[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2607 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 2607

 To amend title 38, United States Code, to establish in the Department 
  of Veterans Affairs procedures to determine presumptions of service 
      connection based on toxic exposure, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 15, 2021

  Mr. Trone introduced the following bill; which was referred to the 
  Committee on Veterans' Affairs, and in addition to the Committee on 
   Armed Services, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to establish in the Department 
  of Veterans Affairs procedures to determine presumptions of service 
      connection based on toxic exposure, 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 ``Fairly Assessing Service-related 
Toxic Exposure Residuals Presumptions Act'' or the ``FASTER 
Presumptions Act''.

SEC. 2. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF VETERANS AFFAIRS TO 
              ESTABLISH PRESUMPTIONS OF SERVICE CONNECTION BASED ON 
              TOXIC EXPOSURE.

    (a) Advisory Committees, Panels, and Boards.--
            (1) Establishment.--Chapter 11 of title 38, United States 
        Code, is amended by adding at the end the following new 
        subchapter:

``SUBCHAPTER VII--RESEARCH AND DETERMINATIONS RELATING TO PRESUMPTIONS 
             OF SERVICE CONNECTION BASED ON TOXIC EXPOSURE

``Sec. 1171. Procedures to determine presumptions of service connection 
              based on toxic exposure; definitions
    ``(a) Procedures.--The Secretary shall determine whether to 
establish, or to remove, presumptions of service connection based on 
toxic exposure pursuant to this subchapter, whereby--
            ``(1) the Formal Advisory Committee on Toxic Exposure under 
        section 1172 assesses research regarding veterans who, during 
        active military, naval, or air service, were exposed to toxic 
        substances, commissions additional research, and provides 
        nominations for the Science Review Board to evaluate the 
        research;
            ``(2) the Science Review Board under section 1173 evaluates 
        research nominated by the Formal Advisory Committee on Toxic 
        Exposure and determines the strength of evidence supporting a 
        positive association between exposure to a toxic substance and 
        an illness;
            ``(3) the Working Group under section 1174 evaluates the 
        conclusions of the Science Review Board and recommends to the 
        Secretary whether to establish or modify a presumption of 
        service connection; and
            ``(4) the Secretary prescribes regulations under section 
        1175.
    ``(b) Illness Defined.--In this subchapter, the term `illness' 
includes a disease or other condition affecting the health of an 
individual.
    ``(c) Nonapplication of Sunset Requirements.--Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an 
entity established under this subchapter.
``Sec. 1172. Formal Advisory Committee on Toxic Exposure
    ``(a) Establishment.--(1) There is in the Veterans Benefits 
Administration of the Department the Formal Advisory Committee on Toxic 
Exposure (in this section referred to as the `Committee').
    ``(2) The Secretary shall appoint not more than 10 members to the 
Committee, of which--
            ``(A) at least one member shall be appointed from among 
        individuals who are officials or employees of the Veterans 
        Benefits Administration or the Veterans Health Administration;
            ``(B) at least one member shall be appointed from among 
        individuals who are officials or employees of other departments 
        or agencies of the Federal Government, including the Department 
        of Defense and the Agency of Toxic Substances and Disease 
        Registry of the Centers for Disease Control and Prevention;
            ``(C) at least three members shall be appointed from among 
        individuals who are representatives of disabled veterans; and
            ``(D) at least one member shall be appointed from among 
        individuals in the private sector, State or local government, 
        or academia, who are experts in toxicology and epidemiology.
    ``(3) The Secretary shall determine the pay and allowances of the 
members, including with respect to any additional pay and allowances 
for members who are officials or employees of the Federal Government.
    ``(4) Each member of the Committee shall be appointed for a two-
year term, and may serve not more than three successive terms.
    ``(5) A vacancy in the Committee shall be filled in the manner in 
which the original appointment was made.
    ``(b) Consultation.--The Secretary may consult with, and seek the 
advice of, the Committee with respect to disability-related questions 
relating to veterans who, during active military, naval, or air 
service, are suspected of having been exposed to toxic substances.
    ``(c) Assessments.--(1) The Committee shall assess the exposure of 
veterans to toxic substances that occurred during active military, 
naval, or air service.
    ``(2) The assessments under paragraph (1) shall cover suspected and 
known toxic exposures occurring during active military, naval, or air 
service, including by identifying and evaluating new and emerging 
exposures that are not recognized under existing presumptions of 
service connection.
    ``(3) The Committee may conduct an assessment under paragraph (1) 
in response to a recommendation by the Science Review Board pursuant to 
section 1173(c)(2)(B) of this title or the Working Group under section 
1174(c)(1)(B).
    ``(4) In assessing the exposure of veterans to toxic substances 
under paragraph (1), the Commission shall determine whether--
            ``(A) under subsection (d), further research into the 
        exposure is warranted;
            ``(B) under subsection (e), the existing research being 
        assessed is sufficient to nominate to the Science Review Board 
        under section 1173 of this title for evaluation;
            ``(C) under subsection (f), there is sufficient evidence 
        regarding an existing presumption of service connection for 
        review by the Science Review Board or Working Group under 
        section 1174 of this title, as the case may be; or
            ``(D) no further action is warranted.
    ``(d) Research.--(1)(A) Following an assessment of the exposure of 
veterans to toxic substances that occurred during active military, 
naval, or air service under subsection (c), the Committee may 
commission an appropriate entity (including an element of the 
Department, an academic entity, or a private-sector entity) to conduct 
additional research into the exposure and the health effects of the 
exposure, including such research to be conducted in response to data 
and analyses provided by the Secretary of Defense or the Secretary of 
Veterans Affairs relating to suspected toxic exposure occurring during 
such service.
    ``(B) In carrying out subparagraph (A), the Committee shall 
determine whether additional research is needed with respect to the 
following:
            ``(i) Identification of the composition of suspected toxic 
        substances.
            ``(ii) Exposure assessments.
            ``(iii) Epidemiological studies.
            ``(iv) Toxicology and mechanistic studies.
    ``(C) In carrying out subparagraph (A), the Committee shall 
consider the following information:
            ``(i) All available health tracking data.
            ``(ii) All available surveillance data.
            ``(iii) All germane research previously considered by the 
        Committee.
    ``(2) In assessing the suitability of topics for additional 
research pursuant to subparagraph (A), the Committee shall consider the 
following:
            ``(A) Conditions of service in the active military, naval, 
        or air service, known or suspected exposure to agents, and 
        circumstances of exposure.
            ``(B) Existing evidence of a connection between illnesses 
        and service in the active military, naval, or air service, and 
        the size or ability to define the group of affected veterans.
            ``(C) In accordance with subsection (g), input from persons 
        who may be affected by the actions of the Committee.
            ``(D) Exposure assessments, including data on activities of 
        the Armed Forces or exposures that may be classified.
            ``(E) Existing health tracking and surveillance, including 
        veterans and members of the active military, naval, or air 
        service, such as the burn pit registry established 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).
            ``(F) Research, including laboratory research discoveries 
        and findings from studies of members of the active military, 
        naval, or air service and civilian workers who were exposed to 
        toxic substances.
            ``(G) The effect of sex, gender, age, race, and ethnicity 
        on health outcomes.
    ``(3) The Committee shall ensure that the research commissioned 
under paragraph (1) is tailored to produce results or conclusions 
necessary for the Science Review Board to make a fully informed 
assessment.
    ``(e) Nomination.--If the Committee determines further action is 
appropriate with respect to an assessment of the exposure of veterans 
to toxic substances that occurred during active military, naval, or air 
service under subsection (c), the Committee may nominate the Science 
Review Board to evaluate either or both, as the case may be--
            ``(1) the existing research included in the assessment; or
            ``(2) the further research conducted pursuant to subsection 
        (d).
    ``(f) Review of Existing Presumptions.--(1) Upon receipt of 
evidence suggesting that previous findings supporting a positive 
association between an exposure and an illness are no longer valid, the 
Committee may nominate such exposure or illness for review by the 
Science Review Board.
    ``(2) Upon receipt of evidence suggesting that previous findings 
regarding the periods and locations of exposure covered by an existing 
presumption of service connection are no longer supported, the 
Committee may nominate such evidence for evaluation by the Working 
Group to modify the periods and locations.
    ``(g) Input.--(1) Not less than quarterly, the Committee shall 
provide an opportunity for persons described in paragraph (2) to 
present written or oral comments to the Committee.
    ``(2) The persons described in this paragraph are persons who may 
be affected by the actions of the Committee, including--
            ``(A) veterans, the families of veterans, veterans service 
        organizations and representatives, researchers, and other 
        members of the general public; and
            ``(B) departments and agencies of the Federal Government.
    ``(h) Reports to Congress.--On a biennial basis, the Committee 
shall submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate, and make publicly available, a report 
on the actions of the Committee. Each such report shall include, with 
respect to the period covered by the report, the following:
            ``(1) A description of--
                    ``(A) the exposure and evidence considered by the 
                Committee;
                    ``(B) any research commissioned by the Committee; 
                and
                    ``(C) the rationale of the nominations made by the 
                Committee to the Science Review Board for further 
                evaluation.
            ``(2) A description of each specific action recommended by 
        the Committee described in subsection (c)(3).
            ``(3) Each report received by the Committee under section 
        1173(c)(2) of this title.
``Sec. 1173. Science Review Board
    ``(a) Establishment.--(1) There is in the Department the Science 
Review Board (in this section referred to as the `Board').
    ``(2)(A) The members of the Board shall be appointed by the 
Secretary from the general public from among individuals who are 
distinguished in the fields of medicine, biological sciences, or health 
administration.
    ``(B) An individual may not concurrently serve on the Board and the 
Formal Advisory Committee on Toxic Exposure under section 1172 of this 
title.
    ``(C) The Secretary shall determine the number, terms of service, 
and pay and allowances of members of the Board appointed by the 
Secretary.
    ``(b) Duties.--(1) Upon receiving a nomination for the evaluation 
of research on the health effects of exposure of members of the active 
military, naval, or air service to toxic substances made by the Formal 
Advisory Committee on Toxic Exposure pursuant to section 1172 of this 
title, the Board shall--
            ``(A) evaluate the likelihood that an illness is associated 
        with an exposure to a toxic substance while serving in the 
        active military, naval, or air service; and
            ``(B) assess the exposures and illnesses identified by the 
        Committee and determine whether the evidence supports a finding 
        of a positive association between the exposure and the illness.
    ``(2) In carrying out paragraph (1)(B), the Board shall review all 
relevant data to determine, with respect to the strength of evidence 
for a positive association, that there is--
            ``(A) sufficient evidence of an association;
            ``(B) limited or suggestive evidence of an association;
            ``(C) inadequate or insufficient evidence to determine an 
        association; or
            ``(D) limited or suggestive evidence of no association.
    ``(3) With respect to an evaluation conducted under this 
subsection, if the Board determines that the evidence for a positive 
association is inadequate or insufficient to determine an association 
as described in paragraph (2)(C), the Board shall develop a 
recommendation as to whether additional data gathering and research are 
necessary.
    ``(c) Reports.--(1) For each evaluation conducted under subsection 
(b) where the Board determines that the evidence for a positive 
association is either sufficient or limited or suggestive of an 
association, as described in subparagraph (A) or (B) of paragraph (2) 
of such subsection, the Board shall submit to the Secretary, the 
Working Group under section 1174 of this title, and to the Committees 
on Veterans' Affairs of the House of Representatives and the Senate a 
report identifying the evidence found to reach such positive 
association determinations.
    ``(2) For each evaluation conducted under subsection (b) where the 
Board determines that the evidence for positive association is 
inadequate or insufficient to determine an association as described in 
paragraph (2)(C) of such subsection, the Board shall submit to the 
Secretary, the Formal Advisory Committee on Toxic Exposure, and to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report--
            ``(A) identifying the evidence found to reach such positive 
        association determinations; and
            ``(B) containing the recommendations under subsection 
        (b)(3) as to whether additional data gathering and research are 
        necessary and an outline of a report request proposal for such 
        additional data and research.
``Sec. 1174. Working group on presumptions of service connection
    ``(a) Establishment.--The Secretary shall establish a working group 
(in this section referred to as the `Working Group') to--
            ``(1) evaluate--
                    ``(A) the conclusions of the Science Review Board 
                contained in each report submitted under section 
                1173(c)(1) of this title; and
                    ``(B) evidence nominated by the Formal Advisory 
                Committee on Toxic Exposure under section 1172(f)(2) 
                regarding the periods and locations of exposure covered 
                by an existing presumption of service connection; and
            ``(2) make a recommendation to the Secretary with respect 
        to whether to--
                    ``(A) establish a presumption of service connection 
                for the toxic exposure and illness covered by the 
                report described in subparagraph (A) of paragraph (1); 
                or
                    ``(B) modify an existing presumption of service 
                connection described in subparagraph (B) of such 
                paragraph.
    ``(b) Evaluations.--(1) In evaluating the conclusions of the 
Science Review Board, the Working Group shall consider factors, in 
addition to the conclusions of the Board, that the Working Group 
determines appropriate.
    ``(2) The Working Group shall provide a period of not fewer than 60 
days for persons described in section 1172(g)(2) of this title to 
present written comments to the Working Group with respect to each 
evaluation made under this section.
    ``(c) Recommendations.--(1) In making a recommendation under 
subsection (a)(2), the Working Group shall--
            ``(A) in cases where the evidence for a positive 
        association is either sufficient or limited or suggestive of an 
        association, as described in subparagraph (A) or (B) of section 
        1173(b)(2) of this title, weigh heavily in favor of 
        establishing a presumption of service connection; and
            ``(B) if the Working Group determines that additional 
        research, studies, or reports are appropriate before making a 
        final recommendation with respect to establishing or modifying 
        a presumption of service connection, submit to the Formal 
        Advisory Committee a description of such appropriate additional 
        research, studies, or reports.
    ``(2) Not later than 60 days after the date on which the comment 
period under subsection (b)(2) ends with respect to an evaluation made 
under this section, the Working Group shall submit to the Secretary and 
to the Committees on Veterans' Affairs of the House of Representatives 
and the Senate a description of the recommendation made under 
subsection (a)(2).
``Sec. 1175. Regulations regarding presumptions of service connection 
              based on toxic exposure
    ``(a) Action Upon Working Group Recommendation.--Not later than 60 
days after the date on which the Secretary receives a recommendation to 
establish or modify a presumption of service connection under section 
1174(c)(2) of this title--
            ``(1) if the Secretary determines that the presumption, or 
        modification, is warranted, the Secretary shall issue proposed 
        regulations setting forth the presumption or revise regulations 
        to carry out such modification; or
            ``(2) if the Secretary determines that the presumption, or 
        modification, is not warranted, the Secretary shall publish in 
        the Federal Register a notice of the determination, including 
        the reasons supporting the determination.
    ``(b) Final Regulation.--Not later than 90 days after the date on 
which the Secretary issues any proposed regulations under subsection 
(a)(1), the Secretary shall issue final regulations. Such regulations 
shall be effective on the date of issuance.
    ``(c) Removal of Presumption.--(1) The Secretary may issue 
regulations to remove an illness from a presumption of service 
connection previously established pursuant to a regulation issued under 
subsection (b).
    ``(2) Whenever an illness is removed from regulations pursuant to 
paragraph (1), or the periods and locations of exposure covered by a 
presumption of service connection are modified under subsection (a)--
            ``(A) a veteran who was awarded compensation for such 
        illness on the basis of the presumption provided under such 
        regulations before the effective date of the removal or 
        modification shall continue to be entitled to receive 
        compensation on that basis; and
            ``(B) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from such illness on the basis of such presumption shall 
        continue to be entitled to receive dependency and indemnity 
        compensation on such basis.
``Sec. 1176. Expert Advisory Panel on Constrictive Bronchiolitis
    ``(a) Establishment.--There is in the Department the Expert 
Advisory Panel on Constrictive Bronchiolitis (in this section referred 
to as the `Panel').
    ``(b) Membership.--(1) The Panel shall be appointed by the 
Secretary from the general public from among individuals who are--
            ``(A) experts in pulmonary pathology;
            ``(B) experts in other fields the Secretary determines 
        appropriate, such as pulmonary medicine, toxicology, 
        epidemiology, exposure assessment, and radiology; and
            ``(C) individuals representing the veterans community.
    ``(2) The Secretary shall determine the number, terms of service, 
and pay and allowances of members of the Panel appointed by the 
Secretary.
    ``(c) Duties.--The panel shall develop specific guidelines for 
research conducted by the Department of symptomatic veterans who served 
in the active military, naval, or air service in the Southwest Asia 
theater of operations whom the differential diagnosis includes 
bronchiolitis. The Panel shall--
            ``(1) determine the adequacy of lung biopsy approaches and 
        recommend to the Secretary best practices;
            ``(2) make recommendations to the Secretary for processing, 
        handling, and storing lung biopsies;
            ``(3) establish histologic and pathology criteria for 
        confirming diagnoses; and
            ``(4) submit to the Secretary and to the Committees on 
        Veterans' Affairs of the House of Representatives and the 
        Senate reports on the findings and results of such research.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 1163 the following new items:

 ``subchapter vii--research and determinations relating to presumptions 
             of service connection based on toxic exposure

``1171. Procedures to determine presumptions of service connection 
                            based on toxic exposure; definitions.
``1172. Formal Advisory Committee on Toxic Exposure.
``1173. Science Review Board.
``1174. Working group on presumptions of service connection.
``1175. Regulations regarding presumptions of service connection based 
                            on toxic exposure.
``1176. Expert Advisory Panel on Constrictive Bronchiolitis.''.
    (b) Conforming Amendments.--Chapter 11 of title 38, United States 
Code, is amended as follows:
            (1) Section 1116 is amended--
                    (A) by striking subsections (b), (c), (d), and (e);
                    (B) by inserting after subsection (a) the following 
                new subsection (b):
    ``(b) The Secretary shall ensure that any determination made on or 
after the date of the enactment of the FASTER Presumptions Act 
regarding a presumption of service connection based on exposure to an 
herbicide agent under this section is made pursuant to subchapter VII 
of this chapter, including with respect to assessing reports received 
by the Secretary from the National Academy of Sciences under section 3 
of the Agent Orange Act of 1991 (Public Law 102-4).''; and
                    (C) by redesignating subsection (f) as subsection 
                (c).
            (2) Section 1116B(b)(2)(A) is amended by inserting 
        ``pursuant to subchapter VII of this chapter,'' before ``the 
        Secretary determines''.
            (3) Section 1118 is amended--
                    (A) by striking subsections (b), (c), (d), and (e); 
                and
                    (B) by inserting after subsection (a) the following 
                new subsection (b):
    ``(b) The Secretary shall ensure that any determination made on or 
after the date of the enactment of the FASTER Presumptions Act 
regarding a presumption of service connection based on exposure to a 
toxic substance under this section is made pursuant to subchapter VII 
of this chapter.''.
    (c) Access to Health Care.--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), as determined 
        appropriate by the Secretary, a toxin-exposed veteran is 
        eligible for hospital care and medical services under 
        subsection (a)(2)(F) for any diagnosed illness that the 
        Secretary determines is covered by, or reasonably could be 
        covered by, pending research during the period beginning on the 
        date on which the Formal Advisory Committee on Toxic Exposure 
        begins assessing such research under section 1172(c) of this 
        title and ending on the date specified in clause (ii).
            ``(ii) The date specified in this clause is the following:
                    ``(I) In cases of pending research for which the 
                Secretary determines under section 1175(a)(1) of this 
                title that a presumption of service connection is 
                warranted, the date on which the toxin-exposed veteran 
                is otherwise eligible for hospital care and medical 
                services pursuant to this section by reason of 
                regulations issued under such section 1175.
                    ``(II) In cases of pending research for which the 
                Secretary determines under section 1175(a)(2) that a 
                presumption of service connection is not warranted, the 
                date, if any, that the Secretary determines 
                appropriate.
            ``(iii) In this subparagraph:
                    ``(I) The term `pending research' means research 
                assessed or commissioned by the Formal Advisory 
                Committee on Toxic Exposure under section 1172 
                regarding the exposure of veterans to toxic substances.
                    ``(II) The term `toxin-exposed veteran' means a 
                veteran--
                            ``(aa) whose service in the active 
                        military, naval, or air service is covered by 
                        pending research; and
                            ``(bb) who is not otherwise eligible for 
                        hospital care and medical services pursuant to 
                        this paragraph.''; and
            (2) in paragraph (2)(B), by striking ``or (F)'' and 
        inserting ``(F), or (G)''.

SEC. 3. IMPROVEMENTS TO DATA COLLECTION AND USE.

    (a) Plan.--The Secretary of Defense, in consultation with the 
Secretary of Veterans Affairs, shall develop and implement a plan to 
strengthen the data collection with respect to members of the Armed 
Forces, including members of the reserve components, who are exposed to 
toxic substances while serving in the Armed Forces. The plan shall 
provide for the following:
            (1) Detailing methods of continuous in-service 
        surveillance, including data collection and analysis, of such 
        exposures and the physical and mental health of the members.
            (2) Surveilling such exposures and the health of members 
        from accession through separation, including, where possible, 
        through the use of wearable and portable devices to assess 
        health outcomes, and extend such surveillance indefinitely 
        post-separation for those veterans with suspected exposure to 
        toxic substances.
            (3) Ensuring consistent surveillance efforts across the 
        Armed Forces.
            (4) Determining the feasibility of collecting biological 
        samples and the means by which such collection could be 
        accomplished, including, at a minimum, through use of wearable 
        and portable devices and the collection of blood and urine, to 
        measure exposure in deployed environments.
            (5) Maintaining a repository of data and biological samples 
        available for prospective research.
            (6) With respect to each member, tracking the military 
        occupational specialty, deployment history, disease risk 
        factors, sex, gender, age, race, and ethnicity.
    (b) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs and the Committees on Armed Services of the House of 
Representatives and the Senate, and annually thereafter for five years, 
a report containing the plan developed under subsection (a) and the 
status of implementing the plan.
    (c) Integration.--The Secretary of Defense shall integrate research 
access considerations of the plan developed under subsection (a) into 
the electronic health record modernization program and the individual 
longitudinal exposure record program.
    (d) Determinations.--The Secretary of Veterans Affairs, in 
consultation with the Formal Advisory Committee on Toxic Exposure 
established under section 1172 of title 38, United States Code, as 
added by section 2, shall determine--
            (1) whether studies of respiratory health outcomes from 
        other countries, including Australia, Canada, France, Poland, 
        Sweden, and the United Kingdom, provide useful data, and 
        whether the structure of these studies could be emulated in the 
        United States to improve participation rates; and
            (2) whether the health records of veterans from health care 
        systems other than the Department of Veterans Affairs, 
        including private-sector health providers, the Centers for 
        Medicare & Medicaid Services, and the TRICARE program, can be 
        accessed for research purposes.
    (e) Sharing of Information.--The Secretary of Veterans Affairs 
shall provide to the Formal Advisory Committee on Toxic Exposure and 
the Science Review Board established under section 1173 of title 38, 
United States Code, as added by section 2, the results of surveillance 
conducted pursuant to the plan developed under subsection (a), 
including data collection and analysis.

SEC. 4. STUDIES RELATING TO VETERANS WHO SERVED IN SOUTHWEST ASIA.

    (a) Analysis.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall initiate 
or sponsor an updated analysis of total and respiratory disease 
mortality in covered veterans. The study shall include, to the extent 
practicable--
            (1) metrics of airborne exposures;
            (2) the location and timing of deployments;
            (3) the military occupational specialty;
            (4) the Armed Force in which the veteran served;
            (5) pre-existing health status, including with respect to 
        asthma; and
            (6) relevant personal information, including cigarette and 
        e-cigarette smoking history, diet, sex, gender, age, race, and 
        ethnicity.
    (b) Epidemiological Study.--Not later than 180 days after the date 
of the enactment of this Act, the Secretary shall sponsor an 
epidemiological study of covered veterans that uses the following:
            (1) Improved spatio-temporal estimates of ambient air 
        pollution exposures using advances in retrospective exposure 
        assessment.
            (2) Detailed information on the study subjects obtained 
        through medical records, administrative data, and other 
        existing sources, that include--
                    (A) personal characteristics, including cigarette 
                and e-cigarette smoking history, diet, sex, gender, 
                age, race, and ethnicity;
                    (B) deployment history, including locations, 
                periods, and number of deployments;
                    (C) biospecimen data; and
                    (D) supplementary health status and outcomes data, 
                including imaging and physiological parameters.
    (c) Toxicology Study.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary shall sponsor a toxicology 
study to include variability to replicate exposures of healthy, young 
members of the Armed Forces, as well as potentially susceptible 
members, with preexisting health conditions. The study shall--
            (1) analyze the study results for mechanistic markers and 
        clinically relevant outcomes; and
            (2) validate serum, tissue, and other biomarkers of 
        exposure, susceptibility, or effect.
    (d) Covered Veteran Defined.--The term ``covered veteran'' means 
any veteran who--
            (1) on or after August 2, 1990, served on active duty in--
                    (A) Bahrain;
                    (B) Iraq;
                    (C) Kuwait;
                    (D) Oman;
                    (E) Qatar;
                    (F) Saudi Arabia;
                    (G) Somalia; or
                    (H) United Arab Emirates; or
            (2) on or after September 11, 2001, served on active duty 
        in--
                    (A) Afghanistan;
                    (B) Djibouti;
                    (C) Egypt;
                    (D) Jordan;
                    (E) Lebanon;
                    (F) Syria; or
                    (G) Yemen.

SEC. 5. TRAINING TO IMPROVE CLAIMS ADJUDICATIONS.

    (a) Training on Adjudication.--The Secretary of Veterans Affairs 
shall provide training to each covered employee to improve the handling 
of claims for compensation and pension benefits that relate to toxic 
exposure. The Secretary shall provide such training annually and, in 
addition to the annual training, when the Secretary determines that a 
significant development has occurred in law or regulation with respect 
to such claims, such as the Secretary establishing a new presumption of 
service connection.
    (b) Matters Included.--
            (1) All trainees.--The training under subsection (a) shall 
        include the following explanations with respect to claims 
        relating to toxic exposure:
                    (A) A lack of a presumption of service connection 
                is not by itself sufficient to determine that service 
                connection does not exist.
                    (B) The claims adjudicator shall always consider 
                whether direct service connection is applicable and 
                request, as needed, an advisory medical opinion under 
                section 5109 of title 38, United States Code.
                    (C) While information included in the individual 
                longitudinal exposure record program of the Department 
                of Veterans Affairs may be used to corroborate 
                assertions of toxic exposure, a lack of such 
                information, or a lack of other corroborating evidence 
                of toxic exposure, is not by itself sufficient to 
                determine that such exposure did not occur or 
                sufficient to deny the claim.
            (2) Veterans service representatives.--In addition to the 
        matters under paragraph (1), the Secretary shall ensure that 
        each employee described in subsection (d)(1) receives an 
        individualized assessment of--
                    (A) the ability of the employee to identify claims 
                qualifying for presumptive service connection; and
                    (B) the compliance of the employee with 
                standardized development requirements.
            (3) Rating veterans service representative.--In addition to 
        the matters under paragraph (1), the Secretary shall ensure 
        that each employee described in subsection (d)(2) receives an 
        individualized assessment of--
                    (A) the ability of the employee to identify claims 
                qualifying for presumptive service connection; and
                    (B) the compliance of the employee with the 
                schedule of ratings for disabilities adopted under 
                section 1155 of title 38, United States Code.
            (4) Compensation and pension medical examiners.--In 
        addition to the matters under paragraph (1), the Secretary 
        shall ensure that each employee described in subsection (d)(3) 
        receives an individualized assessment of--
                    (A) the ability of the employee to identify claims 
                qualifying for presumptive service connection; and
                    (B) the compliance of the employee with 
                standardized examination and medical opinion 
                procedures.
    (c) Provision of Training.--With respect to employees described in 
paragraph (1) or (2) of subsection (d), the Secretary shall--
            (1) ensure that the training under subsection (a) is 
        provided as part of the initial training program for such 
        employees;
            (2) place each employee under a second signature review 
        period for claims relating to toxic exposure until the employee 
        meets the required grade scale level quality standard for such 
        claims; and
            (3) using the Systematic Technical Accuracy Review program, 
        or such successor program, conduct a nationwide, quarterly, 
        randomized review of the quality of adjudication of claims 
        relating to toxic exposure.
    (d) Covered Employee Defined.--In this section, the term ``covered 
employee'' means employees of the Department of Veterans Affairs who 
handle claims for compensation and pension benefits, including--
            (1) employees who adjudicate claims;
            (2) employees who apply the schedule of ratings for 
        disabilities adopted under section 1155 of title 38, United 
        States Code, and prepare rating decisions; and
            (3) employees or contractors who provide medical 
        examinations or medical opinions pursuant to section 5103A(d) 
        of such title.
                                 <all>