[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3967 Engrossed in House (EH)]

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117th CONGRESS
  2d Session
                                H. R. 3967

_______________________________________________________________________

                                 AN ACT


 
   To improve health care and benefits for veterans exposed to toxic 
                  substances, and for other purposes.

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

SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE; 
              TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Honoring our 
Promise to Address Comprehensive Toxics Act of 2021'' or the ``Honoring 
our PACT Act of 2021''.
    (b) Matters Relating to Amendments to Title 38, United States 
Code.--
            (1) References.--Except as otherwise expressly provided, 
        when in this Act an amendment or repeal is expressed in terms 
        of an amendment to, or repeal of, a section or other provision, 
        the reference shall be considered to be made to a section or 
        other provision of title 38, United States Code.
            (2) Amendments to tables of contents.--Except as otherwise 
        expressly provided, when an amendment made by this Act to title 
        38, United States Code, adds a section or larger organizational 
        unit to that title or amends the designation or heading of a 
        section or larger organizational unit in that title, that 
        amendment also shall have the effect of amending any table of 
        sections in that title to alter the table to conform to the 
        changes made by the amendment.
    (c) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; references to title 38, United States Code; table 
                            of contents.
             TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY

                   Subtitle A--Toxic-exposed Veterans

Sec. 101. Short title.
Sec. 102. Definitions relating to toxic-exposed veterans.
Sec. 103. Expansion of health care for specific categories of toxic-
                            exposed veterans and veterans supporting 
                            certain overseas contingency operations.
Sec. 104. Assessments of implementation and operation.
Sec. 105. Revision of breast cancer mammography policy of Department of 
                            Veterans Affairs to provide mammography 
                            screening for veterans who served in 
                            locations associated with toxic exposure.
    Subtitle B--Certain Veterans of Combat Service and Other Matters

Sec. 111. Expansion of period of eligibility for health care for 
                            certain veterans of combat service.
Sec. 112. Authorization period for emergency treatment in non-
                            Department of Veterans Affairs medical 
                            facilities.
              TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS

Sec. 201. Short title.
Sec. 202. Improvements to ability of Department of Veterans Affairs to 
                            establish presumptions of service 
                            connection based on toxic exposure.
Sec. 203. Reevaluation of claims for compensation involving 
                            presumptions of service connection.
 TITLE III--IMPROVING THE ESTABLISHMENT OF SERVICE CONNECTION PROCESS 
                       FOR TOXIC-EXPOSED VETERANS

Sec. 301. Short title.
Sec. 302. Presumptions of toxic exposure.
Sec. 303. Medical nexus examinations for toxic exposure risk 
                            activities.
              TITLE IV--PRESUMPTIONS OF SERVICE CONNECTION

Sec. 401. Treatment of veterans who participated in cleanup of Enewetak 
                            Atoll as radiation-exposed veterans for 
                            purposes of presumption of service 
                            connection of certain disabilities by 
                            Department of Veterans Affairs.
Sec. 402. Treatment of veterans who participated in nuclear response 
                            near Palomares, Spain, or Thule, Greenland, 
                            as radiation-exposed veterans for purposes 
                            of presumption of service connection of 
                            certain disabilities by Department of 
                            Veterans Affairs.
Sec. 403. Presumptions of service connection for diseases associated 
                            with exposures to certain herbicide agents 
                            for veterans who served in certain 
                            locations.
Sec. 404. Addition of additional diseases associated with exposure to 
                            certain herbicide agents for which there is 
                            a presumption of service connection for 
                            veterans who served in certain locations.
Sec. 405. Improving compensation for disabilities occurring in Persian 
                            Gulf War veterans.
Sec. 406. Presumption of service connection for certain diseases 
                            associated with exposure to burn pits and 
                            other toxins.
                       TITLE V--RESEARCH MATTERS

Sec. 501. Interagency working group on toxic exposure research.
Sec. 502. Data collection, analysis, and report on treatment of 
                            veterans for illnesses related to toxic 
                            exposure.
Sec. 503. Studies related to veterans who served in Southwest Asia and 
                            certain other locations.
Sec. 504. Study on health trends of post 9/11 veterans.
Sec. 505. Study on cancer rates among veterans.
Sec. 506. Study on feasibility and advisability of furnishing hospital 
                            care and medical services to dependents of 
                            veterans who participated in toxic exposure 
                            risk activities.
Sec. 507. Study on health effects of waste related to Manhattan Project 
                            on certain veterans.
Sec. 508. Study on toxic exposure and mental health outcomes.
Sec. 509. Study on veterans in Territories of the United States.
Sec. 510. Department of Veterans Affairs public website for toxic 
                            exposure research.
Sec. 511. Biennial report on health effects of jet fuels used by Armed 
                            Forces.
TITLE VI--IMPROVEMENT OF RESOURCES AND TRAINING REGARDING TOXIC-EXPOSED 
                                VETERANS

Sec. 601. Short title; definitions.
Sec. 602. Publication of list of resources of Department of Veterans 
                            Affairs for toxic-exposed veterans and 
                            outreach program for such veterans and 
                            caregivers and survivors of such veterans.
Sec. 603. Incorporation of toxic exposure questionnaire during primary 
                            care appointments.
Sec. 604. Training for personnel of the Department of Veterans Affairs 
                            with respect to toxic-exposed veterans.
Sec. 605. Guidelines for active duty military on potential risks and 
                            prevention of toxic exposures.
           TITLE VII--REGISTRIES, RECORDS, AND OTHER MATTERS

Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl 
                            substances on military installations.
Sec. 702. Fort McClellan Health Registry.
Sec. 703. Independent study on Individual Longitudinal Exposure Record.
Sec. 704. Biannual report on Individual Longitudinal Exposure Record.
Sec. 705. Correction of exposure records by members of the Armed Forces 
                            and veterans.
Sec. 706. Federal cause of action relating to water at Camp Lejeune, 
                            North Carolina.
Sec. 707. Veterans Toxic Exposures Fund.
Sec. 708. Authorization of electronic notice in claims under laws 
                            administered by the Secretary of Veterans 
                            Affairs.
Sec. 709. Authorization of appropriations for expansion of claims 
                            automation.
Sec. 710. Non-applicability of non-Department of Veterans Affairs 
                            covenants not to compete to appointment of 
                            Veterans Health Administration personnel.
Sec. 711. Recruitment of physicians on a contingent basis prior to 
                            completion of training requirements.
Sec. 712. Authority for Secretary of Veterans Affairs to award grants 
                            to States to improve outreach to veterans.
Sec. 713. Study and report on herbicide agent exposure in Panama Canal 
                            Zone.
Sec. 714. Budget information for alternatives to burn pits.
Sec. 715. Authorization of appropriations for expansion of claims 
                            automation.
Sec. 716. Burn pit registry updates.
Sec. 717. Burn pit transparency.

             TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY

                   Subtitle A--Toxic-exposed Veterans

SEC. 101. SHORT TITLE.

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

SEC. 102. DEFINITIONS RELATING TO TOXIC-EXPOSED VETERANS.

    (a) In General.--Section 1710(a)(2)(F) is amended by striking ``who 
was exposed to a toxic substance, radiation, or other conditions, as 
provided in subsection (e)'' and inserting ``in accordance with 
subsection (e), who is a toxic-exposed veteran''.
    (b) Definitions of Toxic Exposure and Toxic-exposed Veteran.--
Section 101 is amended by adding at the end the following new 
paragraphs:
    ``(37) The term `toxic exposure' includes the following:
            ``(A) A toxic exposure risk activity, as defined in section 
        1710(e)(4) of this title.
            ``(B) An exposure to a substance, chemical, or airborne 
        hazard identified in the list under section 1119(b)(2) of this 
        title.
    ``(38) The term `toxic-exposed veteran' means a veteran described 
in section 1710(e)(1) of this title.''.
    (c) Definition of Toxic Exposure Risk Activity.--Section 1710(e)(4) 
is amended by adding at the end the following new subparagraph:
            ``(C) The term `toxic exposure risk activity' means any 
        activity--
                    ``(i) that requires a corresponding entry in an 
                exposure tracking record system (as defined in section 
                1119(c) of this title) for the veteran who carried out 
                the activity; or
                    ``(ii) that the Secretary determines qualifies for 
                purposes of this subsection when taking into account 
                what is reasonably prudent to protect the health of 
                veterans.''.

SEC. 103. EXPANSION OF HEALTH CARE FOR SPECIFIC CATEGORIES OF TOXIC-
              EXPOSED VETERANS AND VETERANS SUPPORTING CERTAIN OVERSEAS 
              CONTINGENCY OPERATIONS.

    (a) In General.--
            (1) Expansion.--Subsection (e) of section 1710, as amended 
        by section 102(c), is further amended--
                    (A) in paragraph (1), by adding at the end the 
                following new subparagraphs:
    ``(G) Beginning not later than the applicable date specified in 
paragraph (6), and subject to paragraph (2), a veteran who participated 
in a toxic exposure risk activity while serving on active duty, active 
duty for training, or inactive duty training is eligible for hospital 
care (including mental health services and counseling), medical 
services, and nursing home care under subsection (a)(2)(F) for any 
illness.
    ``(H) Beginning not later than the applicable date specified in 
paragraph (6), and subject to paragraph (2), a covered veteran (as 
defined in section 1119(c) of this title) is eligible for hospital care 
(including mental health services and counseling), medical services, 
and nursing home care under subsection (a)(2)(F) for any illness.
    ``(I)(i) Beginning not later than the applicable date specified in 
paragraph (6), and subject to paragraph (2), a veteran who deployed in 
support of a contingency operation specified in clause (ii) is eligible 
for hospital care (including mental health services and counseling), 
medical services, and nursing home care under subsection (a)(2)(F) for 
any illness.
    ``(ii) A contingency operation specified in this clause is any of 
the following:
            ``(I) Operation Enduring Freedom.
            ``(II) Operation Freedom's Sentinel.
            ``(III) Operation Iraqi Freedom.
            ``(IV) Operation New Dawn.
            ``(V) Operation Inherent Resolve.
            ``(VI) Resolute Support Mission.''; and
                    (B) in paragraph (2)(B)--
                            (i) by striking ``or (F)'' and inserting 
                        ``(F), (G), (H), or (I)''; and
                            (ii) by striking ``service or testing'' and 
                        inserting ``service, testing, or activity''.
            (2) Phase in.--Such subsection is further amended by adding 
        at the end the following new paragraph:
    ``(6)(A) The Secretary shall determine the dates in subparagraphs 
(G), (H), and (I) of paragraph (1) as follows:
            ``(i) October 1, 2024, with respect to a veteran described 
        in such subparagraph (G) or (H) who was discharged or released 
        from the active military, naval, air, or space service during 
        the period beginning on August 2, 1990, and ending on September 
        11, 2001.
            ``(ii) October 1, 2026, with respect to a veteran described 
        in such subparagraph (G) or (H) who was discharged or released 
        from the active military, naval, air, or space service during 
        the period beginning on September 12, 2001, and ending on 
        December 31, 2006.
            ``(iii) October 1, 2028, with respect to a veteran 
        described in such subparagraph (G) or (H) who was discharged or 
        released from the active military, naval, air, or space service 
        during the period beginning on January 1, 2007, and ending on 
        December 31, 2012.
            ``(iv) October 1, 2030, with respect to a veteran described 
        in such subparagraph (G) or (H) who was discharged or released 
        from the active military, naval, air, or space service during 
        the period beginning on January 1, 2013, and ending on December 
        31, 2018.
            ``(v) October 1, 2032, with respect to a veteran described 
        in such subparagraph (I).
    ``(B) The Secretary may modify a date specified in subparagraph (A) 
to an earlier date, as the Secretary determines appropriate based on 
the number of veterans receiving hospital care, medical services, and 
nursing home care under subparagraphs (G), (H), and (I) of paragraph 
(1) and the resources available to the Secretary. If the Secretary 
determines to so modify a date, the Secretary shall--
            ``(i) notify the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate of the proposed 
        modification; and
            ``(ii) publish such modified date in the Federal 
        Register.''.
    (b) Outreach Plans.--With respect to each of clauses (i) through 
(v) of section 1710(e)(6)(A) of title 38, United States Code (as added 
by subsection (a)(2)), not later than 180 days prior to the date 
specified in the clause (including a date modified pursuant to such 
section), the Secretary shall submit to the Committees on Veterans' 
Affairs of the House of Representatives and the Senate a plan to 
conduct outreach to the veterans referred to in the clause to notify 
such veterans of their eligibility for hospital care, medical services, 
or nursing home care under subparagraph (G), (H), or (I), of section 
1710(e)(1) of such title, as the case may be.

SEC. 104. ASSESSMENTS OF IMPLEMENTATION AND OPERATION.

    (a) Initial Resource Assessment and Report.--Not later than 180 
days after the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall--
            (1) complete an assessment to determine--
                    (A) the personnel and material resources necessary 
                to implement section 103 (including the amendments made 
                by such section); and
                    (B) the total number of covered veterans, as such 
                term is defined in section 1119(c) of title 38, United 
                States Code (as added by section 302), 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
            (2) submit to the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate a report containing the 
        findings of the assessment completed under paragraph (1), 
        including a specific determination as to whether the Department 
        has the personnel and material resources necessary to implement 
        section 103.
    (b) Information Systems.--Not later than October 1, 2024, the 
Secretary shall establish information systems to assess the 
implementation of section 103, including the amendments made by such 
section, and use the results of assessments under such systems to 
inform the reports under subsection (c).
    (c) Annual Reports.--
            (1) Reports.--Not later than October 1, 2025, and on an 
        annual basis thereafter until October 1, 2033, the Secretary 
        shall submit to the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate a report on the 
        following:
                    (A) The effect of the implementation of, and the 
                provision and management of care under, section 103, 
                (including the amendments made by such section) on the 
                demand by veterans described in subparagraphs (G), (H), 
                and (I) of section 1710(e)(1) of title 38, United 
                States Code (as added by such section 103) for health 
                care services furnished by the Secretary.
                    (B) Any differing patterns of demand for health 
                care services by such veterans, disaggregated by 
                factors such as the relative distance of the veteran 
                from medical facilities of the Department and whether 
                the veteran had previously received hospital care or 
                medical services furnished by the Secretary under 
                chapter 17 of such title.
                    (C) The extent to which the Secretary has met such 
                demand.
                    (D) Any changes, during the year covered by the 
                report, in the delivery patterns of health care 
                furnished by the Secretary under chapter 17 of such 
                title, and the fiscal impact of such changes.
            (2) Matters.--Each report under paragraph (1) shall 
        include, with respect to the year covered by the report, 
        detailed information on the following:
                    (A) The total number of veterans enrolled in the 
                patient enrollment system who, during such year, 
                received hospital care or medical services furnished by 
                the Secretary under chapter 17 of title 38, United 
                States Code.
                    (B) Of the veterans specified in subparagraph (A), 
                the number of such veterans who, during the preceding 
                three fiscal years, had not received such care or 
                services.
                    (C) With respect to the veterans specified in 
                subparagraph (B), the cost of providing health care to 
                such veterans during the year covered by the report, 
                shown in total and disaggregated by--
                            (i) the level of care; and
                            (ii) whether the care was provided through 
                        the Veterans Community Care Program.
                    (D) With respect to the number of veterans 
                described in subparagraphs (G), (H), and (I) of section 
                1710(e)(1) of title 38, United States Code (as added by 
                section 103), the following (shown in total and 
                disaggregated by medical facility of the Department, as 
                applicable):
                            (i) The number of such veterans who, during 
                        the year covered by the report, enrolled in the 
                        patient enrollment system.
                            (ii) The number of such veterans who 
                        applied for, but were denied, such enrollment.
                            (iii) The number of such veterans who were 
                        denied hospital care or a medical service 
                        furnished by the Secretary that was considered 
                        to be medically necessary but not of an 
                        emergency nature.
                    (E) The numbers and characteristics of, and the 
                type and extent of health care furnished by the 
                Secretary to, veterans enrolled in the patient 
                enrollment system (shown in total and disaggregated by 
                medical facility of the Department).
                    (F) The numbers and characteristics of, and the 
                type and extent of health care furnished by the 
                Secretary to, veterans not enrolled in the patient 
                enrollment system (disaggregated by each class of 
                eligibility for care under section 1710 of title 38, 
                United States Code, and further shown as a total per 
                class and disaggregated by medical facility of the 
                Department).
                    (G) The specific fiscal impact (shown in total and 
                disaggregated by geographic health care delivery areas) 
                of changes in the delivery patterns of health care 
                furnished by the Secretary under chapter 17 of such 
                title as a result of the implementation of section 103 
                (including the amendments made by such section).
    (d) Definitions.--In this section:
            (1) The term ``patient enrollment system'' means the 
        patient enrollment system of the Department of Veterans Affairs 
        established and operated under section 1705 of title 38, United 
        States Code.
            (2) The term ``Veterans Community Care Program'' means the 
        program established under section 1703 of title 38, United 
        States Code.

SEC. 105. REVISION OF BREAST CANCER MAMMOGRAPHY POLICY OF DEPARTMENT OF 
              VETERANS AFFAIRS TO PROVIDE MAMMOGRAPHY SCREENING FOR 
              VETERANS WHO SERVED IN LOCATIONS ASSOCIATED WITH TOXIC 
              EXPOSURE.

    (a) In General.--Section 7322 of title 38, United States Code, is 
amended--
            (1) in subsection (a), by striking ``The'' and inserting 
        ``In General.--The'';
            (2) in subsection (b)--
                    (A) by striking ``The'' and inserting ``Standards 
                for Screening.--The''; and
                    (B) in paragraph (2)(B), by inserting ``a record of 
                service in a location and during a period specified in 
                subsection (d),'' after ``risk factors,''; and
            (3) by adding at the end the following new subsections:
    ``(c) Eligibility for Screening for Veterans Exposed to Toxic 
Substances.--The Under Secretary for Health shall ensure that, under 
the policy developed under subsection (a), any veteran who, during 
active military, naval, or air service, was deployed in support of a 
contingency operation in a location and during a period specified in 
subsection (d), is eligible for a mammography screening by a health 
care provider of the Department.
    ``(d) Locations and Periods Specified.--(1) The locations and 
periods specified in this subsection are the following:
            ``(A) Iraq during following periods:
                    ``(i) The period beginning on August 2, 1990, and 
                ending on February 28, 1991.
                    ``(ii) The period beginning on March 19, 2003, and 
                ending on such date as the Secretary determines burn 
                pits are no longer used in Iraq.
            ``(B) The Southwest Asia theater of operations, other than 
        Iraq, during the period beginning on August 2, 1990, and ending 
        on such date as the Secretary determines burn pits are no 
        longer used in such location, including the following 
        locations:
                    ``(i) Kuwait.
                    ``(ii) Saudi Arabia.
                    ``(iii) Oman.
                    ``(iv) Qatar.
            ``(C) Afghanistan during the period beginning on September 
        11, 2001, and ending on such date as the Secretary determines 
        burn pits are no longer used in Afghanistan.
            ``(D) Djibouti during the period beginning on September 11, 
        2001, and ending on such date as the Secretary determines burn 
        pits are no longer used in Djibouti.
            ``(E) Syria during the period beginning on September 11, 
        2001, and ending on such date as the Secretary determines burn 
        pits are no longer used in Syria.
            ``(F) Jordan during the period beginning on September 11, 
        2001, and ending on such date as the Secretary determines burn 
        pits are no longer used in Jordan.
            ``(G) Egypt during the period beginning on September 11, 
        2001, and ending on such date as the Secretary determines burn 
        pits are no longer used in Egypt.
            ``(H) Lebanon during the period beginning on September 11, 
        2001, and ending on such date as the Secretary determines burn 
        pits are no longer used in Lebanon.
            ``(I) Yemen during the period beginning on September 11, 
        2001, and ending on such date as the Secretary determines burn 
        pits are no longer used in Yemen.
            ``(J) Such other locations and corresponding periods as set 
        forth by the Airborne Hazards and Open 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).
            ``(K) Such other locations and corresponding periods as the 
        Secretary, in collaboration with the Secretary of Defense, may 
        determine appropriate in a report submitted under paragraph 
        (2).
    ``(2) Not later than two years after the date of the enactment of 
the Supporting Expanded Review for Veterans In Combat Environments Act 
of 2021, and not less frequently than once every two years thereafter, 
the Secretary of Veterans Affairs, in collaboration with the Secretary 
of Defense, shall submit to Congress a report specifying other 
locations and corresponding periods for purposes of paragraph (1)(K).
    ``(3) A location under this subsection shall not include any body 
of water around or any airspace above such location.
    ``(4) In this subsection, the term `burn pit' means an area of land 
that is used for disposal of solid waste by burning in the outdoor 
air.''.
    (b) Report on Breast Cancer Rates for Veterans Deployed to Certain 
Areas.--Not later than two years after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives a report that 
compares the rates of breast cancer among members of the Armed Forces 
deployed to the locations and during the periods specified in section 
7322(d) of title 38, United States Code, as added by subsection (a), as 
compared to members of the Armed Forces who were not deployed to those 
locations during those periods and to the civilian population.

    Subtitle B--Certain Veterans of Combat Service and Other Matters

SEC. 111. EXPANSION OF PERIOD OF ELIGIBILITY FOR HEALTH CARE FOR 
              CERTAIN VETERANS OF COMBAT SERVICE.

    (a) Expanded Period.--Section 1710(e)(3) is amended--
            (1) in subparagraph (A)--
                    (A) by striking ``January 27, 2003'' and inserting 
                ``September 11, 2001''; and
                    (B) by striking ``five-year period'' and inserting 
                ``10-year period'';
            (2) by amending subparagraph (B) to read as follows:
            ``(B) With respect to a veteran described in paragraph 
        (1)(D) who was discharged or released from the active military, 
        naval, air, or space service after September 11, 2001, and 
        before October 1, 2013, but did not enroll to receive such 
        hospital care, medical services, or nursing home care under 
        such paragraph pursuant to subparagraph (A) before October 1, 
        2022, the one-year period beginning on October 1, 2022.''; and
            (3) by striking subparagraph (C).
    (b) Clarification of Coverage.--Section 1710(e)(1)(D) is amended by 
inserting after ``Persian Gulf War'' the following: ``(including any 
veteran who, in connection with service during such period, received 
the Armed Forces Expeditionary Medal, Service Specific Expeditionary 
Medal, Combat Era Specific Expeditionary Medal, Campaign Specific 
Medal, or any other combat theater award established by a Federal 
statute or an Executive order)''.
    (c) Outreach Plan.--Not later than December 1, 2022, the Secretary 
shall submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a plan to conduct outreach to veterans 
described in subparagraph (B) of section 1710(e)(3) of title 38, United 
States Code, as amended by subsection (a)(2), to notify such veterans 
of their eligibility for hospital care, medical services, or nursing 
home care pursuant to such subparagraph.
    (d) Report on Enrollments.--Not later than January 30, 2024, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
House of Representatives and the Senate a report identifying, with 
respect to the one-year period beginning on October 1, 2022, the number 
of veterans described in section 1710(e)(3)(B) of title 38, United 
States Code, as amended by subsection (a)(2), who, during such period, 
enrolled in the patient enrollment system of the Department of Veterans 
Affairs established and operated under section 1705 of such title.
    (e) Effective Date.--This section and the amendments made by this 
section shall take effect on October 1, 2022.

SEC. 112. AUTHORIZATION PERIOD FOR EMERGENCY TREATMENT IN NON-
              DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.

    Section 1703(a)(3) of title 38, United States Code, is amended--
            (1) by striking ``A covered veteran'' and inserting ``(A) 
        Except as provided by subparagraph (B), a covered veteran''; 
        and
            (2) by adding at the end the following new subparagraph:
    ``(B) In the case of an emergency which existed at the time of 
admission of a covered veteran to a health care provider, the Secretary 
shall deem the care or services received by the veteran during such 
admission to be authorized under subparagraph (A) if the covered 
veteran (or an individual acting on behalf of the covered veteran) 
makes an application for such authorization during the period following 
such admission that the Secretary determines appropriate for purposes 
of this paragraph, except such period may not be less than 96 hours.''.

              TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS

SEC. 201. SHORT TITLE.

    This subtitle may be cited as the ``Fairly Assessing Service-
related Toxic Exposure Residuals Presumptions Act'' or the ``FASTER 
Presumptions Act''.

SEC. 202. IMPROVEMENTS TO ABILITY OF DEPARTMENT OF VETERANS AFFAIRS TO 
              ESTABLISH PRESUMPTIONS OF SERVICE CONNECTION BASED ON 
              TOXIC EXPOSURE.

    (a) Advisory Committees, Panels, and Boards.--Chapter 11 is amended 
by adding at the end the following new subchapter:

 ``SUBCHAPTER VII--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 of this title--
                    ``(A) provides advice to the Secretary on toxic-
                exposed veterans and cases in which veterans who, 
                during active military, naval, air, or space service, 
                may have experienced a toxic exposure or their 
                dependents may have experienced a toxic exposure while 
                the veterans were serving in the active military, 
                naval, air, or space service;
                    ``(B) provides to the Secretary recommendations on 
                corrections needed in the Individual Longitudinal 
                Exposure Record, or successor system, to better reflect 
                veterans and dependents described in subparagraph (A); 
                and
                    ``(C) provides to the Secretary recommendations 
                regarding which cases of possible toxic exposure should 
                be reviewed; and
            ``(2) the Secretary provides for formal evaluations of such 
        recommendations under section 1173 of this title; and
            ``(3) the Secretary issues regulations under section 1174 
        of this title.
    ``(b) Illness Defined.--In this subchapter, the term `illness' 
includes a disease or other condition affecting the health of an 
individual, including mental and physical health.
``Sec. 1172. Formal Advisory Committee on Toxic Exposure
    ``(a) Establishment.--(1) There is in the Veterans Health 
Administration of the Department the Formal Advisory Committee on Toxic 
Exposure (in this section referred to as the `Committee').
    ``(2)(A) The Committee shall be composed of nine members appointed 
as follows:
            ``(i) Five members shall be appointed by the Secretary.
            ``(ii) One member shall be appointed by the Speaker of the 
        House of Representatives.
            ``(iii) One member shall be appointed by the minority 
        leader of the House of Representatives.
            ``(iv) One member shall be appointed by the majority leader 
        of the Senate.
            ``(v) One member shall be appointed by the minority leader 
        of the Senate.
    ``(B) The members appointed under subparagraph (A) shall meet the 
following criteria:
            ``(i) Not more than three members shall be appointed from 
        among individuals who are officials or employees of the 
        Veterans Benefits Administration or the Veterans Health 
        Administration.
            ``(ii) 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.
            ``(iii) At least two members shall represent an 
        organization recognized by the Secretary for the representation 
        of veterans under section 5902 of this title.
            ``(iv) 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 of the Committee, including with respect to any additional pay 
and allowances for members who are officials or employees of the 
Federal Government.
    ``(4)(A) Except as provided by subparagraph (B), each member of the 
Committee shall be appointed for a two-year term, and may serve not 
more than three successive terms.
    ``(B) With respect to the five members who are initially appointed 
by the Secretary under subparagraph (A)(i), the Secretary shall 
determine the length of the term of each such member in a manner that 
ensures the expiration of the terms on a staggered basis.
    ``(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 cases in which veterans who, 
during active military, naval, air, or space service, are suspected of 
having experienced a toxic exposure or dependents of veterans who may 
have experienced a toxic exposure during such service.
    ``(c) Assessments.--(1) The Committee shall assess cases of the 
toxic exposure of veterans and their dependents that occurred during 
active military, naval, air, or space service, including by conducting 
ongoing surveillance and reviewing such exposure described in 
scientific literature, media reports, information from veterans, and 
information from Congress.
    ``(2) The assessments under paragraph (1) shall cover suspected and 
known toxic exposures occurring during active military, naval, air, or 
space service, including by identifying and evaluating new and emerging 
toxic exposures that are not recognized under existing presumptions of 
service connection.
    ``(3) The Committee may conduct an assessment under paragraph (1) 
in response to comments by a person described in subsection (e)(2), by 
a majority vote of the members of the Committee.
    ``(4) The Committee shall on a periodic basis assess the Individual 
Longitudinal Exposure Record, or successor system, to ensure the 
accuracy of data collected.
    ``(d) Research Recommendations.--(1) Following an assessment of a 
case of the toxic exposure of veterans or their dependents that 
occurred during active military, naval, air, or space service under 
subsection (c), the Committee may develop a recommendation for formal 
evaluation under section 1173 of this title to conduct a review of the 
health effects related to the case of exposure if the Committee 
determines that the research may change the current understanding of 
the relationship between an exposure to an environmental hazard and 
adverse health outcomes in humans.
    ``(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 formal evaluation under 
section 1173 of this title to modify the periods and locations.
    ``(e) 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.
    ``(f) Reports by the Committee.--Not less frequently than once each 
year, the Committee shall submit to the Secretary and the Committees on 
Veterans' Affairs of the Senate and the House of Representatives, and 
make publicly available, a report on--
            ``(1) recommendations for research under subsection (d), if 
        any; and
            ``(2) recommendations for such legislative or 
        administrative action as the Committee considers necessary for 
        the Committee to be more effective in carrying out the 
        requirements of this section.
    ``(g) Responses by Secretary.--In response to each report submitted 
under subsection (f), the Secretary shall submit to the Secretary and 
the Committees on Veterans' Affairs of the Senate and the House of 
Representatives, and make publicly available, a report on--
            ``(1) the findings and opinions of the Secretary with 
        respect to the report most recently submitted under subsection 
        (f); and
            ``(2) whether the Secretary will conduct research 
        recommended under subsection (f) included in the report, and if 
        not, an explanation of why, including citations and sources.
    ``(h) Nonapplication of Sunset Requirements.--Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
Committee.
``Sec. 1173. Formal evaluation of recommendations
    ``(a) Formal Evaluation.--The Secretary shall establish a process 
to conduct a formal evaluation with respect to each recommendation made 
by the Formal Advisory Committee on Toxic Exposure under section 1172 
of this title--
            ``(1) to conduct research regarding the health effects 
        related to a case of toxic exposure; or
            ``(2) to evaluate evidence regarding the periods and 
        locations of exposure covered by an existing presumption of 
        service connection.
    ``(b) Evidence, Data, and Factors.--The Secretary shall ensure that 
each formal evaluation under paragraph (1) covers the following:
            ``(1) Scientific evidence, based on the review of available 
        scientific literature, including human, toxicological, animal, 
        and methodological studies, and other factors.
            ``(2) Claims data, based on the review of claim rate, grant 
        rate, and service connection prevalence, and other factors.
            ``(3) Other factors the Secretary determines appropriate, 
        such as--
                    ``(A) the level of disability and mortality caused 
                by the health effects related to the case of toxic 
                exposure being evaluated;
                    ``(B) the level of assistance required to remain in 
                the community because of such health effects;
                    ``(C) the quantity and quality of the information 
                available and reviewed;
                    ``(D) the feasibility of and period for generating 
                relevant information and evidence;
                    ``(E) whether such health effects are combat- or 
                deployment-related; and
                    ``(F) the ubiquity or rarity of the health effects.
    ``(c) Conduct of Evaluations.--(1) The Secretary shall ensure that 
each formal evaluation under subsection (a)--
            ``(A) reviews scientific evidence in a manner that--
                    ``(i) conforms to principles of scientific and data 
                integrity;
                    ``(ii) is free from suppression or distortion of 
                scientific or technological findings, data, 
                information, conclusions, or technical results; and
            ``(B)(i) evaluates the likelihood that a positive 
        association exists between an illness and a toxic exposure 
        while serving in the active military, naval, air, or space 
        service; and
            ``(ii) assesses the toxic exposures and illnesses and 
        determines whether the evidence supports a finding of a 
        positive association between the toxic exposure and the 
        illness.
    ``(2) In carrying out paragraph (1)(B)(ii), a formal evaluation 
under subsection (a) shall include reviewing all relevant data to 
determine the strength of evidence for a positive association based on 
the following four categories:
            ``(A) The `sufficient' category, where the evidence is 
        sufficient to conclude that a positive association exists.
            ``(B) The `equipoise and above' category, where the 
        evidence is sufficient to conclude that a positive association 
        is at least as likely as not, but not sufficient to conclude 
        that a positive association exists.
            ``(C) The `below equipoise' category, where the evidence is 
        not sufficient to conclude that a positive association is at 
        least as likely as not, or is not sufficient to make a 
        scientifically informed judgment.
            ``(D) The `against' category, where the evidence suggests 
        the lack of a positive association.
    ``(d) Recommendation for Rulemaking.--Not later than 120 days after 
the date on which a formal evaluation is commenced, the element of the 
Department that conducts the evaluation shall submit to the Secretary a 
recommendation with respect to establishing a presumption of service 
connection for the toxic exposure and illness, or modifying an existing 
presumption of service connection, covered by the evaluation.
``Sec. 1174. Regulations regarding presumptions of service connection 
              based on toxic exposure
    ``(a) Action Upon Recommendation.--Not later than 160 days after 
the date on which the Secretary receives a recommendation to establish 
or modify a presumption of service connection under section 1173 of 
this title--
            ``(1) if the Secretary determines that the presumption, or 
        modification, is warranted, the Secretary shall commence 
        issuing regulations in accordance with the provisions of 
        subchapter II of chapter 5 of title 5 (commonly referred to as 
        the Administrative Procedures Act) setting forth the 
        presumption or commence revising 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) 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 (a).
    ``(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. 1175. Authority to modify process; congressional oversight
    ``(a) Authority.--(1) The Secretary may modify the process under 
which the Secretary conducts formal evaluations under section 1173 of 
this title and issues regulations under section 1174 if--
            ``(A) such evaluations cover the evidence, data, and 
        factors required by subsection (b) of such section 1173; and
            ``(B) a period of 180 days has elapsed following the date 
        on which the Secretary submits the notice under paragraph (2) 
        regarding the modification.
    ``(2) If the Secretary proposes to modify the process under which 
the Secretary conducts formal evaluations under section 1173 of this 
title or issues regulations under section 1174, the Secretary shall 
submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a notice of the proposed modifications 
containing the following:
            ``(A) A description of the proposed modifications.
            ``(B) A description of any exceptions to the requirements 
        of such sections that are proposed because of limited available 
        scientific evidence, and a description of how such evaluations 
        will be conducted.
    ``(b) Reports and Briefings.--(1)(A) Not later than two years after 
the date of the enactment of the Honoring our Promise to Address 
Comprehensive Toxics Act of 2021, the Secretary shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report on the implementation of, and recommendations for, this 
subchapter.
    ``(B) The Secretary shall develop the report under subparagraph (A) 
in consultation with organizations recognized by the Secretary for the 
representation of veterans under section 5902 of this title and any 
other entity the Secretary determines appropriate.
    ``(2) On a quarterly basis during the two-year period beginning on 
the date of the enactment of the Honoring our Promise to Address 
Comprehensive Toxics Act of 2021, the Secretary shall provide to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a briefing on the implementation of this subchapter.
    ``(c) Independent Review.--The Secretary shall seek to enter into 
an agreement with a nongovernmental entity or a federally funded 
research and development center to conduct a review of the 
implementation of this subchapter. Not later than 540 days after the 
date of the enactment of the Honoring our Promise to Address 
Comprehensive Toxics Act of 2021, the Secretary shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report containing such review.''.
    (b) Conforming Amendments.--Chapter 11 is amended--
            (1) in section 1116--
                    (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 Honoring our Promise to Address 
Comprehensive Toxics Act of 2021 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) in section 1116B(b)(2)(A), by inserting ``pursuant to 
        subchapter VII of this chapter,'' before ``the Secretary 
        determines''; and
            (3) in section 1118--
                    (A) by striking subsections (b) through (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 Honoring our Promise to Address 
Comprehensive Toxics Act of 2021 regarding a presumption of service 
connection based on a toxic exposure under this section is made 
pursuant to subchapter VII of this chapter.''.
    (c) Rule of Construction.--Nothing in section 1172(a)(2)(A) of 
title 38, United States Code, as added by subsection (a), shall be 
construed so as to require the advice and consent of the Senate in the 
appointment of members of the Formal Advisory Committee on Toxic 
Exposure.

SEC. 203. REEVALUATION OF CLAIMS FOR COMPENSATION INVOLVING 
              PRESUMPTIONS OF SERVICE CONNECTION.

    (a) In General.--Subchapter VI of chapter 11 is amended by adding 
at the end the following new section:
``Sec. 1167. Reevaluation of compensation determinations pursuant to 
              changes in presumptions of service connection
    ``(a) Reevaluation.--Whenever a law, including through a regulation 
or Federal court decision, establishes or modifies a presumption of 
service connection, the Secretary shall--
            ``(1) identify all claims for compensation under this 
        chapter that--
                    ``(A) were submitted to the Secretary;
                    ``(B) were evaluated and denied by the Secretary 
                before the date on which such provision of law went 
                into effect; and
                    ``(C) might have been evaluated differently had the 
                establishment or modification been applicable to the 
                claim;
            ``(2) allow for the reevaluation of such claims at the 
        election of the veteran; and
            ``(3) notwithstanding section 5110 of this title, with 
        respect to claims approved pursuant to such reevaluation, 
        provide compensation under this chapter effective as if the 
        establishment or modification of the presumption of service 
        connection had been in effect on the date of the submission of 
        the original claim described in paragraph (1).
    ``(b) Outreach.--The Secretary shall conduct outreach to inform 
relevant veterans that they may elect to have a claim be reevaluated in 
light of the establishment or modification of a presumption of service 
connection described in subsection (a). Such outreach shall include the 
following:
            ``(1) The Secretary shall publish on the internet website 
        of the Department a notice that such veterans may elect to have 
        a claim so reevaluated.
            ``(2) The Secretary shall notify, in writing or by 
        electronic means, veterans service organizations of the ability 
        of such veterans to elect to have a claim so reevaluated.''.
    (b) Application.--Section 1167 of title 38, United States Code, as 
added by subsection (a), shall apply with respect to presumptions of 
service connection established or modified on or after the date of the 
enactment of this Act, including pursuant to amendments made by this 
Act.

 TITLE III--IMPROVING THE ESTABLISHMENT OF SERVICE CONNECTION PROCESS 
                       FOR TOXIC-EXPOSED VETERANS

SEC. 301. SHORT TITLE.

    This title may be cited as the ``Veterans Burn Pits Exposure 
Recognition Act''.

SEC. 302. PRESUMPTIONS OF TOXIC EXPOSURE.

    Subchapter II of chapter 11 is amended by adding at the end the 
following new section:
``Sec. 1119. Presumptions of toxic exposure
    ``(a) Consideration of Records.--If a veteran submits to the 
Secretary a claim for compensation for a service-connected disability 
under section 1110 of this title with evidence of a disability and a 
toxic exposure that occurred during active military, naval, air, or 
space service, the Secretary may, in adjudicating such claim, 
consider--
            ``(1) any record of the veteran in an exposure tracking 
        record system; and
            ``(2) if no record of the veteran in an exposure tracking 
        record system indicates that the veteran was subject to a toxic 
        exposure during active military, naval, air, or space service, 
        the totality of the circumstances of the service of the 
        veteran.
    ``(b) Presumption of Specific Toxic Exposure for Members Who Served 
in Certain Locations.--(1) The Secretary shall, for purposes of section 
1110 and chapter 17 of this title, presume that any covered veteran was 
exposed to the substances, chemicals, and airborne hazards identified 
in the list under paragraph (2) during the service of the covered 
veteran specified in subsection (c)(1), unless there is affirmative 
evidence to establish that the covered veteran was not exposed to any 
such substances, chemicals, or hazards in connection with such service.
    ``(2) The Secretary shall establish and maintain a list that 
contains an identification of one or more such substances, chemicals, 
and airborne hazards as the Secretary, in collaboration with the 
Secretary of Defense, may determine appropriate for purposes of this 
section.
    ``(3) Beginning not later than two years after the date of the 
enactment of the Honoring our Promise to Address Comprehensive Toxics 
Act of 2021, and not less frequently than once every two years 
thereafter, the Secretary shall submit to the Committees on Veterans' 
Affairs of the House of Representatives and the Senate a report 
identifying any additions or removals to the list under paragraph (2) 
during the period covered by the report.
    ``(c) Definitions.--In this section:
            ``(1) The term `covered veteran' means any veteran who--
                    ``(A) on or after August 2, 1990, performed active 
                military, naval, air, or space 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, air, or space 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 `exposure tracking record system'--
                    ``(A) means any system, program, or pilot program 
                used by the Secretary of Veterans Affairs or the 
                Secretary of Defense to track how veterans or members 
                of the Armed Forces have been exposed to various 
                occupational or environmental hazards; and
                    ``(B) includes the Individual Longitudinal Exposure 
                Record, or successor system.
            ``(3) The term `toxic exposure risk activity' has the 
        meaning given such term in section 1710(e)(4) of this title.''.

SEC. 303. MEDICAL NEXUS EXAMINATIONS FOR TOXIC EXPOSURE RISK 
              ACTIVITIES.

    Subchapter VI of chapter 11, as amended by section 203, is further 
amended by adding at the end the following new section:
``Sec. 1168. Medical nexus examinations for toxic exposure risk 
              activities
    ``(a) Medical Examinations and Medical Opinions.--(1) Except as 
provided in subsection (b), if a veteran submits to the Secretary a 
claim for compensation for a service-connected disability under section 
1110 of this title with evidence of a disability and evidence of 
participation in a toxic exposure risk activity during active military, 
naval, air, or space service, and such evidence is not sufficient to 
establish a service connection for the disability, the Secretary 
shall--
            ``(A) provide the veteran with a medical examination under 
        section 5103A(d) of this title; and
            ``(B) obtain a medical opinion (to be requested by the 
        Secretary in connection with the medical examination under 
        subparagraph (A)) as to whether it is at least as likely as not 
        that there is a nexus between the disability and the toxic 
        exposure risk activity.
    ``(2) When providing the Secretary with a medical opinion under 
paragraph (1)(B) for a veteran, the health care provider shall 
consider--
            ``(A) the total potential exposure through all applicable 
        military deployments of the veteran; and
            ``(B) the synergistic, combined effect of all toxic 
        exposure risk activities of the veteran.
    ``(3) The requirement under paragraph (2)(B) shall not be construed 
as requiring a health care provider to consider the synergistic, 
combined effect of each of the substances, chemicals, and airborne 
hazards identified in the list under section 1119(b)(2) of this title.
    ``(b) Exception.--Subsection (a) shall not apply if the Secretary 
determines there is no indication of an association between the 
disability claimed by the veteran and the toxic exposure risk activity 
for which the veteran submitted evidence.
    ``(c) Toxic Exposure Risk Activity Defined.--In this section, the 
term `toxic exposure risk activity' has the meaning given that term in 
section 1710(e)(4) of this title.''.

              TITLE IV--PRESUMPTIONS OF SERVICE CONNECTION

SEC. 401. TREATMENT OF VETERANS WHO PARTICIPATED IN CLEANUP OF ENEWETAK 
              ATOLL AS RADIATION-EXPOSED VETERANS FOR PURPOSES OF 
              PRESUMPTION OF SERVICE CONNECTION OF CERTAIN DISABILITIES 
              BY DEPARTMENT OF VETERANS AFFAIRS.

    (a) Short Title.--This section may be cited as the ``Mark Takai 
Atomic Veterans Healthcare Parity Act''.
    (b) Enewetak Atoll.--Section 1112(c)(3)(B) is amended by adding at 
the end the following new clause:
                    ``(v) Cleanup of Enewetak Atoll during the period 
                beginning on January 1, 1977, and ending on December 
                31, 1980.''.

SEC. 402. TREATMENT OF VETERANS WHO PARTICIPATED IN NUCLEAR RESPONSE 
              NEAR PALOMARES, SPAIN, OR THULE, GREENLAND, AS RADIATION-
              EXPOSED VETERANS FOR PURPOSES OF PRESUMPTION OF SERVICE 
              CONNECTION OF CERTAIN DISABILITIES BY DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Short Title.--This section may be cited as the ``Palomares or 
Thule Veterans Act''
    (b) Palomares or Thule.--Section 1112(c)(3)(B), as amended by 
section 401, is further amended by adding at the end the following new 
clauses:
                    ``(vi) Onsite participation in the response effort 
                following the collision of a United States Air Force B-
                52 bomber and refueling plane that caused the release 
                of four thermonuclear weapons in the vicinity of 
                Palomares, Spain, during the period beginning January 
                17, 1966, and ending March 31, 1967.
                    ``(vii) Onsite participation in the response effort 
                following the on-board fire and crash of a United 
                States Air Force B-52 bomber that caused the release of 
                four thermonuclear weapons in the vicinity of Thule Air 
                Force Base, Greenland, during the period beginning 
                January 21, 1968, and ending September 25, 1968.''.

SEC. 403. PRESUMPTIONS OF SERVICE CONNECTION FOR DISEASES ASSOCIATED 
              WITH EXPOSURES TO CERTAIN HERBICIDE AGENTS FOR VETERANS 
              WHO SERVED IN CERTAIN LOCATIONS.

    (a) Short Title.--This section may be cited as the ``Veterans Agent 
Orange Exposure Equity Act''.
    (b) In General.--Section 1116, as amended by section 202, is 
further amended--
            (1) by striking ``, during active military, naval, air, or 
        space service, served in the Republic of Vietnam during the 
        period beginning on January 9, 1962, and ending on May 7, 
        1975'' each place it appears and inserting ``performed covered 
        service'';
            (2) by striking ``performed active military, naval, air, or 
        space service in the Republic of Vietnam during the period 
        beginning on January 9, 1962, and ending on May 7, 1975'' each 
        place it appears and inserting ``performed covered service''; 
        and
            (3) by adding at the end the following new subsection:
    ``(d) In this section, the term `covered service' means active 
military, naval, air, or space service--
            ``(1) performed in the Republic of Vietnam during the 
        period beginning on January 9, 1962, and ending on May 7, 1975;
            ``(2) performed in Thailand at any United States or Royal 
        Thai base during the period beginning on January 9, 1962, and 
        ending on June 30, 1976, without regard to where on the base 
        the veteran was located or what military job specialty the 
        veteran performed;
            ``(3) performed in Laos during the period beginning on 
        December 1, 1965, and ending on September 30, 1969;
            ``(4) performed in Cambodia at Mimot or Krek, Kampong Cham 
        Province during the period beginning on April 16, 1969, and 
        ending on April 30, 1969; or
            ``(5) performed on Guam or American Samoa, or in the 
        territorial waters thereof, during the period beginning on 
        January 9, 1962, and ending on July 31, 1980, or served on 
        Johnston Atoll or on a ship that called at Johnston Atoll 
        during the period beginning on January 1, 1972, and ending on 
        September 30, 1977.''.
    (c) Eligibility for Hospital Care and Medical Services.--Section 
1710(e)(4), as amended by section 102(c), is further amended by 
striking subparagraph (A) and inserting the following new subparagraph:
            ``(A) The term `Vietnam-era herbicide-exposed veteran' 
        means a veteran who--
                    ``(i) performed covered service, as defined in 
                section 1116(d) of this title; or
                    ``(ii) the Secretary finds may have been exposed 
                during such service to dioxin or was exposed during 
                such service to a toxic substance found in a herbicide 
                or defoliant used for military purposes during such 
                period.''.
    (d) Conforming Amendment.--The heading for section 1116 is amended 
by striking ``the Republic of Vietnam'' and inserting ``certain 
locations''.

SEC. 404. ADDITION OF ADDITIONAL DISEASES ASSOCIATED WITH EXPOSURE TO 
              CERTAIN HERBICIDE AGENTS FOR WHICH THERE IS A PRESUMPTION 
              OF SERVICE CONNECTION FOR VETERANS WHO SERVED IN CERTAIN 
              LOCATIONS.

    (a) Short Title.--This section may be cited as the ``Fair Care for 
Vietnam Veterans Act''.
    (b) Additional Diseases.--Section 1116(a)(2), as amended by section 
9109 of the William M. (Mac) Thornberry National Defense Authorization 
Act for Fiscal Year 2021 (Public Law 116-283), is further amended by 
adding at the end the following new subparagraphs:
            ``(L) Hypertension.
            ``(M) Monoclonal gammopathy of undetermined 
        significance.''.

SEC. 405. IMPROVING COMPENSATION FOR DISABILITIES OCCURRING IN PERSIAN 
              GULF WAR VETERANS.

    (a) Reduction in Threshold of Eligibility.--Subsection (a)(1) of 
section 1117 is amended by striking ``became manifest--'' and all that 
follows through the period at the end and inserting ``became manifest 
to any degree at any time.''.
    (b) Permanent Extension of Period of Eligibility.--Such section is 
further amended--
            (1) by striking subsection (b);
            (2) by redesignating subsections (c) and (d) as subsections 
        (b) and (c), respectively; and
            (3) in subsection (a)(2)(C), by striking ``under subsection 
        (d)'' and inserting ``under subsection (c)''.
    (c) Establishing Singular Disability-based Questionnaire.--Such 
section is further amended by inserting after subsection (c) (as 
redesignated by subsection (b)) the following new subsection (d):
    ``(d) If a Persian Gulf veteran at a medical facility of the 
Department presents with any one symptom associated with Gulf War 
Illness, the Secretary shall ensure that health care personnel of the 
Department use a disability benefits questionnaire, or successor 
questionnaire, designed to identify Gulf War Illness, in addition to 
any other diagnostic actions the personnel determine appropriate.''.
    (d) Expansion of Definition of Persian Gulf Veteran.--Subsection 
(f) of such section is amended by inserting ``, Afghanistan, Israel, 
Egypt, Turkey, Syria, or Jordan,'' after ``operations''.
    (e) Training.--Such section is further amended by adding at the end 
the following new subsection:
    ``(i)(1) The Secretary shall take such actions as may be necessary 
to ensure that health care personnel of the Department are 
appropriately trained to effectively carry out this section.
    ``(2) Not less frequently than once each year, the Secretary shall 
submit to Congress a report on the actions taken by the Secretary to 
carry out paragraph (1).''.

SEC. 406. PRESUMPTION OF SERVICE CONNECTION FOR CERTAIN DISEASES 
              ASSOCIATED WITH EXPOSURE TO BURN PITS AND OTHER TOXINS.

    (a) Short Title.--This section may be cited as the ``Presumptive 
Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act''.
    (b) In General.--Subchapter II of chapter 11, as amended by section 
302, is further amended by inserting after section 1119 the following 
new section:
``Sec. 1120. Presumption of service connection for certain diseases 
              associated with exposure to burn pits and other toxins
    ``(a) Presumption of Service Connection.--For the purposes of 
section 1110 of this title, and subject to section 1113 of this title, 
a disease specified in subsection (b) becoming manifest in a covered 
veteran shall be considered to have been incurred in or aggravated 
during active military, naval, air, or space service, notwithstanding 
that there is no record of evidence of such disease during the period 
of such service.
    ``(b) Diseases Specified.--The diseases specified in this 
subsection are the following:
            ``(1) Asthma that was diagnosed after service of the 
        covered veteran as specified in subsection (c).
            ``(2) The following types of cancer:
                    ``(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.
                    ``(K) Pancreatic cancer.
            ``(3) Chronic bronchitis.
            ``(4) Chronic obstructive pulmonary disease.
            ``(5) Constrictive bronchiolitis or obliterative 
        bronchiolitis.
            ``(6) Emphysema.
            ``(7) Granulomatous disease.
            ``(8) Interstitial lung disease.
            ``(9) Pleuritis.
            ``(10) Pulmonary fibrosis.
            ``(11) Sarcoidosis.
            ``(12) Chronic sinusitis.
            ``(13) Chronic rhinitis.
            ``(14) Glioblastoma.
            ``(15) Any other disease for which the Secretary 
        determines, pursuant to regulations prescribed under subchapter 
        VII that a presumption of service connection is warranted based 
        on a positive association with a substance, chemical, or 
        airborne hazard identified in the list under section 1119(b)(2) 
        of this title.
    ``(c) Covered Veteran Defined.--In this section, the term `covered 
veteran' has the meaning given that term in section 1119(c) of this 
title.''.
    (c) Conforming Amendment.--Section 1113 is amended by striking ``or 
1118'' each place it appears and inserting ``1118, or 1120''.

                       TITLE V--RESEARCH MATTERS

SEC. 501. INTERAGENCY WORKING GROUP ON TOXIC EXPOSURE RESEARCH.

    (a) In General.--Subchapter II of chapter 73 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 7330D. Interagency working group on toxic exposure research
    ``(a) Establishment.--(1) The Secretary shall establish the Toxic 
Exposure Research Working Group (in this section referred to as the 
`Working Group').
    ``(2) The Working Group shall consist of employees, selected by the 
Secretary, of the following:
            ``(A) The Department.
            ``(B) The Department of Defense.
            ``(C) The Department of Health and Human Services.
            ``(D) The Environmental Protection Agency.
            ``(E) Other Federal entities involved in research 
        activities regarding the health consequences of toxic exposures 
        experienced during active military, naval, air, or space 
        service.
    ``(b) Functions.--The Working Group shall perform the following 
functions:
            ``(1) Identify collaborative research activities and 
        resources available among entities represented by members of 
        the Working Group to conduct such collaborative research 
        activities.
            ``(2) Develop a 5-year strategic plan for Federal entities 
        represented in the Working Group to carry out collaborative 
        research activities.
    ``(c) Reporting.--The Secretary shall submit, to the Committees on 
Veterans' Affairs of the Senate and House of Representatives, the 
following:
            ``(1) Not later than one year after the date of the 
        enactment of the Act, a report on the establishment of the 
        Working Group under subsection (a).
            ``(2) Not later than two years after the date of enactment 
        of the Act, a report containing the collaborative research 
        activities identified, and the Strategic Plan developed, by the 
        Working Group, under subsection (b).
            ``(3) Annually during the 5-year period covered by the 
        strategic plan under subsection (b), a progress reports on 
        implementation of the Strategic Plan under subsection (b).
    ``(d) Termination.--The Working Group shall terminate after 
submitting the final report under subsection (c).
    ``(e) Definitions.--For purposes of this section--
            ``(1) The term `Act' means the Honoring our Promise to 
        Address Comprehensive Toxics Act of 2021.
            ``(2) The term `collaborative research activity' means a 
        research activity--
                    ``(A) conducted by an entity represented by a 
                member of the Working Group;
                    ``(B) funded by the Federal Government; and
                    ``(C) regarding the health consequences of toxic 
                exposures experienced during active military, naval, 
                air, or space service.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such subchapter is amended by inserting after the item relating to 
section 7330C the following new item:

``7330D. Interagency working group on toxic exposure research.''.
    (c) Implementation.--The Secretary of Veterans Affairs shall 
establish the Working Group under section 7330D of such title, as added 
by subsection (a), not later than one year after the date of the 
enactment of this Act.

SEC. 502. DATA COLLECTION, ANALYSIS, AND REPORT ON TREATMENT OF 
              VETERANS FOR ILLNESSES RELATED TO TOXIC EXPOSURE.

    (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 Secretary in connection with 
        hospital care (including mental health services and 
        counseling), medical services, or nursing home care furnished 
        to a veteran for an illness under section 1710(a)(2)(F) of 
        title 38, United States Code, as amended by section 102; and
            (2) is likely to be scientifically useful, as determined by 
        the Secretary, in determining whether a positive association 
        exists between the illness of the veteran and a toxic exposure.
    (b) Consent of Patients.--The Secretary shall ensure that the 
compilation and analysis of the clinical data of a veteran under 
subsection (a) shall be conducted, and such data shall be used, in a 
manner that is 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 Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report containing--
            (1) any data compiled under subsection (a);
            (2) an analysis of any such data;
            (3) a description of the types and incidences of illnesses 
        identified by the Secretary pursuant to such subsection;
            (4) an explanation by the Secretary for the incidence of 
        such illnesses and such alternate explanations for the 
        incidence of such illnesses as the Secretary may consider 
        reasonable; and
            (5) a description of the views of the Secretary regarding 
        the scientific validity of drawing conclusions from the 
        incidence of such illnesses, as evidenced by the data compiled 
        under subsection (a), regarding the existence of a positive 
        association between such illness and a toxic exposure.
    (d) Definitions.--In this section:
            (1) The term ``toxic exposure'' has the meaning given that 
        term in section 101 of title 38, United States Code.
            (2) The term ``illness'' has the meaning given that term in 
        section 1171 of such title, as added by section 202.

SEC. 503. STUDIES RELATED TO VETERANS WHO SERVED IN SOUTHWEST ASIA AND 
              CERTAIN OTHER LOCATIONS.

    (a) Analysis on Mortality in Covered Veterans.--
            (1) Analysis.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall conduct an updated analysis of total and respiratory 
        disease mortality in covered veterans.
            (2) Elements.--The analysis under paragraph (1) shall 
        include, to the extent practicable, the following:
                    (A) Metrics of airborne exposures.
                    (B) The location and timing of any deployments of 
                the veteran.
                    (C) The military occupational specialty of the 
                veteran.
                    (D) The Armed Force in which the veteran served.
                    (E) The preexisting health status of the veteran, 
                including with respect to asthma.
                    (F) Such personal information of the veteran as the 
                Secretary may consider relevant, 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 conduct an 
epidemiological study of covered veterans that involves--
            (1) the use of improved spatio-temporal estimates of 
        ambient air pollution exposures that leverage advances in 
        retrospective exposure assessment; and
            (2) the collection of detailed information on the covered 
        veterans studied through medical records, administrative data, 
        and other existing sources, including, with respect to the 
        covered veterans--
                    (A) personal information, 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.--
            (1) Study.--Not later than 180 days after the date of the 
        enactment of this Act, the Secretary shall conduct a toxicology 
        study, to include variability, to replicate toxic exposures of 
        healthy, young members of the Armed Forces, as well as 
        potentially susceptible members, with preexisting health 
        conditions.
            (2) Elements.--The study under paragraph (1) shall 
        include--
                    (A) an analysis of results for mechanistic markers 
                and clinically relevant outcomes; and
                    (B) a validation of any serum, tissue, or other 
                biomarkers of toxic exposure, susceptibility, or effect 
                with respect to the subjects of the study.
    (d) Covered Veteran Defined.--In this section, the term ``covered 
veteran'' has the meaning given that term in section 1119(c) of title 
38, United States Code, as added by section 302.

SEC. 504. STUDY ON HEALTH TRENDS OF POST 9/11 VETERANS.

    (a) Study.--The Secretary of Veterans Affairs shall conduct an 
epidemiological study on the health trends of veterans who served in 
the Armed Forces after September 11, 2001.
    (b) Elements.--The study under subsection (a) shall assess, with 
respect to each veteran included in the study, the following:
            (1) The race and ethnicity of the veteran.
            (2) The age of the veteran.
            (3) The period of service and length of service of the 
        veteran in the Armed Forces.
            (4) Any military occupational speciality of the veteran.
            (5) The gender of the veteran.
            (6) The disability status of the veteran.
    (c) Report.--Not later than two years after the date of the 
enactment of this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the House of Representatives and the Senate a 
report on the study under subsection (a).

SEC. 505. STUDY ON CANCER RATES AMONG VETERANS.

    (a) Study.--The Secretary of Veterans Affairs shall conduct a study 
on the incidence of cancer in veterans, to determine trends in the 
rates of the incidence of cancer in veterans, and on available early 
detection diagnostics, to determine the feasibility and advisability of 
including such diagnostics as part of the health care furnished to 
veterans by the Secretary.
    (b) Elements.--The study under subsection (a) shall assess, with 
respect to each veteran included in the study, the following:
            (1) The race and ethnicity of the veteran.
            (2) The age of the veteran.
            (3) The period of service and length of service of the 
        veteran in the Armed Forces.
            (4) Any military occupational speciality of the veteran.
            (5) The gender of the veteran.
            (6) Any type of cancer that the veteran has.
    (c) Report.--Not later than two years after the date of the 
enactment of this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the House of Representatives and the Senate a 
report on the study under subsection (a).

SEC. 506. STUDY ON FEASIBILITY AND ADVISABILITY OF FURNISHING HOSPITAL 
              CARE AND MEDICAL SERVICES TO DEPENDENTS OF VETERANS WHO 
              PARTICIPATED IN TOXIC EXPOSURE RISK ACTIVITIES.

    (a) Study.--The Secretary of Veterans Affairs shall conduct a study 
on the feasibility and advisability of furnishing hospital care and 
medical services to qualifying dependents of veterans described in 
section 1710(e)(1)(G) of title 38, United States Code, as added by 
section 103(a)(1), for any illness determined by the Secretary to be 
connected to a toxic exposure risk activity carried out by the veteran, 
as determined by the Secretary, notwithstanding that there is 
insufficient medical evidence to conclude that such illness is 
attributable to such activity.
    (b) Elements.--The study under subsection (a) shall include--
            (1) an assessment of the impact of furnishing hospital care 
        and medical services to qualifying dependents as described in 
        such subsection on the ability of the Department of Veterans 
        Affairs to furnish hospital care and medical services to 
        veterans;
            (2) an assessment of the potential cost of furnishing 
        hospital care and medical services to qualifying dependents as 
        described in such subsection;
            (3) an estimate of the resources required to furnish such 
        care and services;
            (4) an assessment of any stress or other effect furnishing 
        such care and services would have on the claims and appeals 
        system of the Department;
            (5) an estimate of the number of qualifying dependents who 
        would be eligible for such care and services; and
            (6) an assessment of the feasibility of adjudicating claims 
        for such care and services.
    (c) Phased-In Application.--In conducting the study under 
subsection (a), the Secretary shall assess the feasibility and 
advisability of phasing in the furnishing of hospital care and medical 
services to qualifying dependents described in such subsection by the 
decade in which such toxic exposure risk activity occurred, starting 
with the most recent decade.
    (d) Review of Toxic Exposure Cases Regarding Liability of 
Department of Defense.--In conducting the study under subsection (a), 
the Secretary shall--
            (1) review known cases of toxic exposure on military 
        installations of the Department of Defense;
            (2) analyze the liability of the Department of Defense in 
        each such case; and
            (3) assess whether the Secretary of Defense should provide 
        care and services relating to such toxic exposures under the 
        TRICARE program.
    (e) Report.--Not later than two years after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the study conducted under subsection (a).
    (f) Definitions.--In this section:
            (1) The terms ``hospital care'' and ``medical services'' 
        have the meanings given those terms in section 1701 of title 
        38, United States Code.
            (2) The term ``illness'' has the meaning given that term in 
        section 1171 of such title, as added by section 202.
            (3) The term ``qualifying dependent'' means--
                    (A) a dependent of a veteran described in section 
                1710(e)(1)(G) of title 38, United States Code, as added 
                by section 104(a)(1), who resided with the veteran 
                during the period in which, and on the installation at 
                which, the veteran participated in a toxic exposure 
                risk activity;
                    (B) an individual who was in utero of such a 
                veteran or other qualifying dependent when the veteran 
                participated in a toxic exposure risk activity; or
                    (C) a dependent of such a veteran who is not 
                described in subparagraph (A) or (B) but who may have 
                an illness that is connected to the toxic exposure risk 
                activity of the veteran, as determined by the 
                Secretary.
            (4) The term ``toxic exposure'' has the meaning given that 
        term in section 101 of such title, as added by section 102(b).
            (5) The term ``toxic exposure risk activity'' has the 
        meaning given that term in section 1710(e)(4) of such title, as 
        added by section 102(c).
            (6) The term ``TRICARE program'' has the meaning given that 
        term in section 1072 of such title.

SEC. 507. STUDY ON HEALTH EFFECTS OF WASTE RELATED TO MANHATTAN PROJECT 
              ON CERTAIN VETERANS.

    (a) Study.--The Secretary of Veterans Affairs shall conduct a study 
on the health trends of veterans who, while serving in the active 
military, naval, air, or space service--
            (1) participated in activities relating to the Manhattan 
        Project (including activities relating to covered waste) in 
        connection with such service; or
            (2) resided at or near, as determined by the Secretary, the 
        locations described in subsection (b).
    (b) Covered Locations.--The locations described in this subsection 
are the following locations in the county of St. Louis, Missouri:
            (1) Coldwater Creek.
            (2) The St. Louis Airport Site.
            (3) The West Lake Landfill.
            (4) Any other location in the county of St. Louis, Missouri 
        that is proximate to covered waste, as determined by the 
        Secretary.
    (c) Elements.--The study under subsection (a) shall assess, with 
respect to each veteran included in the study, the following:
            (1) The age, gender, and race of the veteran.
            (2) The period and location of exposure to covered waste.
            (3) Any type of cancer, or other illness associated with 
        toxic exposure, that the veteran has.
            (4) A comparison of the overall health condition of the 
        veteran, including any illness of the veteran identified 
        pursuant to paragraph (3), with the overall health condition of 
        past and present civilian populations residing at the same 
        location of exposure.
    (d) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the House of Representatives and the Senate a 
report on the study under subsection (a).
    (e) Definitions.--In this section:
            (1) The term ``covered waste'' means any waste arising from 
        activities carried out in connection with the Manhattan 
        Project.
            (2) The term ``illness'' has the meaning given that term in 
        section 1171 of title 38, United States Code, as added by 
        section 202.
            (3) The term ``toxic exposure'' has the meaning given that 
        term in section 101 of such title, as added by section 102(b).

SEC. 508. STUDY ON TOXIC EXPOSURE AND MENTAL HEALTH OUTCOMES.

    (a) Study Required.--The Secretary of the Department of Veterans 
Affairs shall enter into an agreement with the National Academies of 
Sciences, Engineering, and Medicine for the conduct of a study of 
veterans to assess possible relationships between toxic exposures 
experienced during service in the Armed Forces and mental health 
outcomes, including chronic multisymptom illness, traumatic brain 
injury, post-traumatic stress disorder, depression, psychosis, suicide 
attempts, and suicide deaths.
    (b) Elements.--For each veteran included in the study under 
subsection (a), the following information shall be collected and 
assessed:
            (1) Age.
            (2) Gender.
            (3) Race and ethnicity.
            (4) Period and length of service in the Armed Forces.
            (5) History of toxic exposure during service in the Armed 
        Forces.
            (6) Any diagnosis of chronic multisymptom illness.
            (7) Any diagnosis of a mental health or cognitive disorder.
            (8) Any history of suicide attempt or suidcidality.
            (9) If the veteran died by suicide.
    (c) Report.--Not later than two years after the date after the 
enactment of this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
containing the findings of the study conducted under subsection (a).

SEC. 509. STUDY ON VETERANS IN TERRITORIES OF THE UNITED STATES.

    (a) GAO Study.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study on the state of access and 
        barriers to benefits and services furnished under laws 
        administered by the Secretary of Veterans Affairs to veterans 
        in Territories of the United States, including deficits in the 
        availability and accessibility of such benefits and services 
        compared to veterans elsewhere in the United States.
            (2) Elements.--The study under paragraph (1) shall 
        include--
                    (A) the number of veterans in each Territory of the 
                United States;
                    (B) the number of veterans in each Territory who 
                are enrolled in the system of annual patient enrollment 
                of the Department of Veterans Affairs under section 
                1705(a) of title 38, United States Code;
                    (C) the number of veterans in each Territory who 
                are eligible for services under section 1710 of such 
                title but who are not enrolled as described in 
                subparagraph (B);
                    (D) a detailed description of obstacles facing 
                veterans in each Territory in accessing health care 
                services, including those involving the availability of 
                such services to veterans in the Territory in which the 
                veterans reside, and the distance required of veterans 
                to journey to receive services at a regional medical 
                center of the Veterans Health Administration, a 
                community-based outpatient clinic, or other full-
                service medical facility of the Department, or death 
                center, respectively;
                    (E) a detailed description of obstacles facing 
                veterans in each Territory in accessing readjustment 
                counseling services, including those involving the 
                availability of such services to veterans in the 
                Territory in which the veterans reside, and the 
                distance required of veterans to journey to receive 
                services at a readjustment counseling services center 
                of the Department;
                    (F) a detailed description of obstacles facing 
                veterans in each Territory in accessing other veterans 
                benefits, including those involving the availability of 
                benefits and services to veterans in the Territory in 
                which the veterans reside, and the distance required of 
                the veterans to journey to the nearest office of the 
                Veterans Benefits Administration;
                    (G) an analysis of the staffing and recordkeeping 
                levels and quality of the offices of the Department 
                charged with serving veterans in the Territories, 
                including the availability of the full- and part-time 
                staff of each office to the veterans they are charged 
                with serving, and the continuity of care provided by 
                such staff to such veterans;
                    (H) an analysis of the availability of the Veterans 
                Community Care Program established under section 1703 
                of title 38, United States Code, to veterans in each 
                Territory;
                    (I) an analysis of the economic and health 
                consequences for veterans in each Territory resulting 
                from obstacles to accessing adequate assistance and 
                health care at facilities of the Department;
                    (J) an analysis of the access to assistance and 
                health care provided to veterans in the aftermath of 
                major disasters declared in each of the Territories 
                since September 4, 2017; and
                    (K) recommendations for improving access of 
                veterans in the Territories to benefits and services 
                furnished by the Secretary, and reducing barriers and 
                deficits in the availability and accessibility of such 
                benefits and services compared to veterans elsewhere in 
                the United States.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to Congress a final report setting forth the results of 
the study conducted under subsection (a), including the recommendations 
developed under paragraph (2)(K) of such subsection.
    (c) Territory Defined.--In this section, the term ``Territory'' 
includes American Samoa, the Commonwealth of the Northern Marianas 
Islands, Guam, Puerto Rico, and the Virgin Islands.

SEC. 510. DEPARTMENT OF VETERANS AFFAIRS PUBLIC WEBSITE FOR TOXIC 
              EXPOSURE RESEARCH.

    (a) Website.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
establish, and maintain thereafter, a publically accessible internet 
website of the Department of Veterans Affairs that serves as a 
clearinghouse for the publication of all toxic exposure research 
carried out or funded by the executive branch of the Federal 
Government.
    (b) Relation to War Related Illness and Injury Study Center.--The 
website developed and maintained under subsection (a) shall be housed 
under the website of the War Related Illness and Injury Study Center of 
the Department of Veterans Affairs, or successor center.
    (c) Coordination.--In carrying out subsection (a), the Secretary 
shall coordinate with--
            (1) the heads of each Federal department or agency carrying 
        out or funding toxic exposure research;
            (2) the War Related Illness and Injury Study Center of the 
        Department of Veterans Affairs, or successor center; and
            (3) any working group of the Department of Veterans Affairs 
        or other similar entity responsible for coordinating toxic 
        exposure research.
    (d) Definitions.--In this section:
            (1) The term ``toxic exposure'' has the meaning given that 
        term in section 101 of title 38, United States Code, as added 
        by section 102(b).
            (2) The term ``toxic exposure research'' means research on 
        the health consequences of toxic exposures experienced during 
        service in the Armed Forces.

SEC. 511. BIENNIAL REPORT ON HEALTH EFFECTS OF JET FUELS USED BY ARMED 
              FORCES.

    Not later than one year after the date of the enactment of this 
Act, and biennially thereafter during the subsequent eight-year period, 
the Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the House of Representatives and the Senate, and 
make publicly available, a report that includes--
            (1) a discussion of the effect of various different types 
        of jet fuels used by the Armed Forces on the health of 
        individuals by length of exposure;
            (2) an identification of the immediate symptoms of jet fuel 
        exposure that may indicate future health risks;
            (3) a chronology of health safeguards implemented by the 
        Armed Forces intended to reduce the exposure of members of the 
        Armed Foces to jet fuel; and
            (4) an identification of any areas relating to jet fuel 
        exposure about which new research needs to be conducted.

TITLE VI--IMPROVEMENT OF RESOURCES AND TRAINING REGARDING TOXIC-EXPOSED 
                                VETERANS

SEC. 601. SHORT TITLE; DEFINITIONS.

    (a) Short Title.--This title may be cited as the ``Toxic Exposure 
in the American Military Act'' or the ``TEAM Act''.
    (b) Definitions.--In this title, the terms ``active military, 
naval, air, or space service'', ``toxic exposure'', and ``toxic-exposed 
veteran'' have the meanings given those terms in section 101 of title 
38, United States Code.

SEC. 602. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF VETERANS 
              AFFAIRS FOR TOXIC-EXPOSED VETERANS 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) toxic-exposed veterans, including with respect 
                to--
                            (i) disability compensation under chapter 
                        11 of title 38, United States Code; and
                            (ii) hospital care, medical services, and 
                        nursing home care under section 1710(a)(2)(F) 
                        of such title;
                    (B) caregivers of toxic-exposed veterans who are 
                participating in the program of comprehensive 
                assistance for family caregivers under section 1720G(a) 
                of such title; and
                    (C) survivors of toxic-exposed veterans 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).
            (3) Languages.--The Secretary shall publish the list under 
        paragraph (1) in languages including the following:
                    (A) English.
                    (B) Spanish.
                    (C) Chinese.
                    (D) The seven other most commonly spoken languages 
                in the United States.
    (b) Outreach.--The Secretary shall develop, with input from the 
community, an informative outreach program for veterans on illnesses 
that may be related to toxic exposure, including outreach with respect 
to benefits and support programs. Information distributed under the 
outreach program shall be treated as a fact sheet of the Department of 
Veterans Affairs for purposes of making the information available in 
multiple languages pursuant to section 2 of the Veterans and Family 
Information Act (Public Law 117-62; 38 U.S.C. 6303 note).
    (c) Veterans Organizations.--To the extent practicable, the 
Secretary shall share with national veterans service organizations and 
other veterans groups, including such organizations and groups that 
improve access by veterans to health care and benefits, the list of 
resources under subsection (a) and the outreach program under 
subsection (b).

SEC. 603. 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 toxic 
exposures during active military, naval, air, or space 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 toxic exposures of veterans 
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. 604. TRAINING FOR PERSONNEL OF THE DEPARTMENT OF VETERANS AFFAIRS 
              WITH RESPECT TO TOXIC-EXPOSED VETERANS.

    (a) Health Care Personnel.--The Secretary of Veterans Affairs shall 
provide to health care personnel of the Department of Veterans Affairs 
education and training to identify, treat, and assess the impact on 
toxic-exposed veterans of illnesses related to toxic exposure and 
inform such personnel of how to ask for additional information from 
veterans regarding different toxic exposures.
    (b) Benefits Personnel.--
            (1) Standard claims processor training curriculum.--
                    (A) Curriculum.--Not later than 180 days after the 
                date of the enactment of this Act, the Secretary shall 
                ensure that a standard training curriculum exists for 
                processors of claims under the laws administered by the 
                Secretary who review claims for disability benefits 
                relating to service-connected disabilities based on 
                toxic exposure, including employees who adjudicate such 
                claims.
                    (B) Matters included.--The Secretary shall ensure 
                that the training under subparagraph (A) includes the 
                following explanations with respect to claims relating 
                to toxic exposure:
                            (i) A lack of a presumption of service 
                        connection is not by itself sufficient to 
                        determine that service connection does not 
                        exist.
                            (ii) The claims adjudicator shall always 
                        consider whether direct service connection is 
                        applicable and request, as needed, an advisory 
                        medical opinion pursuant to section 1168 of 
                        title 38, United States Code, as added by 
                        section 303.
                            (iii) The claims adjudicator may review and 
                        consider any record of the claimant in an 
                        exposure tracking record system pursuant to 
                        section 1119 of such title, as added by section 
                        302, but a lack of such information is not by 
                        itself sufficient to determine that such 
                        exposure did not occur or sufficient to deny 
                        the claim.
                    (C) Provision of training.--The Secretary shall--
                            (i) provide training under subparagraph (A) 
                        to each employee described in such subparagraph 
                        not less frequently than annually; and
                            (ii) 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.
            (2) Standard medical examiner training curriculum.--
                    (A) Curriculum.--Not later than 180 days after the 
                date of the enactment of this Act, the Secretary shall 
                ensure that a standard medical training curriculum 
                exists for medical providers who conduct examinations 
                and provide opinions pursuant to section 1168 of title 
                38, United States Code, as added by section 303, 
                regardless of whether the provider is an employee of 
                the Department or a contractor.
                    (B) Standardized approach.--The Secretary shall 
                ensure that the curriculum established under 
                subparagraph (A)--
                            (i) provides a standardized approach to 
                        conducting and providing examinations and 
                        opinions in accordance with such section 1168; 
                        and
                            (ii) instructs medical providers to 
                        consider, when conducting an examination or 
                        providing an opinion--
                                    (I) relevant medical and scientific 
                                literature;
                                    (II) the proximity, intensity, and 
                                frequency of exposure of the individual 
                                to the identified toxic exposure;
                                    (III) medically unexplained chronic 
                                multisymptom illnesses; and
                                    (IV) all competent and credible 
                                evidence of record.

SEC. 605. GUIDELINES FOR ACTIVE DUTY MILITARY ON POTENTIAL RISKS AND 
              PREVENTION OF TOXIC EXPOSURES.

    Not later than 90 days after the date of the enactment of this Act, 
the Secretary of Defense and the Secretary of Veterans Affairs shall 
jointly coordinate and establish guidelines to be used during training 
of members of the Armed Forces serving on active duty to provide the 
members awareness of the potential risks of toxic exposures and ways to 
prevent being exposed during combat.

           TITLE VII--REGISTRIES, RECORDS, AND OTHER MATTERS

SEC. 701. REGISTRY OF INDIVIDUALS EXPOSED TO PER- AND POLYFLUOROALKYL 
              SUBSTANCES ON MILITARY INSTALLATIONS.

    (a) Establishment of Registry.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall--
                    (A) establish and maintain a registry for eligible 
                individuals who may have been exposed to per- and 
                polyfluoroalkyl substances (in this section referred to 
                as ``PFAS'') due to the environmental release of 
                aqueous film-forming foam (in this section referred to 
                as ``AFFF'') on military installations to meet the 
                requirements of military specification MIL-F-24385F;
                    (B) include any information in such registry that 
                the Secretary determines necessary to ascertain and 
                monitor the health effects of the exposure of members 
                of the Armed Forces to PFAS associated with AFFF;
                    (C) develop a public information campaign to inform 
                eligible individuals about the registry, including how 
                to register and the benefits of registering; and
                    (D) periodically notify eligible individuals of 
                significant developments in the study and treatment of 
                conditions associated with exposure to PFAS.
            (2) Coordination.--The Secretary of Veterans Affairs shall 
        coordinate with the Secretary of Defense in carrying out 
        paragraph (1).
    (b) Reports.--
            (1) Initial report.--Not later than one year after the date 
        of the enactment of this Act, the Secretary of Defense shall 
        submit to Congress a report regarding the following:
                    (A) Sources of PFAS on military installations other 
                than AFFF.
                    (B) Any recommendation of the Secretary regarding 
                whether to expand eligibility for the registry to 
                individuals exposed to sources of PFAS described in 
                subparagraph (A).
            (2) Interim report.--Not later than two years after the 
        date on which the registry under subsection (a) is established, 
        the Secretary of Veterans Affairs shall submit to Congress an 
        initial report containing the following:
                    (A) An assessment of the effectiveness of actions 
                taken by the Secretary of Veterans Affairs and the 
                Secretary of Defense to collect and maintain 
                information on the health effects of exposure to PFAS.
                    (B) Recommendations to improve the collection and 
                maintenance of such information.
                    (C) Using established and previously published 
                epidemiological studies, recommendations regarding the 
                most effective and prudent means of addressing the 
                medical needs of eligible individuals with respect to 
                exposure to PFAS.
            (3) Followup report.--Not later than five years after 
        submitting the initial report under paragraph (1), the 
        Secretary of Veterans Affairs shall submit to Congress a 
        followup report containing the following:
                    (A) An update to the initial report submitted under 
                paragraph (1).
                    (B) An assessment of whether and to what degree the 
                content of the registry established under subsection 
                (a) is current and scientifically up to date.
            (4) Independent scientific organization.--The Secretary of 
        Veterans Affairs shall enter into an agreement with an 
        independent scientific organization to prepare the reports 
        under paragraphs (1) and (2).
    (c) Recommendations for Additional Exposures To Be Included.--Not 
later than five years after the date of the enactment of this Act, and 
every five years thereafter, the Secretary of Veterans Affairs, in 
consultation with the Secretary of Defense and the Administrator of the 
Environmental Protection Agency, shall submit to Congress 
recommendations for additional chemicals with respect to which 
individuals exposed to such chemicals should be included in the 
registry established under subsection (a).
    (d) Eligible Individual Defined.--In this section, the term 
``eligible individual'' means any individual who, on or after a date 
specified by the Secretary of Veterans Affairs through regulations, 
served or is serving in the Armed Forces at a military installation 
where AFFF was used or at another location of the Department of Defense 
where AFFF was used.

SEC. 702. FORT MCCLELLAN HEALTH REGISTRY.

    (a) Establishment.--The Secretary of Veterans Affairs shall 
establish and maintain a special record to be known as the Fort 
McClellan Health Registry (in this section referred to as the 
``Registry'').
    (b) Contents.--Except as provided in subsection (c), the Registry 
shall include the following information:
            (1) A list containing the name of each individual who, 
        while serving as a member of the Armed Forces, was stationed at 
        Fort McClellan, Alabama, at any time during the period 
        beginning January 1, 1935, and ending on May 20, 1999, and 
        who--
                    (A) applies for care or services from the 
                Department of Veterans Affairs under chapter 17 of 
                title 38, United States Code;
                    (B) files a claim for compensation under chapter 11 
                of such title on the basis of any disability which may 
                be associated with such service;
                    (C) dies and is survived by a spouse, child, or 
                parent who files a claim for dependency and indemnity 
                compensation under chapter 13 of such title on the 
                basis of such service;
                    (D) requests from the Secretary a health 
                examination under subsection (d); or
                    (E) receives from the Secretary a health 
                examination similar to the health examination referred 
                to in subparagraph (D) and requests inclusion in the 
                Registry.
            (2) Relevant medical data relating to the health status of, 
        and other information that the Secretary considers relevant and 
        appropriate with respect to, each individual described in 
        paragraph (1) who--
                    (A) grants to the Secretary permission to include 
                such information in the Registry; or
                    (B) at the time the individual is listed in the 
                Registry, is deceased.
    (c) Individuals Submitting Claims or Making Requests Before Date of 
Enactment.--If in the case of an individual described in subsection 
(b)(1) the application, claim, or request referred to in such 
subsection was submitted, filed, or made before the date of the 
enactment of this Act, the Secretary shall, to the extent feasible, 
include in the Registry such individual's name and the data and 
information, if any, described in subsection (b)(2) relating to the 
individual.
    (d) Examinations.--Upon the request of a veteran who was stationed 
at Fort McClellan, Alabama, at any time during the period beginning 
January 1, 1935, and ending on May 20, 1999, the Secretary shall 
provide the veteran with a health examination (including any 
appropriate diagnostic tests) and consultation and counseling with 
respect to the results of the examination and the tests.
    (e) Outreach.--
            (1) Ongoing outreach to individuals listed in registry.--
        The Secretary shall, from time to time, notify individuals 
        listed in the Registry of significant developments in research 
        on the health consequences of potential exposure to a toxic 
        substance or environmental hazard related to service at Fort 
        McClellan.
            (2) Examination outreach.--The Secretary shall carry out 
        appropriate outreach activities with respect to the provision 
        of any health examinations (including any diagnostic tests) and 
        consultation and counseling services under subsection (d).
    (f) Consultation.--The Secretary of Veterans Affairs shall consult 
with the Secretary of Defense to acquire information maintained by the 
Secretary of Defense that the Secretary of Veterans Affairs considers 
necessary to establish and maintain the Registry.

SEC. 703. INDEPENDENT STUDY ON INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.

    (a) In General.--Not later than 60 days after the date of the 
enactment of this Act, the Secretary of Defense shall enter into a 
contract with an independent research entity described in subsection 
(b) to carry out a comprehensive study of the development of the 
Individual Longitudinal Exposure Record, or successor system, to 
determine--
            (1) the quality of the location data, occupational and 
        environmental exposure data, and health surveillance data; and
            (2) whether a member of the Armed Forces can be reasonably 
        assured that any toxic exposure they experience during service 
        in the Armed Forces will be accurately reflected in the record 
        of the member in such Individual Longitudinal Exposure Record.
    (b) Independent Research Entity.--The entity described in this 
subsection is an independent research entity that is a not-for-profit 
entity or a federally funded research and development center with 
appropriate expertise and analytical capability to carry out the study 
required under subsection (a).
    (c) Toxic Exposure Defined.--In this section, the term ``toxic 
exposure'' has the meaning given that term in section 101(37) of title 
38, United States Code, as added by section 102(b).

SEC. 704. BIANNUAL REPORT ON INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.

    (a) In General.--Not later than one year after the date on which 
the Individual Longitudinal Exposure Record, or successor system, 
achieves full operation capability, as determined by the Secretary of 
Defense, and every 180 days thereafter, the Secretary of Defense, in 
consultation with the Secretary of Veterans Affairs, shall submit to 
the appropriate committees of Congress a report on--
            (1) the data quality of the databases of the Department of 
        Defense that provide the information presented in such 
        Individual Longitudinal Exposure Record; and
            (2) the usefulness of such Individual Longitudinal Exposure 
        Record in supporting members of the Armed Forces and veterans 
        in receiving health care and benefits from the Department of 
        Defense and the Department of Veterans Affairs.
    (b) Elements.--Each report required by subsection (a) shall 
include, for the period covered by the report, the following:
            (1) An identification of toxic exposure events that may not 
        be fully captured by the current systems of the Department of 
        Defense for environmental, occupational, and health monitoring, 
        and recommendations for how to improve those systems.
            (2) An analysis of the quality of the location data used by 
        the Department of Defense in determining toxic exposures of 
        members of the Armed Forces and veterans, and recommendations 
        for how to improve the quality of that location data if 
        necessary.
    (c) Report on National Guard Use of ILER.--Not later than one year 
after the date of the enactment of this Act, the Secretary of Defense 
shall submit to the appropriate committees of Congress a report on the 
feasibility of modifying the Individual Longitudinal Exposure Record to 
ensure that a member of the National Guard who is deployed in the 
United States in connection with a natural disaster, without regard to 
duty status (including any duty under title 10 or title 32, United 
States Code, or State active duty), may record information regarding a 
suspected exposure by the member to toxic substances during such 
deployment.
    (d) Definitions.--In this section:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Armed Services and the 
                Committee on Veterans' Affairs of the Senate; and
                    (B) the Committee on Armed Services and the 
                Committee on Veterans' Affairs of the House of 
                Representatives.
            (2) Toxic exposure.--The term ``toxic exposure'' has the 
        meaning given that term in section 101(37) of title 38, United 
        States Code, as added by section 102(b).

SEC. 705. CORRECTION OF EXPOSURE RECORDS BY MEMBERS OF THE ARMED FORCES 
              AND VETERANS.

    (a) In General.--The Secretary of Defense shall provide a means for 
members of the Armed Forces and veterans to update their records as 
necessary to reflect a toxic exposure by such member or veteran in the 
Individual Longitudinal Exposure Record, or successor system.
    (b) Evidence.--
            (1) Provision of evidence.--To update a record under 
        subsection (a), a member of the Armed Forces or veteran, as the 
        case may be, shall provide such evidence as the Secretary of 
        Defense considers necessary.
            (2) Benefit of the doubt.--In reviewing evidence provided 
        under paragraph (1), the Secretary of Defense shall give the 
        benefit of the doubt to the member of the Armed Forces or 
        veteran who provided the evidence, as the case may be, in a 
        manner that is equivalent to the benefit of the doubt required 
        under section 5107(b) of title 38, United States Code.
            (3) Regulations.--The Secretary of Defense shall prescribe 
        by regulation the evidence considered necessary under paragraph 
        (1).
    (c) Toxic Exposure Defined.--In this section, the term ``toxic 
exposure'' has the meaning given that term in section 101(37) of title 
38, United States Code, as added by section 102(b).

SEC. 706. FEDERAL CAUSE OF ACTION RELATING TO WATER AT CAMP LEJEUNE, 
              NORTH CAROLINA.

    (a) In General.--An individual, including a veteran (as defined in 
section 101 of title 38, United States Code), or the legal 
representative of such an individual, who resided, worked, or was 
otherwise exposed (including in utero exposure) for not less than 30 
days during the period beginning on August 1, 1953, and ending on 
December 31, 1987, to water at Camp Lejeune, North Carolina, that was 
supplied by, or on behalf of, the United States may bring an action in 
the United States District Court for the Eastern District of North 
Carolina to obtain appropriate relief for harm that was caused by 
exposure to the water at Camp Lejeune.
    (b) Burdens and Standard of Proof.--
            (1) In general.--The burden of proof shall be on the party 
        filing the action to show one or more relationships between the 
        water at Camp Lejeune and the harm.
            (2) Standards.--To meet the burden of proof described in 
        paragraph (1), a party shall produce evidence showing that the 
        relationship between exposure to the water at Camp Lejeune and 
        the harm is--
                    (A) sufficient to conclude that a causal 
                relationship exists; or
                    (B) sufficient to conclude that a causal 
                relationship is at least as likely as not.
    (c) Exclusive Jurisdiction and Venue.--The United States District 
Court for the Eastern District of North Carolina shall have exclusive 
jurisdiction over any action filed under subsection (a), and shall be 
the exclusive venue for such an action. Nothing in this subsection 
shall impair the right of any party to a trial by jury.
    (d) Exclusive Remedy.--
            (1) In general.--An individual, or legal representative of 
        an individual, who brings an action under this section for a 
        harm described in subsection (a), including a latent disease, 
        may not thereafter bring a tort action against the United 
        States for such harm pursuant to any other law.
            (2) Health and disability benefits relating to water 
        exposure.--Any award made to an individual, or legal 
        representative of an individual, under this section shall be 
        offset by the amount of any disability award, payment, or 
        benefit provided to the individual, or legal representative--
                    (A) under--
                            (i) any program under the laws administered 
                        by the Secretary of Veterans Affairs;
                            (ii) the Medicare program under title XVIII 
                        of the Social Security Act (42 U.S.C. 1395 et 
                        seq.); or
                            (iii) the Medicaid program under title XIX 
                        of the Social Security Act (42 U.S.C. 1396 et 
                        seq.); and
                    (B) in connection with health care or a disability 
                relating to exposure to the water at Camp Lejeune.
    (e) Immunity Limitation.--The United States may not assert any 
claim to immunity in an action under this section that would otherwise 
be available under section 2680(a) of title 28, United States Code.
    (f) No Punitive Damages.--Punitive damages may not be awarded in 
any action under this section.
    (g) Disposition by Federal Agency Required.--An individual may not 
bring an action under this section before complying with section 2675 
of title 28, United States Code.
    (h) Exception for Combatant Activities.--This section does not 
apply to any claim or action arising out of the combatant activities of 
the Armed Forces.
    (i) Applicability; Period for Filing.--
            (1) Applicability.--This section shall apply only to a 
        claim accruing before the date of enactment of this Act.
            (2) Statute of limitations.--A claim in an action under 
        this section may not be commenced after the later of--
                    (A) the date that is two years after the date of 
                enactment of this Act; or
                    (B) the date that is 180 days after the date on 
                which the claim is denied under section 2675 of title 
                28, United States Code.
            (3) Inapplicability of other limitations.--Any applicable 
        statute of repose or statute of limitations, other than under 
        paragraph (2), shall not apply to a claim under this section.

SEC. 707. VETERANS TOXIC EXPOSURES FUND.

    Chapter 3 is amended by adding at the end the following new 
section:
``Sec. 324. Veterans Toxic Exposures Fund
    ``(a) Establishment.--There is hereby established in the Treasury 
of the United States an account to be known as the ``Veterans Toxic 
Exposures Fund'' (the ``Fund''), to be administered through the 
Department of Veterans Affairs, to provide for investment in the 
delivery of veterans' health care, research, and benefits associated 
with hazardous exposure in service.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to the Fund for fiscal year 2023 and each subsequent 
fiscal year such sums as are necessary to increase funding, over the 
fiscal year 2021 level for the Veterans Health Administration of the 
Department of Veterans Affairs, for any expenses incident to the 
delivery of veterans' health care and benefits associated with exposure 
to environmental hazards in service, including administrative expenses, 
such as claims processing and appeals, and for medical research related 
to hazardous exposures. Amounts appropriated to the Fund pursuant to 
this subsection shall be counted as direct spending under the 
Congressional Budget and Impoundment Control Act of 1974 and any other 
Act.
    ``(c) Estimates for Congressional Consideration.--The Secretary 
shall include in documents submitted to Congress in support of the 
President's budget submitted pursuant to section 1105 of title 31, 
United States Code, detailed estimates of the sums described in 
subsection (b) for the applicable fiscal year.
    ``(d) Procedures for Estimates.--The Secretary, after consultation 
with the Committees on Appropriations of the House of Representatives 
and the Senate, may establish policies and procedures for developing 
the annual detailed estimates required in subsection (c).''.

SEC. 708. AUTHORIZATION OF ELECTRONIC NOTICE IN CLAIMS UNDER LAWS 
              ADMINISTERED BY THE SECRETARY OF VETERANS AFFAIRS.

    Title 38, United States Code, is amended as follows:
            (1) By striking section 5100 and inserting the following:
``Sec. 5100. Definitions
    ``In this chapter:
            ``(1) The term `claimant' means any individual applying 
        for, or submitting a claim for, any benefit under the laws 
        administered by the Secretary.
            ``(2) The term `notice' means a communication issued 
        through means (including electronic means) prescribed by the 
        Secretary.''.
            (2) In section 5104, by adding at the end the following new 
        subsection:
    ``(c) The Secretary may provide notice under subsection (a) 
electronically if a claimant (or the claimant's representative) elects 
to receive such notice electronically. A claimant (or the claimant's 
representative) may revoke such an election at any time, by means 
prescribed by the Secretary.
    ``(d) The Secretary shall annually--
            ``(1) solicit recommendations from stakeholders on how to 
        improve notice under this section; and
            ``(2) publish such recommendations on a publicly available 
        website of the Department.''.
            (3) In section 5104B(c), in the matter preceding paragraph 
        (1) by striking ``in writing'' and inserting ``to the claimant 
        (and any representative of such claimant)''.
            (4) In section 7104--
                    (A) in the heading, by adding ``; decisions; 
                notice'' at the end; and
                    (B) by striking subsection (e) and inserting the 
                following:
    ``(e) After reaching a decision on an appeal, the Board shall 
promptly issue notice (as that term is defined in section 5100 of this 
title) of such decision to the following:
            ``(1) The appellant.
            ``(2) Any other party with a right to notice of such 
        decision.
            ``(3) Any authorized representative of the appellant or 
        party described in paragraph (2).
    ``(f) The Secretary may provide notice under subsection (e) 
electronically if a claimant (or the claimant's representative) elects 
to receive such notice electronically. A claimant (or the claimant's 
representative) may revoke such an election at any time, by means 
prescribed by the Secretary.''.
            (5) In section 7105(b)(1)(A), by striking ``mailing'' and 
        inserting ``issuance''.
            (6) In section 7105A(a), by striking ``mailed'' and 
        inserting ``issued''.
            (7) In section 7266(a), by striking ``mailed'' and 
        inserting ``issued''.

SEC. 709. AUTHORIZATION OF APPROPRIATIONS FOR EXPANSION OF CLAIMS 
              AUTOMATION.

    There is authorized to be appropriated to the Secretary of Veterans 
Affairs $30,000,000 for fiscal year 2023 to support expected increased 
claims processing for newly eligible veterans pursuant to this Act and 
the amendments made by this Act by--
            (1) supporting the automation of processing claims by the 
        Veterans Benefits Administration of the Department of Veterans 
        Affairs;
            (2) adding self-service features to the system by which 
        individuals file claims;
            (3) removing duplicative efforts regarding the processing 
        of claims; and
            (4) reducing the dependency of the Department on the legacy 
        claim system.

SEC. 710. NON-APPLICABILITY OF NON-DEPARTMENT OF VETERANS AFFAIRS 
              COVENANTS NOT TO COMPETE TO APPOINTMENT OF VETERANS 
              HEALTH ADMINISTRATION PERSONNEL.

    (a) In General.--Subchapter I of chapter 74 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 7414. Effect of non-Department covenants not to compete
    ``(a) Non-Applicability.--Except as provided in subsection (b), in 
the case of an individual who is an applicant for appointment to a 
position in the Veterans Health Administration described in section 
7401 of this title, any covenant not to compete into which the 
individual has entered with a non-Department facility or party shall 
have no force or effect with respect to the appointment of the 
individual to such a position.
    ``(b) Service Obligation.--(1) Any individual who is appointed to 
such a position in the Veterans Health Administration shall, as a 
condition of such appointment, agree to provide clinical services at a 
Department medical facility for the duration of the period described in 
paragraph (2).
    ``(2) The period described in this paragraph is the period that 
begins on the date on which an individual is appointed to such a 
position and ends on the latter of the following dates:
            ``(A) The date that is one year after such date of 
        appointment.
            ``(B) The date of the termination of any covenant not to 
        compete entered into between the individual and a non-
        Department facility or party.
    ``(3) The Secretary may waive the requirement under paragraph (1) 
with respect to an individual at the discretion of the Secretary.
    ``(c) Termination of Department Employment.--In the case of an 
individual who is appointed to such a position in the Veterans Health 
Administration who has entered into a covenant not to compete that is 
rendered non-applicable pursuant to subsection (a), if the individual's 
employment at the Veterans Health Administration is terminated for any 
reason before the specified termination date of such covenant, 
subsection (a) shall not apply with respect to such covenant after the 
date of the termination of the individual's employment at the Veterans 
Health Administration.
    ``(d) Covenant Not To Compete.--In this section, the term `covenant 
not to compete' means an agreement--
            ``(1) between an employee and employer or a contractor and 
        principal that restricts such employee or contractor from 
        performing--
                    ``(A) any work for another employer for a specified 
                period of time;
                    ``(B) any work in a specified geographical area; or
                    ``(C) work for another employer performing work 
                that is similar to the work such employee or contractor 
                performed for the employer or principal, included as a 
                party to the agreement; and
            ``(2) that is entered into after the date of enactment of 
        this Act.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
7413 the following new item:

``7414. Effect of non-Department covenants not to compete.''.

SEC. 711. RECRUITMENT OF PHYSICIANS ON A CONTINGENT BASIS PRIOR TO 
              COMPLETION OF TRAINING REQUIREMENTS.

    Section 7402 of title 38, United States Code, is amended--
            (1) in subsection (b)(1)--
                    (A) in the matter preceding subparagraph (A) by 
                inserting ``or to be offered an appointment to such 
                position on a contingent basis under subsection (h)'' 
                after ``position''; and
                    (B) by striking subparagraph (B) and inserting the 
                following:
            ``(B)(i) have completed a residency leading to board 
        eligibility in a specialty, satisfactory to the Secretary; or
            ``(ii) with respect to an offer for an appointment on a 
        contingent basis under subsection (h), complete such a 
        residency by not later than two years after the date of such 
        offer; and''; and
            (2) by adding at the end the following new subsection:
    ``(h)(1) The Secretary may appoint an individual under subsection 
(b)(1) on a contingent basis in accordance with this subsection if the 
Secretary reasonably anticipated that the individual will have 
completed the requirements for appointment under such subsection (b)(1) 
by not later than two years after the date on which the individual is 
so appointed.
    ``(2) An individual who is appointed to a position on a contingent 
basis under paragraph (1) shall be appointed to such position on a 
permanent basis if, by not later than two years after the date of the 
contingent appointment, the individual completes all the requirements 
for appointment under subsection (b)(1).
    ``(3) An individual who is appointed on a contingent basis under 
paragraph (1) who fails to complete the requirements for appointment 
under subsection (b)(1) by not later than two years after the date on 
which the individual is so appointed may not be appointed to such 
position on a permanent basis.''.

SEC. 712. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS 
              TO STATES TO IMPROVE OUTREACH TO VETERANS.

    (a) In General.--Chapter 63 of title 38, United States Code, is 
amended--
            (1) by redesignating sections 6307 and 6308 and sections 
        6308 and 6309, respectively; and
            (2) by inserting after section 6306 the following new 
        section 6307:
``Sec. 6307. Grants to States to improve outreach to veterans
    ``(a) Purpose.--It is the purpose of this section to provide for 
assistance by the Secretary to States to carry out programs that--
            ``(1) improve outreach and assistance to veterans and the 
        spouses, children, and parents of veterans, to ensure that such 
        individuals are fully informed about any veterans and veterans-
        related benefits and programs (including State veterans 
        programs) for which they may be eligible; and
            ``(2) facilitate opportunities for such individuals to 
        receive competent, qualified services in the preparation, 
        presentation, and prosecution of veterans benefits claims.
    ``(b) Authority.--The Secretary may award grants to States--
            ``(1) to carry out, coordinate, improve, or otherwise 
        enhance outreach activities;
            ``(2) to increase the number of county or tribal veterans 
        service officers serving in the State by hiring new, additional 
        such officers; or
            ``(3) to expand, carry out, coordinate, improve, or 
        otherwise enhance existing programs, activities, and services 
        of the State's existing organization that has been recognized 
        by the Department of Veterans Affairs pursuant to section 5902, 
        in the preparation, presentation, and prosecution of claims for 
        veterans benefits through representatives who hold positions as 
        county or Tribal veterans service officers.
    ``(c) Application.--(1) To be eligible for a grant under this 
section, a State shall submit to the Secretary an application therefor 
at such time, in such manner, and containing such information as the 
Secretary may require.
    ``(2) Each application submitted under paragraph (1) shall include 
the following:
            ``(A) A detailed plan for the use of the grant.
            ``(B) A description of the programs through which the State 
        will meet the outcome measures developed by the Secretary under 
        subsection (i).
            ``(C) A description of how the State will distribute grant 
        amounts equitably among counties (or Tribal lands, as the case 
        may be) with varying levels of urbanization.
            ``(D) A plan for how the grant will be used to meet the 
        unique needs of American Indian or Alaska Native veterans, 
        elderly veterans, women veterans, and veterans from other 
        underserved communities.
    ``(d) Distribution.--The Secretary shall seek to ensure that grants 
awarded under this section are equitably distributed among States with 
varying levels of urbanization.
    ``(e) Priority.--The Secretary shall prioritize awarding grants 
under this section that will serve the following areas:
            ``(1) Areas with a critical shortage of county or tribal 
        veterans service officers.
            ``(2) Areas with high rates of--
                    ``(A) suicide among veterans; or
                    ``(B) referrals to the Veterans Crisis Line.
    ``(f) Use of County or Tribal Veterans Service Officers.--A State 
that receives a grant under this section to carry out an activity 
described in subsection (b)(1) shall carry out the activity through--
            ``(1) a county or Tribal veterans service officer of the 
        State; or
            ``(2) if the State does not have a county or tribal 
        veterans service officer, or if the county or Tribal veterans 
        service officers of the State cover only a portion of that 
        State, an appropriate entity of a State, local, or Tribal 
        government, or another publicly funded entity, as determined by 
        the Secretary.
    ``(g) Required Activities.--Any grant awarded under this section 
shall be used--
            ``(1) to expand existing programs, activities, and 
        services;
            ``(2) to hire and maintain new, additional county or Tribal 
        veterans service officers; or
            ``(3) for travel and transportation to facilitate carrying 
        out paragraph (1) or (2).
    ``(h) Other Permissible Activities.--A grant under this section may 
be used to provide education and training, including on-the-job 
training, for State, county, local, and tribal government employees who 
provide (or when trained will provide) veterans outreach services in 
order for those employees to obtain and maintain accreditation in 
accordance with procedures approved by the Secretary.
    ``(i) Outcome Measures.--(1) The Secretary shall develop and 
provide to each State that receives a grant under this section written 
guidance on the following:
            ``(A) Outcome measures.
            ``(B) Policies of the Department.
    ``(2) In developing outcome measures under paragraph (1), the 
Secretary shall consider the following goals:
            ``(A) Increasing the use of veterans and veterans-related 
        benefits, particularly among vulnerable populations.
            ``(B) Increasing the number of county and tribal veterans 
        service officers recognized by the Secretary for the 
        representation of veterans under chapter 59 of this title.
    ``(j) Tracking Requirements.--(1) With respect to each grant 
awarded under this section, the Secretary shall track the use of 
veterans benefits among the population served by the grant, including 
the average period of time between the date on which a veteran or other 
eligible claimant applies for such a benefit and the date on which the 
veteran or other eligible claimant receives the benefit, disaggregated 
by type of benefit.
    ``(2) Not less frequently than annually during the life of the 
grant program established under this section, the Secretary shall 
submit to Congress a report on--
            ``(A) the information tracked under paragraph (1);
            ``(B) how the grants awarded under this section serve the 
        unique needs of American Indian or Alaska Native veterans, 
        elderly veterans, women veterans, and veterans from other 
        underserved communities; and
            ``(C) other information provided by States pursuant to the 
        grant reporting requirements.
    ``(k) Performance Review.--(1) The Secretary shall--
            ``(A) review the performance of each State that receives a 
        grant under this section; and
            ``(B) make information regarding such performance publicly 
        available.
    ``(l) Remediation Plan.--(1) In the case of a State that receives a 
grant under this section and does not meet the outcome measures 
developed by the Secretary under subsection (i), the Secretary shall 
require the State to submit a remediation plan under which the State 
shall describe how and when it plans to meet such outcome measures.
    ``(2) The Secretary may not award a subsequent grant under this 
section to a State described in paragraph (1) unless the Secretary 
approves the remediation plan submitted by the State.
    ``(m) Maximum Amount.--The amount of a grant awarded under this 
section may not exceed 10 percent of amounts made available for grants 
under this section for the fiscal year in which the grant is awarded.
    ``(n) Supplement, Not Supplant.--Any grant awarded under this 
section shall be used to supplement and not supplant State and local 
funding that is otherwise available.
    ``(o) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary for each of fiscal years 2023 through 
2027, $50,000,000 to carry out this section.
    ``(p) Definitions.--In this section:
            ``(1) The term `county or tribal veterans service officer' 
        includes a local equivalent veterans service officer.
            ``(2) The term `State' includes each Indian Tribe, the 
        District of Columbia, the Commonwealth of Puerto Rico, the 
        Commonwealth of the Northern Mariana Islands, and any territory 
        or possession of the United States.
            ``(3) The term `Veterans Crisis Line' means the toll-free 
        hotline for veterans established under section 1720F(h) of this 
        title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 63 of such title is amended by striking the items relating to 
sections 6307 and 6308 and inserting the following new items:

``6307. Grants to States to improve outreach to veterans.
``6308. Outreach for eligible dependents.
``6309. Biennial report to Congress.''.
    (c) Authorization of Additional Full-time Equivalent Employee.--
During fiscal years 2023 through 2027, the Secretary of Veterans 
Affairs may hire an additional full-time equivalent employee in the 
Office of the General Counsel of the Department of Veterans Affairs, as 
compared to the number of full-time equivalent employees that would 
otherwise be authorized for such office, to carry out duties under the 
accreditation, discipline, and fees program.

SEC. 713. STUDY AND REPORT ON HERBICIDE AGENT EXPOSURE IN PANAMA CANAL 
              ZONE.

    (a) Study.--The Secretary of Defense shall conduct a study on the 
exposure of members of the Armed Forces to herbicide agents, including 
Agent Orange and Agent Purple, in the Panama Canal Zone during the 
period beginning on January 1, 1958, and ending on December 31, 1999.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the study conducted under subsection (a).

SEC. 714. BUDGET INFORMATION FOR ALTERNATIVES TO BURN PITS.

    The Secretary of Defense shall include in the budget submission of 
the President under section 1105(a) of title 31, United States Code, 
for each of fiscal years 2023 through 2027, a dedicated budget line 
item for incinerators and waste-to-energy waste disposal alternatives 
to burn pits.

SEC. 715. AUTHORIZATION OF APPROPRIATIONS FOR EXPANSION OF CLAIMS 
              AUTOMATION.

    There is authorized to be appropriated to the Secretary of Veterans 
Affairs $150,000,000 for fiscal year 2023 to continue the modernization 
and expansion of capabilities and capacity of the Veterans Benefits 
Management System of the Department of Veterans Affairs to support 
expected increased claims processing for newly eligible veterans 
pursuant to this Act and the amendments made by this Act.

SEC. 716. BURN PIT REGISTRY UPDATES.

    (a) Individuals Eligible to Update.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall take actions necessary to ensure that the burn pit 
        registry may be updated with the cause of death of a deceased 
        registered individual by--
                    (A) an individual designated by such deceased 
                registered individual; or
                    (B) if no such individual is designated, an 
                immediate family member of such deceased registered 
                individual.
            (2) Designation.--The Secretary shall provide, with respect 
        to the burn pit registry, a process by which a registered 
        individual may make a designation for purposes of paragraph 
        (1)(A).
    (b) Definitions.--In this section:
            (1) The term ``burn pit registry'' means the 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).
            (2) The term ``immediate family member'', with respect to a 
        deceased individual, means--
                    (A) the spouse, parent, brother, sister, or adult 
                child of the individual;
                    (B) an adult person to whom the individual stands 
                in loco parentis; or
                    (C) any other adult person--
                            (i) living in the household of the 
                        individual at the time of the death of the 
                        individual; and
                            (ii) related to the individual by blood or 
                        marriage.
            (3) The term ``registered individual'' means an individual 
        registered with the burn pit registry.

SEC. 717. BURN PIT TRANSPARENCY.

    (a) Short Title.--This section may be cited as the ``SFC Heath 
Robinson Burn Pit Transparency Act''.
    (b) Notifications and Reports Regarding Reported Cases of Burn Pit 
Exposure.--
            (1) Quarterly notifications.--
                    (A) In general.--On a quarterly basis, the 
                Secretary of Veterans Affairs shall submit to the 
                appropriate congressional committees a report on each 
                reported case of burn pit exposure by a covered veteran 
                reported during the previous quarter.
                    (B) Elements.--Each report submitted under 
                subparagraph (A) shall include, with respect to each 
                reported case of burn pit exposure of a covered veteran 
                included in the report, the following:
                            (i) Notice of the case, including the 
                        medical facility at which the case was 
                        reported.
                            (ii) Notice of, as available--
                                    (I) the enrollment status of the 
                                covered veteran with respect to the 
                                patient enrollment system of the 
                                Department of Veterans Affairs under 
                                section 1705(a) of title 38, United 
                                States Code;
                                    (II) a summary of all health care 
                                visits by the covered veteran at the 
                                medical facility at which the case was 
                                reported that are related to the case;
                                    (III) the demographics of the 
                                covered veteran, including age, sex, 
                                and race;
                                    (IV) any non-Department of Veterans 
                                Affairs health care benefits that the 
                                covered veteran receives;
                                    (V) the Armed Force in which the 
                                covered veteran served and the rank of 
                                the covered veteran;
                                    (VI) the period in which the 
                                covered veteran served;
                                    (VII) each location of an open burn 
                                pit from which the covered veteran was 
                                exposed to toxic airborne chemicals and 
                                fumes during such service;
                                    (VIII) the medical diagnoses of the 
                                covered veteran and the treatment 
                                provided to the veteran; and
                                    (IX) whether the covered veteran is 
                                registered in the Airborne Hazards and 
                                Open Burn Pit Registry.
                    (C) Protection of information.--The Secretary shall 
                ensure that the reports submitted under subparagraph 
                (A) do not include the identity of covered veterans or 
                contain other personally identifiable data.
            (2) Annual report on cases.--
                    (A) In general.--Not later than 180 days after the 
                date of the enactment of this Act, and annually 
                thereafter, the Secretary of Veterans Affairs, in 
                collaboration with the Secretary of Defense, shall 
                submit to the appropriate congressional committees a 
                report detailing the following:
                            (i) The total number of covered veterans.
                            (ii) The total number of claims for 
                        disability compensation under chapter 11 of 
                        title 38, United States Code, approved and the 
                        total number denied by the Secretary of 
                        Veterans Affairs with respect to a covered 
                        veteran, and for each such denial, the 
                        rationale of the denial.
                            (iii) A comprehensive list of--
                                    (I) the conditions for which 
                                covered veterans seek treatment; and
                                    (II) the locations of the open burn 
                                pits from which the covered veterans 
                                were exposed to toxic airborne 
                                chemicals and fumes.
                            (iv) Identification of any illnesses 
                        relating to exposure to open burn pits that 
                        formed the basis for the Secretary to award 
                        benefits, including entitlement to service 
                        connection or an increase in disability rating.
                            (v) The total number of covered veterans 
                        who died after seeking care for an illness 
                        relating to exposure to an open burn pit.
                            (vi) Any updates or trends with respect to 
                        the information described in clauses (i), (ii), 
                        (iii), (iv), and (v) that the Secretary 
                        determines appropriate.
                    (B) Matters included in first report.--The 
                Secretary shall include in the first report under 
                paragraph (1) information specified in paragraph (1)(B) 
                with respect to reported cases of burn pit exposure 
                made during the period beginning January 1, 1990, and 
                ending on the day before the date of the enactment of 
                this Act.
            (3) Information regarding the airborne hazards and open 
        burn pit registry.--
                    (A) Notice.--The Secretary of Veterans Affairs 
                shall ensure that a medical professional of the 
                Department of Veterans Affairs informs a veteran of the 
                Airborne Hazards and Open Burn Pit Registry if the 
                veteran presents at a medical facility of the 
                Department for treatment that the veteran describes as 
                being related to, or ancillary to, the exposure of the 
                veteran to toxic airborne chemicals and fumes caused by 
                open burn pits.
                    (B) Display.--In making information public 
                regarding the number of participants in the Airborne 
                Hazards and Open Burn Pit Registry, the Secretary shall 
                display such numbers by both State and by congressional 
                district.
            (4) Comptroller general report.--Not later than 180 days 
        after the date of the enactment of this Act, the Comptroller 
        General of the United States shall submit to the appropriate 
        congressional committees a report containing an assessment of 
        the effectiveness of any memorandum of understanding or 
        memorandum of agreement entered into by the Secretary of 
        Veterans Affairs with respect to--
                    (A) the processing of reported cases of burn pit 
                exposure; and
                    (B) the coordination of care and provision of 
                health care relating to such cases at medical 
                facilities of the Department of Veterans Affairs and at 
                non-Department facilities.
            (5) Definitions.--In this section:
                    (A) The term ``Airborne Hazards and Open Burn Pit 
                Registry'' means the registry established by the 
                Secretary of Veterans Affairs 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).
                    (B) The term ``appropriate congressional 
                committees'' means--
                            (i) the Committee on Veterans' Affairs and 
                        the Committee on Armed Services of the Senate; 
                        and
                            (ii) The Committee on Veterans' Affairs and 
                        the Committee on Armed Services of the House of 
                        Representatives.
                    (C) The term ``covered veteran'' means a veteran 
                who presents at a medical facility of the Department of 
                Veterans Affairs (or in a non-Department facility 
                pursuant to section 1703 or 1703A of title 38, United 
                States Code) for treatment that the veteran describes 
                as being related to, or ancillary to, the exposure of 
                the veteran to toxic airborne chemicals and fumes 
                caused by open burn pits at any time while serving in 
                the Armed Forces.
                    (D) 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).
                    (E) The term ``reported case of burn pit exposure'' 
                means each instance in which a veteran presents at a 
                medical facility of the Department of Veterans Affairs 
                (or in a non-Department facility pursuant to section 
                1703 or 1703A of title 38, United States Code) for 
                treatment that the veteran describes as being related 
                to, or ancillary to, the exposure of the veteran to 
                toxic airborne chemicals and fumes caused by open burn 
                pits at any time while serving in the Armed Forces.

            Passed the House of Representatives March 3, 2022.

            Attest:

                                                                 Clerk.
117th CONGRESS

  2d Session

                               H. R. 3967

_______________________________________________________________________

                                 AN ACT

   To improve health care and benefits for veterans exposed to toxic 
                  substances, and for other purposes.