determinations under paragraph (1), the 
Secretary shall take into account--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(B) all other sound medical and scientific 
        information and analyses available to the Secretary.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(B) The Secretary may define the standards described in 
subparagraph (A) for purposes of that subparagraph.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(B) A determination described in this subparagraph is a 
determination by the Secretary under paragraph (1) that--</DELETED>
        <DELETED>    ``(i) a presumption of service connection is not 
        warranted for a disease; and</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(II) limited evidence or suggestive evidence of 
        such an association exists.</DELETED>
<DELETED>    ``(C) Any notice published under subparagraph (A) shall 
include an explanation of the scientific basis for the determination 
described in subparagraph (B).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Removal of Presumption of Service Connection.--
Whenever the presumption of service connection for a disease under this 
section is removed under subsection (c)--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(f) Definitions.--In this section:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) The term `toxic substance' has the meaning 
        given that term in section 1720J(i) of this title.''.</DELETED>
<DELETED>    (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:</DELETED>

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

  <DELETED>TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC 
                          SUBSTANCES</DELETED>

<DELETED>SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW 
              COMMISSION.</DELETED>

<DELETED>    (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:</DELETED>
<DELETED>``Sec. 547. Toxic Exposure Review Commission</DELETED>
<DELETED>    ``(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').</DELETED>
<DELETED>    ``(b) Duties.--The Commission shall carry out the 
following duties:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Hold public meetings to gather relevant 
        information regarding exposure to toxic substances.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Recommend, by majority vote, whether such a 
        study should be conducted.</DELETED>
        <DELETED>    ``(5) Recommend to the Secretary, by majority 
        vote, whether new, independent studies should be conducted 
        regarding the health outcomes of exposure to toxic 
        substances.</DELETED>
        <DELETED>    ``(6) Annually report to Congress on progress 
        regarding the duties set forth in paragraphs (1) through 
        (5).</DELETED>
<DELETED>    ``(c) Membership.--(1)(A) The Commission shall be composed 
of 9 members, appointed as follows:</DELETED>
        <DELETED>    ``(i) Two members appointed by the Speaker of the 
        House of Representatives.</DELETED>
        <DELETED>    ``(ii) Two members appointed by the minority 
        leader of the House of Representatives.</DELETED>
        <DELETED>    ``(iii) Two members appointed by the majority 
        leader of the Senate.</DELETED>
        <DELETED>    ``(iv) Two members appointed by the minority 
        leader of the Senate.</DELETED>
        <DELETED>    ``(v) One member appointed by the 
        Secretary.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(A) The field of respiratory medicine.</DELETED>
        <DELETED>    ``(B) The field of endocrinology and metabolic 
        medicine.</DELETED>
        <DELETED>    ``(C) The field of hematology.</DELETED>
        <DELETED>    ``(D) The field of oncology.</DELETED>
        <DELETED>    ``(E) The field of public health.</DELETED>
        <DELETED>    ``(F) The field of occupational and environmental 
        health.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Meetings.--(1) The Commission shall meet not less 
frequently than twice each year.</DELETED>
<DELETED>    ``(2)(A) Each meeting of the Commission shall be open to 
the public.</DELETED>
<DELETED>    ``(B) All the proceedings, information, and deliberations 
of the Commission shall be available for review by the 
public.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(g) Pay.--(1) Members of the Commission shall serve 
without pay.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(3) Members shall receive travel expenses, including per 
diem in lieu of subsistence, in accordance with sections 5702 and 5703 
of title 5.</DELETED>
<DELETED>    ``(h) Director of Staff.--(1) The Commission shall appoint 
a Director who--</DELETED>
        <DELETED>    ``(A) has not served as an employee of the 
        Department during the one-year period preceding the date of 
        such appointment; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(3)(A) Not more than two-thirds of the personnel 
employed by or detailed to the Commission may be on detail from the 
Department.</DELETED>
<DELETED>    ``(B) Not more than half of the professional analysts of 
the Commission staff may be persons detailed from the Department to the 
Commission.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(k) Communications.--(1)(A) Except as provided in 
subparagraph (B), no person may restrict an employee of the Department 
in communicating with the Commission.</DELETED>
<DELETED>    ``(B) Subparagraph (A) does not apply to a communication 
that is unlawful.</DELETED>
<DELETED>    ``(2) All ex parte communications with the Commission 
shall be made part of the public record.''.</DELETED>
<DELETED>    (b) Clerical Amendment.--The table of sections at the 
beginning of such subchapter is amended by adding at the end the 
following new item:</DELETED>

<DELETED>``547. Toxic Exposure Review Commission.''.

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

<DELETED>    (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.</DELETED>
<DELETED>    (b) Agreement.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (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;</DELETED>
        <DELETED>    (2) the increased risk of the disease among those 
        exposed to toxic substances during active military, naval, or 
        air service; and</DELETED>
        <DELETED>    (3) whether there exists a plausible biological 
        mechanism or other evidence of a causal relationship between 
        the exposure and the occurrence of the disease.</DELETED>
<DELETED>    (e) Scientific Studies.--</DELETED>
        <DELETED>    (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).</DELETED>
        <DELETED>    (2) Recommendations for additional scientific 
        studies.--</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (B) Considerations.--In making 
                recommendations under subparagraph (A), the Academies 
                shall consider--</DELETED>
                        <DELETED>    (i) the scientific information 
                        that is available at the time of the 
                        recommendation;</DELETED>
                        <DELETED>    (ii) the value and relevance of 
                        the information that could result from 
                        additional studies; and</DELETED>
                        <DELETED>    (iii) the cost and feasibility of 
                        carrying out such additional studies.</DELETED>
<DELETED>    (f) Subsequent Reviews.--Under an agreement between the 
Secretary and the Academies under this section, the Academies shall--
</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (g) Reports.--</DELETED>
        <DELETED>    (1) Initial report.--</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (B) Elements.--The report submitted under 
                subparagraph (A) shall include the following:</DELETED>
                        <DELETED>    (i) The determinations described 
                        in subsection (d).</DELETED>
                        <DELETED>    (ii) A full explanation of the 
                        scientific evidence and reasoning that led to 
                        such determinations.</DELETED>
                        <DELETED>    (iii) Any recommendations of the 
                        Academies under subsection (e)(2).</DELETED>
                        <DELETED>    (iv) The recommendation described 
                        in subparagraph (C).</DELETED>
                <DELETED>    (C) Recommendation for implementation of 
                analysis of examinations and treatment of veterans for 
                disabilities related to exposure to toxic substances.--
                </DELETED>
                        <DELETED>    (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.</DELETED>
                        <DELETED>    (ii) Considerations.--In making a 
                        recommendation under clause (i), the Academies 
                        shall consider--</DELETED>
                                <DELETED>    (I) the scientific 
                                information that is available at the 
                                time of the recommendation;</DELETED>
                                <DELETED>    (II) the value and 
                                relevance of the information that could 
                                result from the implementation of 
                                section 203; and</DELETED>
                                <DELETED>    (III) the cost and 
                                feasibility of such 
                                implementation.</DELETED>
                        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (i) Alternative Contract Scientific Organization.--
</DELETED>
        <DELETED>    (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--
        </DELETED>
                <DELETED>    (A) is not part of the Federal 
                Government;</DELETED>
                <DELETED>    (B) operates as a not-for-profit entity; 
                and</DELETED>
                <DELETED>    (C) has expertise and objectivity 
                comparable to that of the Academies.</DELETED>
        <DELETED>    (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.</DELETED>

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

<DELETED>    (a) In General.--The Secretary of Veterans Affairs shall 
compile and analyze, on a continuous basis, all clinical data that--
</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (1) the information compiled under subsection 
        (a);</DELETED>
        <DELETED>    (2) an analysis of such information;</DELETED>
        <DELETED>    (3) a description of the types and incidences of 
        disabilities identified by the Department under such 
        subsection;</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (d) Effective Date.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (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.</DELETED>

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

<DELETED>    (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.</DELETED>
<DELETED>    (b) Existing Data.--The Secretary shall use data from 
existing record and tracking systems to develop each report under 
subsection (a).</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (1) the Million Veteran Program of the 
        Department;</DELETED>
        <DELETED>    (2) health records of veterans; and</DELETED>
        <DELETED>    (3) benefits records of veterans.</DELETED>
<DELETED>    (d) Elements of Report.--Each report submitted under 
subsection (a) shall--</DELETED>
        <DELETED>    (1) identify groups at a high-risk for illnesses 
        relating to exposure to toxic substances and recommend an 
        outreach strategy for those groups; and</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (e) Appropriate Committees of Congress Defined.--In this 
section, the term ``appropriate committees of Congress'' means--
</DELETED>
        <DELETED>    (1) the Committee on Armed Services and the 
        Committee on Veterans' Affairs of the Senate; and</DELETED>
        <DELETED>    (2) the Committee on Armed Services and the 
        Committee on Veterans' Affairs of the House of 
        Representatives.</DELETED>

<DELETED>TITLE III--IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS 
       AFFAIRS REGARDING EXPOSURES TO TOXIC SUBSTANCES</DELETED>

<DELETED>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.</DELETED>

<DELETED>    (a) Publication of List of Resources.--</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (A) veterans provided disability 
                compensation under chapter 11 of title 38, United 
                States Code, relating to exposure to toxic 
                substances;</DELETED>
                <DELETED>    (B) veterans eligible for consultation, 
                testing, and treatment under section 1720J of such 
                title, as added by section 101(a);</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (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.</DELETED>
        <DELETED>    (2) Update.--The Secretary shall periodically 
        update the list published under paragraph (1).</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 302. INCORPORATION OF TOXIC EXPOSURE QUESTIONNAIRE DURING 
              PRIMARY CARE APPOINTMENTS.</DELETED>

<DELETED>    (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.</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 303. PORTAL FOR ACCESS BY VETERANS TO INDIVIDUAL 
              LONGITUDINAL EXPOSURE RECORD.</DELETED>

<DELETED>    (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.</DELETED>
<DELETED>    (b) Elements of Portal.--The portal established under 
subsection (a) shall--</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (2) be hosted on an internet website of the 
        Department that is commonly used by veterans.</DELETED>

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

<DELETED>    (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.</DELETED>
<DELETED>    (b) Elements of Training.--The training required under 
subsection (a) shall--</DELETED>
        <DELETED>    (1) provide veterans and personnel with specific 
        education with respect to illnesses related to exposure to 
        toxic substances;</DELETED>
        <DELETED>    (2) inform disability raters of secondary effects 
        that can be attributed to exposure to toxic substances; 
        and</DELETED>
        <DELETED>    (3) inform personnel of how to probe for 
        additional information regarding exposures to different 
        toxicants.</DELETED>
<DELETED>    (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).</DELETED>

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. Expansion of health care eligibility for certain individuals 
                            exposed to open burn pits and other toxic 
                            substances.
Sec. 102. Expansion of health care eligibility for veterans awarded 
                            certain medals.
Sec. 103. 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. 104. Permanent reauthorization of authority of Secretary of 
                            Veterans Affairs to prescribe regulations 
                            providing that a presumption of service 
                            connection is warranted for an illness 
                            associated with service in the Persian Gulf 
                            during the Persian Gulf War.
Sec. 105. 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. Collection, analysis, and report on treatment of veterans for 
                            medical conditions related to 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 health care 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 of title 38, United States Code.
            (2) Open burn pit.--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).
            (3) Toxic substance.--The term ``toxic substance'' has the 
        meaning given that term in subparagraph (G)(iv) of section 
        1710(e)(1) 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. EXPANSION OF HEALTH CARE ELIGIBILITY FOR CERTAIN INDIVIDUALS 
              EXPOSED TO OPEN BURN PITS AND OTHER TOXIC SUBSTANCES.

    (a) In General.--Section 1710(e) of title 38, United States Code, 
is amended--
            (1) in paragraph (1), by adding at the end the following 
        new subparagraph:
    ``(G)(i) Subject to paragraph (2), a covered individual is eligible 
for hospital care, medical services, and nursing home care under 
subsection (a)(2)(F) for any illness.
    ``(ii) For purposes of this subparagraph, a covered individual is 
an individual who--
            ``(I) is eligible for inclusion in the Airborne Hazards and 
        Open Burn Pit Registry; or
            ``(II) has been identified by the Secretary of Defense to 
        have been possibly exposed, inside or outside the United 
        States, during active duty, active duty for training, or 
        inactive duty training, to--
                    ``(aa) an open burn pit;
                    ``(bb) a toxic substance; or
                    ``(cc) a site included in a database maintained by 
                the Department of Defense and shared with the 
                Department of Veterans Affairs to serve as the central 
                portal for exposure-related data that compiles, 
                collates, presents, and provides available occupational 
                and environmental exposure information to support the 
                needs of the Department of Defense and the Department 
                of Veterans Affairs.
    ``(iii) A covered individual shall be enrolled in the system of 
annual patient enrollment of the Department in the priority group under 
subsection (a)(6) of section 1705 of this title.
    ``(iv) In this subparagraph:
            ``(I) The term `Airborne Hazards and Open Burn Pit 
        Registry' means the registry established by the Secretary under 
        section 201 of the Dignified Burial and Other Veterans' 
        Benefits Improvement Act of 2012 (Public Law 112-260; 38 U.S.C. 
        527 note).
            ``(II) The term `open burn pit' has the meaning given that 
        term in section 201(c) of the Dignified Burial and Other 
        Veterans' Benefits Improvement Act of 2012 (Public Law 112-260; 
        38 U.S.C. 527 note).
            ``(III) The term `toxic substance' means a toxicant or a 
        toxin.
            ``(IV) 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.
            ``(V) The term `toxin' means any substance that can injure 
        or kill humans, animals, or plants and that is produced 
        naturally.''; and
            (2) in paragraph (2)(B), by striking ``or (F)'' and 
        inserting ``(F), or (G)''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date that is 90 days after the date of the enactment 
of this Act.
    (c) Determinations of Exposure.--
            (1) In general.--The Secretary of Veterans Affairs shall, 
        to the extent practicable, establish and maintain a mechanism 
        by which veterans may determine whether or not they have been 
        possibly exposed to an open burn pit or toxic substance 
        described in subparagraph (G)(ii)(II) of section 1710(e)(1) of 
        title 38, United States Code, as added by subsection (a), for 
        purposes of being considered as covered individuals under such 
        subparagraph.
            (2) Approval of secretary.--Any determination made under 
        paragraph (1) shall be subject to the approval of the 
        Secretary.
            (3) Appeals.--The Secretary shall establish a mechanism for 
        appealing a decision made by the Secretary under paragraph (2).
    (d) Report.--
            (1) In general.--Not later than 30 days after the date on 
        which the Secretary of Defense identifies the individuals 
        described in subparagraph (G)(ii)(II) of section 1710(e)(1) of 
        title 38, United States Code, as added by subsection (a), the 
        Secretary, in consultation with the Secretary of Veterans 
        Affairs, shall submit to the appropriate committees of Congress 
        a report.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) The duty locations or units of the individuals 
                described in paragraph (1), or other information on 
                groups to which such individuals belong.
                    (B) The evidence considered in identifying 
                individuals who were possibly exposed to an open burn 
                pit, toxic substance, or site as described in 
                subparagraph (G)(ii)(II) of section 1710(e)(1) of title 
                38, United States Code, as added by subsection (a).
                    (C) The criteria used to determine whether an 
                individual was so exposed.
            (3) Appropriate committees of congress.--In this 
        subsection, the term ``appropriate committees of Congress'' 
        means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Armed Services of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Armed Services of the House of 
                Representatives.

SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR VETERANS AWARDED 
              CERTAIN MEDALS.

    (a) In General.--Section 1710(e) of title 38, United States Code, 
as amended by section 101(a), is further amended--
            (1) in paragraph (1), by adding at the end the following 
        new subparagraph:
    ``(H)(i) Subject to paragraph (2), a veteran is eligible for 
hospital care, medical services, and nursing home care under subsection 
(a)(2)(F) for any illness if the veteran was awarded any of the 
following:
            ``(I) The Armed Forces Service Medal.
            ``(II) The Afghanistan Campaign Medal.
            ``(III) The Global War on Terrorism Expeditionary Medal.
            ``(IV) The Inherent Resolve Campaign Medal.
            ``(V) The Iraq Campaign Medal.
            ``(VI) The Southwest Asia Service Medal.
    ``(ii) A veteran described in clause (i) shall be enrolled in the 
system of annual patient enrollment of the Department in the priority 
group under subsection (a)(6) of section 1705 of this title.''; and
            (2) in paragraph (2), by striking ``or (G)'' and inserting 
        ``(G), or (H)''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date that is 90 days after the date of the enactment 
of this Act.

SEC. 103. 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. 104. PERMANENT REAUTHORIZATION OF AUTHORITY OF SECRETARY OF 
              VETERANS AFFAIRS TO PRESCRIBE REGULATIONS PROVIDING THAT 
              A PRESUMPTION OF SERVICE CONNECTION IS WARRANTED FOR AN 
              ILLNESS ASSOCIATED WITH SERVICE IN THE PERSIAN GULF 
              DURING THE PERSIAN GULF WAR.

    (a) In General.--Section 1118 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 1118 of such title shall take effect on the 
date of the enactment of this Act.

SEC. 105. 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 a presumption 
of service connection is not warranted for a disease as to which the 
National Academies of Sciences, Engineering, and Medicine determined 
that there was--
            ``(i) sufficient evidence of an association 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.
    ``(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(h)(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 1710(e)(1)(G)(iv) 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.--The Secretary shall establish an independent 
commission to be known as the `Toxic Exposure Review Commission' (in 
this section referred to as the `Commission').
    ``(b) Purpose.--The Commission shall--
            ``(1) advise the Secretary on questions relating to 
        exposure to toxic substances that require scientific research; 
        and
            ``(2) assist in the consideration of possible presumptions 
        of service connection.
    ``(c) Duties.--The Commission shall carry out the following duties:
            ``(1) Collect any relevant information from the Department 
        of Defense and other sources to identify possible toxic 
        exposures related to service during active duty, active duty 
        for training, or inactive duty training in order to determine 
        the need for a comprehensive review under an agreement under 
        section 202 of the Toxic Exposure in the American Military Act 
        of 2020. Relevant information may be collected from the 
        following:
                    ``(A) Any Federal agency, 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.
                    ``(B) Public meetings or hearings, which may be 
                held to take such testimony and receive such evidence 
                as the Commission considers advisable to carry out the 
                duties of the Commission.
            ``(2) Recommend to the Secretary, by majority vote, whether 
        a comprehensive scientific review should be conducted by the 
        National Academies of Sciences, Engineering, and Medicine under 
        an agreement under section 202 of the Toxic Exposure in the 
        American Military Act of 2020.
            ``(3) Recommend to the Secretary, by majority vote, whether 
        new, independent studies regarding the health outcomes of 
        exposure to toxic substances, or any other new, independent 
        studies that the Commission deems necessary and appropriate, 
        should be conducted.
            ``(4) Annually report to Congress on progress regarding the 
        duties set forth in paragraphs (1) through (3), any 
        recommendations made to the Secretary, and any responses of the 
        Secretary to such recommendations.
    ``(d) 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 at least five 
members of the Commission are scientists or health care professionals--
            ``(A) of whom--
                    ``(i) one has a background in the field of 
                respiratory medicine;
                    ``(ii) one has a background in the field of 
                endocrinology and metabolic medicine;
                    ``(iii) one has a background in hematology;
                    ``(iv) one has a background in oncology; and
                    ``(v) one has a background in occupational and 
                environmental health; and
            ``(B) who are not officials or employees of the Federal 
        Government.
    ``(3) In appointing individuals under paragraph (1)(A), the 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.
    ``(e) Meetings.--(1) The Commission shall meet not less frequently 
than twice each year.
    ``(2)(A) Each meeting of the Commission shall be open to the 
public.
    ``(B) All the proceedings, information, and deliberations of the 
Commission shall be available for review by the public.
    ``(C) Meetings of the Commission may be carried out through the use 
of telephonic or other appropriate telecommunication technology if the 
Commission determines that such technology will allow the members to 
communicate simultaneously.
    ``(f) Chair and Vice Chair.--At the initial meeting of the 
Commission under subsection (e), 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.
    ``(g) Period of Appointment; Vacancies.--(1) A member of the 
Commission shall be appointed for a term that may not exceed four 
years.
    ``(2) The Secretary shall ensure that terms of members of the 
Commission are staggered so that no such terms end on the same date.
    ``(3) A vacancy in the Commission shall be filled in the same 
manner as the original appointment, but the individual appointed to 
fill the vacancy shall serve only for the unexpired portion of the term 
for which the individual's predecessor was appointed.
    ``(4) In appointing the initial members of the Commission, each 
official who is authorized to appoint two members of the Commission 
shall appoint--
            ``(A) one member whose term expires after two years; and
            ``(B) one member whose term expires after four years.
    ``(h) Pay.--(1) Members of the Commission shall serve without pay.
    ``(2) Each member of the Commission who is an officer or employee 
of the United States shall serve without compensation in addition to 
that received for service as an officer or employee of the United 
States.
    ``(3) Members shall receive travel expenses, including per diem in 
lieu of subsistence, in accordance with sections 5702 and 5703 of title 
5.
    ``(i) Director of Staff.--(1) The Commission shall appoint a 
Director who--
            ``(A) has not served as an employee of the Department 
        during the one-year period preceding the date of such 
        appointment; and
            ``(B) is not otherwise barred or prohibited from serving as 
        Director under Federal ethics laws and regulations, by reason 
        of post-employment conflict of interest.
    ``(2) The Director shall be paid at the rate of basic pay payable 
for level IV of the Executive Schedule under section 5315 of title 5.
    ``(j) Staff.--(1) Subject to paragraphs (2) and (3), the Director, 
with the approval of the Commission, may appoint and fix the pay of 
additional personnel.
    ``(2) The Director may make such appointments without regard to the 
provisions of title 5 governing appointments in the competitive 
service, and any personnel so appointed may be paid without regard to 
the provisions of chapter 51 and subchapter III of chapter 53 of that 
title relating to classification and General Schedule pay rates, except 
that an individual so appointed may not receive pay in excess of the 
annual rate of basic pay payable for GS-15 of the General Schedule.
    ``(3)(A) Not more than two-thirds of the personnel employed by or 
detailed to the Commission may be on detail from the Department.
    ``(B) Not more than half of the professional analysts of the 
Commission staff may be persons detailed from the Department to the 
Commission.
    ``(4) Subject to paragraph (3), the head of any Federal agency, 
upon the request of the Director, may detail any of the personnel of 
that agency to the Commission to assist the Commission in carrying out 
its duties under this section.
    ``(5) The Commission may secure directly from any Federal agency 
such information as the Commission considers necessary to carry out 
this section. Upon request of the Chair, the head of such agency shall 
furnish such information to the Commission, unless such information is 
classified.
    ``(k) Other Authority.--(1) The Commission may procure by contract, 
to the extent funds are available, the temporary or intermittent 
services of experts or consultants pursuant to section 3109 of title 5.
    ``(2) To the extent funds are available, the Commission may lease 
real property and acquire personal property either of its own accord or 
in consultation with the General Services Administration.
    ``(l) Communications.--(1)(A) Except as provided in subparagraph 
(B), no person may restrict an employee of the Department in 
communicating with the Commission.
    ``(B) Subparagraph (A) does not apply to a communication that is 
unlawful.
    ``(2) All ex parte communications with the Commission shall be made 
part of the public record.
    ``(m) 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(h)(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.
    ``(n) Toxic Substance Defined.--In this section, the term `toxic 
substance' has the meaning given that term in subparagraph (G)(iv) of 
section 1710(e)(1) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 5 of such title 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 a five-year 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.
            (3) Extension.--An agreement under this section may be 
        extended in five-year increments.
    (c) Review of Scientific Evidence.--Under an agreement between the 
Secretary and the Academies under this section, the Academies shall 
review and summarize the scientific evidence, and assess the strength 
thereof, concerning the association between 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) Cooperation of Federal Agencies.--
            (1) In general.--The head of each relevant Federal agency, 
        including the Secretary of Defense, shall cooperate fully with 
        the Academies in performing the services covered by this 
        section.
            (2) Technical and scientific capabilities.--In performing 
        the services covered by this section, the Academies shall make 
        use of the technical and scientific capabilities of any Federal 
        agency.
    (f) Recommendations for Additional Scientific Studies.--
            (1) 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.
            (2) Considerations.--In making recommendations under 
        paragraph (1), the Academies shall consider--
                    (A) the scientific information that is available at 
                the time of the recommendation;
                    (B) the value and relevance of the information that 
                could result from additional studies; and
                    (C) the cost and feasibility of carrying out such 
                additional studies.
    (g) Reports.--
            (1) 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 (f).
            (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) 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 547 of title 38, United 
        States Code, as added by section 201(a), and section 1119 of 
        such title, as added by section 105(a), to the National 
        Academies of Sciences, Engineering, and Medicine shall be 
        treated as a reference to the other organization.

SEC. 203. COLLECTION, ANALYSIS, AND REPORT ON TREATMENT OF VETERANS FOR 
              MEDICAL CONDITIONS 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 hospital care, medical services, and nursing 
        home care furnished under section 1710(a)(2)(F) of title 38, 
        United States Code; and
            (2) is likely to be scientifically useful in determining 
        the association, if any, between the medical condition of a 
        veteran and 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 date of the 
enactment of this Act, and annually thereafter, the Secretary shall 
submit to the Committee on Veterans' Affairs of the Senate, the 
Committee on Veterans' Affairs of the House of Representatives, and the 
Toxic Exposure Review Commission established by section 547 of title 
38, United States Code, as added by section 201(a) of this Act, a 
report containing--
            (1) the data compiled under subsection (a);
            (2) an analysis of such data;
            (3) a description of the types and incidences of medical 
        conditions identified by the Department under such subsection;
            (4) the explanation of the Secretary for the incidence of 
        such medical conditions and other explanations for the 
        incidence of such conditions as the Secretary considers 
        reasonable; and
            (5) the views of the Secretary on the scientific validity 
        of drawing conclusions from the incidence of such medical 
        conditions, as evidenced by the data compiled under subsection 
        (a), regarding any association between such conditions and 
        exposure to a toxic substance.

 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 hospital care, medical 
                services, and nursing home care under section 
                1710(a)(2)(F) of such title;
                    (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 HEALTH CARE 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 health care personnel of the Department of Veterans Affairs 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 health care personnel of the Department with 
        specific education with respect to illnesses related to 
        exposure to toxic substances; and
            (2) inform such personnel of how to probe for additional 
        information from veterans regarding exposures to different 
        toxicants.
    (c) Toxicant Defined.--In this section, the term ``toxicant'' has 
the meaning given that term in subparagraph (G)(iv) of section 
1710(e)(1) of title 38, United States Code, as added by section 101(a).
                                                       Calendar No. 602

116th CONGRESS

  2d Session

                                S. 4393

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                            December 8, 2020

                       Reported with an amendment