[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2368 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 2368

 To amend title 38, United States Code, to establish a presumption of 
 service connection for illnesses associated with exposure to certain 
               airborne hazards, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 5, 2021

  Mrs. Luria introduced the following bill; which was referred to the 
                     Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to establish a presumption of 
 service connection for illnesses associated with exposure to certain 
               airborne hazards, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Conceding Our Veterans' Exposures 
Now And Necessitating Training Act of 2021'' or the ``COVENANT Act of 
2021''.

SEC. 2. PRESUMPTIONS OF SERVICE CONNECTION FOR ILLNESSES ASSOCIATED 
              WITH EXPOSURE TO CERTAIN AIRBORNE HAZARDS.

    (a) Sense of Congress.--It is the sense of Congress that--
            (1) as in past theaters of operation, Southwest Asia and 
        its supporting theaters of operation pose numerous natural and 
        manmade hazards that negatively affect the health outcomes of 
        individuals serving in these foreign environments;
            (2) toxic exposures from burn pits, oil well fires, and 
        other regional airborne hazards increase the potential for 
        immediate and long-term illnesses to emerge among members of 
        the Armed Forces; and
            (3) legislation is necessary--
                    (A) to confront the scientific challenge of 
                producing clear associations between in-theater toxic 
                exposures and the illnesses confronting veterans who 
                served in Southwest Asia and beyond;
                    (B) to address the insufficient data hindering the 
                Secretary of Veterans Affairs, the Secretary of 
                Defense, and relevant partners from reaching proactive 
                determinations regarding such associations; and
                    (C) to improve evaluations associated with claims 
                for disability compensation that relate to toxic 
                exposure.
    (b) Presumptions of Service Connection.--
            (1) 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 illnesses 
              associated with exposure to certain airborne hazards
    ``(a) Presumptions.--(1) For the purposes of section 1110 of this 
title, and subject to section 1113 of this title, an illness specified 
in subsection (d) becoming manifest in a covered veteran to a degree of 
10 percent or more shall be considered to have been incurred in or 
aggravated during active military, naval, or air service, 
notwithstanding that there is no record of evidence of such illness 
during a period of such service.
    ``(2) A covered veteran shall be presumed to have been exposed to 
an airborne hazard specified in subsection (e) during service of the 
covered veteran specified in subsection (f)(1) unless there is 
affirmative evidence to establish that the covered veteran was not 
exposed to any such airborne hazard during such service.
    ``(b) Medical Examinations and Opinions.--(1) If a covered veteran 
submits to the Secretary a claim for disability compensation for a 
diagnosed illness not specified in subsection (d) that includes an 
assertion that the illness is related to airborne hazard exposure 
(regardless of whether such assertion identifies a particular airborne 
hazard specified in subsection (e)) or open burn pit exposure, and the 
evidence of record is insufficient to establish service connection for 
the illness, the Secretary shall provide to the covered veteran a 
medical examination and obtain a medical opinion under section 5103A of 
this title to determine whether the illness is at least as likely as 
not caused by an airborne hazard specified in subsection (e).
    ``(2) In carrying out paragraph (1), if the diagnosed illness for 
which a claim is submitted involves a sign or symptom specified in 
section 1117(g) of this title, the Secretary shall ensure that--
            ``(A) the medical examination provided pursuant to such 
        paragraph includes an evaluation of each corresponding body 
        part or system that relates to the sign or symptom; and
            ``(B) the sign or symptom is considered in making the 
        determination under such paragraph.
    ``(3) In providing the Secretary with a medical opinion pursuant to 
paragraph (1), a medical provider shall consider--
            ``(A) the total potential exposure to airborne hazards 
        through any service of the covered veteran specified in 
        subsection (f)(1) and the synergistic effect of combined 
        airborne hazards, including airborne hazards that involve 
        exposure through inhalation, dermal exposure, or ingestion; and
            ``(B) the medical evidence and scientific reporting 
        available at the time of the determination under paragraph (1).
    ``(c) Relationship to Presumptions for Illnesses Associated With 
Service in Persian Gulf.--A determination that a presumption of service 
connection is not warranted pursuant to this section shall not preclude 
the Secretary from--
            ``(1) determining that a presumption of service connection 
        is warranted pursuant to section 1118 of this title; or
            ``(2) paying compensation to the veteran (or dependency and 
        indemnity compensation to a survivor of the veteran) pursuant 
        to section 1117 of this title.
    ``(d) Illnesses.--The illnesses specified in this subsection are 
the following:
            ``(1) Asthma that was diagnosed after a period of service 
        specified in subsection (f)(1).
            ``(2)(A) Head cancer of any type.
            ``(B) Neck cancer of any type.
            ``(C) Respiratory cancer of any type.
            ``(D) Gastrointestinal cancer of any type.
            ``(E) Reproductive cancer of any type.
            ``(F) Lymphoma cancer of any type.
            ``(G) Lymphomatic cancer of any type.
            ``(H) Kidney cancer.
            ``(I) Brain cancer.
            ``(J) Melanoma.
            ``(3) Chronic obstructive pulmonary disease.
            ``(4) Chronic bronchitis.
            ``(5) Constrictive bronchiolitis or obliterative 
        bronchiolitis.
            ``(6) Emphysema.
            ``(7) Granulomatous disease.
            ``(8) Interstitial lung disease.
            ``(9) Pleuritis.
            ``(10) Pulmonary fibrosis.
            ``(11) Sarcoidosis.
            ``(12) Rhinitis.
            ``(13) Sinusitis.
    ``(e) Airborne Hazards.--The airborne hazards specified in this 
subsection are the following:
            ``(1) Particulate matter, including the following:
                    ``(A) PM-10.
                    ``(B) PM-2.5.
            ``(2) Polycyclic aromatic hydrocarbons (PAHs), including 
        the following:
                    ``(A) Acenaphthene.
                    ``(B) Acenaphthylene.
                    ``(C) Anthracene.
                    ``(D) Benzo(a)anthracene.
                    ``(E) Benzo(a)pyrene.
                    ``(F) Benzo(b)fluoroanthene.
                    ``(G) Benzo(g,h,i)perylene.
                    ``(H) Benzo(k)fluoroanthene.
                    ``(I) Chrysene.
                    ``(J) Dibenze(a,h)anthracene.
                    ``(K) Fluoranthene.
                    ``(L) Fluorene.
                    ``(M) Indeno(1,2,3-cd)pyrene.
                    ``(N) Naphthalene.
                    ``(O) Phenanthrene.
                    ``(P) Pyrene.
            ``(3) Volatile organic compounds, including the following:
                    ``(A) Acetone.
                    ``(B) Acrolein.
                    ``(C) Benzene.
                    ``(D) Carbon disulfide.
                    ``(E) Chlorofluoromethane.
                    ``(F) Chloromethane.
                    ``(G) Ethylbenzene.
                    ``(H) Hexane.
                    ``(I) Hexachlorobutadiene.
                    ``(J) M/p-Xylene.
                    ``(K) Methylene chloride.
                    ``(L) Pentane.
                    ``(M) Propylene.
                    ``(N) Styrene.
                    ``(O) Toluene.
            ``(4) Toxic organic halogenated dioxins and furans 
        (dioxins), including the following:
                    ``(A) 1,2,3,4,6,7,8-HPCDD.
                    ``(B) 1,2,3,4,6,7,8-HPCDF.
                    ``(C) 1,2,3,4,7,8,9-HPCDF.
                    ``(D) 1,2,3,4,7,8-HXCDD.
                    ``(E) 1,2,3,4,7,8-HXCDF.
                    ``(F) 1,2,3,6,7,8-HXCDD.
                    ``(G) 1,2,3,6,7,8-HXCDF.
                    ``(H) 1,2,3,7,8,9-HXCDD.
                    ``(I) 1,2,3,7,8,9-HXCDF.
                    ``(J) 1,2,3,7,8-PECDD.
                    ``(K) 1,2,3,7,8-PECDF.
                    ``(L) 2,3,4,6,7,8-HXCDF.
                    ``(M) 2,3,4,7,8-PECDF.
                    ``(N) 2,3,7,8-TCDD.
                    ``(O) 2,3,7,8-TCDF.
                    ``(P) Octachlorodibenzodioxin.
                    ``(Q) Octachlorodibenzofuran.
            ``(5) Any other airborne hazard determined relevant by the 
        Secretary.
    ``(f) Definitions.--In this section:
            ``(1) The term `covered veteran' means any veteran who--
                    ``(A) on or after August 2, 1990, performed active 
                military, naval, or air service while assigned to a 
                duty station in--
                            ``(i) Bahrain;
                            ``(ii) Iraq;
                            ``(iii) Kuwait;
                            ``(iv) Oman;
                            ``(v) Qatar;
                            ``(vi) Saudi Arabia;
                            ``(vii) Somalia; or
                            ``(viii) United Arab Emirates; or
                    ``(B) on or after September 11, 2001, performed 
                active military, naval, or air service while assigned 
                to a duty station in--
                            ``(i) Afghanistan;
                            ``(ii) Djibouti;
                            ``(iii) Egypt;
                            ``(iv) Jordan;
                            ``(v) Lebanon;
                            ``(vi) Syria;
                            ``(vii) Yemen;
                            ``(viii) Uzbekistan;
                            ``(ix) the Philippines; or
                            ``(x) any other country determined relevant 
                        by the Secretary.
            ``(2) The term `illness' means a disease or other condition 
        that affects the health of an individual on a basis other than 
        an acute or transient basis.
            ``(3) The term `open burn pit' has the meaning given such 
        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), except that the area of land may be 
        located in any country specified in paragraph (1) or determined 
        relevant by the Secretary pursuant to such paragraph.
    ``(g) Effective Date of Award.--The effective date of an award 
under this section shall be determined in accordance with section 5110 
of this title, except that such date may not be earlier than the date 
of the enactment of this Act.''.
            (2) Clerical amendment.--The table of contents at the 
        beginning of chapter 11 of title 38, United States Code, is 
        amended by inserting after the item relating to section 1118 
        the following new item:

``1119. Presumptions of service connection for illnesses associated 
                            with exposure to certain airborne 
                            hazards.''.
            (3) Implementation deadline.--The Secretary of Veterans 
        Affairs shall implement the amendments made by this subsection 
        by not later than 18 months after the date of the enactment of 
        this Act.
    (c) Relationship to Presumptions for Illnesses Associated With 
Service in the Persian Gulf.--Subchapter II of chapter 11 of title 38, 
United States Code, is further amended--
            (1) in section 1117, by adding at the end the following new 
        subsection:
    ``(i) A denial or termination of compensation paid to a veteran 
pursuant to this section shall not preclude the Secretary from 
determining that a presumption of service connection is warranted 
pursuant to section 1119 of this title.''; and
            (2) in section 1118, by adding at the end the following new 
        subsection:
    ``(f) A determination that a presumption of service connection is 
not warranted pursuant to this section shall not preclude the Secretary 
from determining that a presumption of service connection is warranted 
pursuant to section 1119 of this title.''.
    (d) Pending Cases.--
            (1) Authority to stay.--The Secretary may stay a claim 
        described in paragraph (2) until the date on which the 
        Secretary commences the implementation of section 1119 of title 
        38, United States Code (as added by subsection (b)).
            (2) Claims described.--A claim described in this 
        subparagraph is a claim for disability compensation that is 
        pending at the Veterans Benefits Administration, the Board of 
        Veterans' Appeals, the Court of Appeals for Veterans Claims, or 
        the Court of Appeals for the Federal Circuit, on or after the 
        date of the enactment of this Act and before the date on which 
        the Secretary commences the implementation of such section 1119 
        and that relates to--
                    (A) the service and illnesses covered by such 
                section 1119; or
                    (B) the service covered by such section 1119 and a 
                diagnosed illness asserted in the claim to be related 
                to airborne hazard exposure, regardless of whether such 
                assertion identifies a particular airborne hazard, or 
                open burn pit exposure.
    (e) Standard Medical Training Curriculum.--
            (1) Curriculum.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall establish a standard medical training curriculum for all 
        medical providers conducting examinations and providing 
        opinions under section 1119(b) of title 38, United States Code 
        (as added by subsection (b)), that provides a standardized 
        approach to conducting and providing examinations and opinions 
        in accordance with such section.
            (2) Elements.--The Secretary shall include in the 
        curriculum under paragraph (1) an instruction for each medical 
        provider conducting an examination or providing an opinion to 
        consider the following:
                    (A) Relevant medical and scientific literature.
                    (B) Available information on the proximity, 
                intensity, and frequency of exposure of the individual 
                to airborne hazards.
                    (C) Medically unexplained chronic multisymptom 
                illnesses.
                    (D) All competent and credible evidence of record.
            (3) Submission to congress.--Prior to implementation of the 
        curriculum under paragraph (1), the Secretary shall submit to 
        the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate such curriculum.
    (f) Definitions.--In this section:
            (1) The terms ``illness'' and ``open burn pit'' have the 
        meaning given such terms in section 1119 of title 38, United 
        States Code (as added by subsection (b)).
            (2) The term ``medically unexplained chronic multisymptom 
        illness'' has the meaning given such term in section 
        1117(a)(2)(B) of title 38, United States Code.

SEC. 3. ELIGIBILITY FOR CARE AND SERVICES BASED ON POTENTIAL EXPOSURE 
              TO CERTAIN AIRBORNE HAZARDS.

    (a) Eligibility for Care and Services.--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 veteran is 
        eligible for hospital care, medical services, and nursing home 
        care under subsection (a)(2)(F) for any diagnosed illness, 
        notwithstanding that there is insufficient medical evidence to 
        conclude that such illness is attributable to the service 
        specified in section 1119(f)(1) of this title.
            ``(ii) In this subparagraph, the term `covered veteran' has 
        the meaning given such term in section 1119 of this title.''; 
        and
            (2) in paragraph (2)(B), by striking ``or (F)'' and 
        inserting ``(F), or (G)''.
    (b) Resource Assessment and Report.--
            (1) Initial assessment and report.--Not later than 180 days 
        after the date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall--
                    (A) complete an assessment to determine--
                            (i) the personnel and material resources 
                        necessary to implement the amendments made by 
                        subsection (a); and
                            (ii) the total number of covered veterans, 
                        as such term is defined in section 1119 of 
                        title 38, United States Code (as added by 
                        section 2(b)), who receive hospital care or 
                        medical services furnished by the Secretary 
                        under chapter 17 of such title, disaggregated 
                        by priority group specified in section 1705(a) 
                        of such title; and
                    (B) submit to the Committees on Veterans' Affairs 
                of the House of Representatives and the Senate an 
                initial report containing the findings of the 
                assessment completed under subparagraph (A), including 
                a specific determination as to whether the Department 
                has the personnel and material resources necessary to 
                implement the amendments made by subsection (a).
            (2) Subsequent reports.--If the initial report submitted 
        under paragraph (1)(B) contains a determination that the 
        Department does not have the personnel or material resources 
        necessary to implement the amendments made by subsection (a), 
        beginning not later than 90 days after the submission of such 
        initial report and every 90 days thereafter until the effective 
        date specified in subsection (c), the Secretary shall submit to 
        the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a subsequent report containing 
        an update to such determination.
    (c) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date that is the earlier of the following:
            (1) The date on which the Secretary submits a report under 
        subsection (b) containing a determination that the Department 
        has the personnel and material resources necessary to implement 
        such amendments.
            (2) The date that is 18 months after the date of the 
        enactment of this Act.
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