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

<DOC>





                                                 Union Calendar No. 179
117th CONGRESS
  2d Session
                                H. R. 3967

                      [Report No. 117-249, Part I]

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 17, 2021

Mr. Takano (for himself, Mrs. Luria, Mr. Ruiz, Ms. Slotkin, Mr. Trone, 
Ms. Brownley, Mr. Levin of California, Mr. Pappas, Mr. Lamb, Mr. Brown 
  of Maryland, Mr. Gallego, Ms. Underwood, Mr. Sablan, Mr. Mrvan, Mr. 
    Allred, Ms. Kaptur, Ms. Lois Frankel of Florida, Mr. Ryan, Mr. 
 McGovern, Mr. Harder of California, Mr. Fitzpatrick, Mr. Kilmer, Mr. 
  Soto, Ms. Meng, Ms. Strickland, and Ms. Spanberger) introduced the 
   following bill; which was referred to the Committee on Veterans' 
  Affairs, and in addition to the Committee on Armed Services, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

                           February 22, 2022

Additional sponsors: Mrs. Kirkpatrick, Ms. Norton, Mr. Malinowski, Ms. 
 Newman, Ms. Sherrill, Mr. Khanna, Mr. Rush, Mr. Aguilar, Mrs. Hayes, 
Mrs. Trahan, Ms. Omar, Mr. Levin of Michigan, Mr. O'Halleran, Mr. Kind, 
 Mr. Carson, Mr. San Nicolas, Mr. Perlmutter, Mr. Neguse, Ms. Lofgren, 
Mrs. Dingell, Ms. Davids of Kansas, Mr. Cohen, Mrs. Axne, Mr. Grijalva, 
  Mr. Grothman, Mr. Cooper, Mr. Moulton, Mr. Pocan, Mr. Swalwell, Mr. 
       Tonko, Ms. Blunt Rochester, Ms. Bonamici, Ms. Porter, Mr. 
 Krishnamoorthi, Mr. Blumenauer, Mrs. Bustos, Ms. DeGette, Mr. Jones, 
 Mr. Courtney, Ms. Pingree, Ms. Bourdeaux, Ms. Manning, Mr. Welch, Ms. 
Leger Fernandez, Mr. Langevin, Mr. Keating, Mr. Bishop of Georgia, Mr. 
 Lieu, Mr. Cline, Mr. Larsen of Washington, Ms. Kelly of Illinois, Mr. 
    Lynch, Mrs. Torres of California, Ms. Williams of Georgia, Ms. 
   Houlahan, Ms. Sewell, Mr. Casten, Mr. Cicilline, Mr. Schiff, Mr. 
Cartwright, Mr. Espaillat, Mr. Horsford, Mr. DeFazio, Mr. Schrader, Mr. 
 Carbajal, Ms. Castor of Florida, Ms. Jacobs of California, Mr. Castro 
   of Texas, Mr. Raskin, Mrs. Cherfilus-McCormick, Ms. Scanlon, Mr. 
            Stanton, Mr. Costa, Mr. Gottheimer, and Ms. Bass

                           February 22, 2022

            Reported from the Committee on Veterans' Affairs

                           February 22, 2022

 Committee on Armed Services discharged; committed to the Committee of 
  the Whole House on the State of the Union and ordered to be printed

_______________________________________________________________________

                                 A BILL


 
   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) References to Title 38, United States Code.--Except as 
otherwise expressly provided, whenever in this title 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.
    (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 FOR 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.
              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, 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. Coordination by Department of Veterans Affairs of 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.
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.
           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.

    TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY FOR 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 specified in section 1119(b)(2).
    ``(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 the 
                Individual Longitudinal Exposure Record of the 
                Department 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.

    (a) In General.--Section 1710(e), as amended by section 102(c), is 
further amended--
            (1) in paragraph (1), by adding at the end the following 
        new subparagraphs:
    ``(G) 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, 
medical services, and nursing home care under subsection (a)(2)(F) for 
any illness.
    ``(H) Subject to paragraph (2), a covered veteran (as defined in 
section 1119(c) of this title) is eligible for hospital care, medical 
services, and nursing home care under subsection (a)(2)(F) for any 
illness.''; and
            (2) in paragraph (2)(B)--
                    (A) by striking ``or (F)'' and inserting ``(F), 
                (G), or (H)''; and
                    (B) by striking ``service or testing'' and 
                inserting ``service, testing, or activity''.
    (b) Resource Assessment and Report.--
            (1) Initial assessment and report.--Not later than 180 days 
        after the date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall--
                    (A) complete an assessment to determine--
                            (i) the personnel and material resources 
                        necessary to implement the amendments made by 
                        subsection (a); and
                            (ii) the total number of covered veterans, 
                        as such term is defined in section 1119(c) of 
                        title 38, United States Code (as added by 
                        section 301), who receive hospital care or 
                        medical services furnished by the Secretary 
                        under chapter 17 of such title, disaggregated 
                        by priority group specified in section 1705(a) 
                        of such title; and
                    (B) submit to the Committees on Veterans' Affairs 
                of the House of Representatives and the Senate an 
                initial report containing the findings of the 
                assessment completed under subparagraph (A), including 
                a specific determination as to whether the Department 
                has the personnel and material resources necessary to 
                implement the amendments made by subsection (a).
            (2) Subsequent reports.--If the initial report submitted 
        under paragraph (1)(B) contains a determination that the 
        Department does not have the personnel or material resources 
        necessary to implement the amendments made by subsection (a), 
        beginning not later than 90 days after the submission of such 
        initial report and every 90 days thereafter until the effective 
        date specified in subsection (c), the Secretary shall submit to 
        the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a subsequent report containing 
        an update to such determination.
    (c) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date that is the earlier of the following:
            (1) The date on which the Secretary submits a report under 
        subsection (b) containing a determination that the Department 
        has the personnel and material resources necessary to implement 
        such amendments, and notifies the Law Revision Counsel of the 
        House of Representatives of the submission of the report so the 
        Law Revision Counsel may execute the amendments.
            (2) The date that is 18 months after the date of the 
        enactment of this Act.

              TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS

SEC. 201. SHORT TITLE.

    This title 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.--
            (1) Establishment.--Chapter 11 is amended by adding at the 
        end the following new subchapter:

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

``Sec. 1171. Procedures to determine presumptions of service connection 
              based on toxic exposure; definitions
    ``(a) Procedures.--The Secretary shall determine whether to 
establish, or to remove, presumptions of service connection based on 
toxic exposure pursuant to this subchapter, whereby--
            ``(1) the Formal Advisory Committee on Toxic Exposure under 
        section 1172 of this title--
                    ``(A) provides advice to the Secretary on toxic 
                exposed veterans and cases in which veterans who, 
                during active military, naval, or air 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, or air 
                service;
                    ``(B) provides to the Secretary recommendations on 
                corrections needed in the Individual Longitudinal 
                Exposure Record to better reflect veterans and 
                dependents described in subparagraph (A); and
                    ``(C) provides to the Secretary recommendations 
                regarding which cases of possible toxic exposure 
                described in subparagraph (A) the Science Review Board 
                should review;
            ``(2) the Science Review Board under section 1173 of this 
        title--
                    ``(A) reviews cases of possible toxic exposure 
                nominated by the Secretary;
                    ``(B) reviews research nominated by the Secretary;
                    ``(C) develops recommendations for new research; 
                and
                    ``(D) determines the strength of evidence 
                supporting positive association between toxic exposure 
                and an illness;
            ``(3) the Working Group under section 1174 of this title 
        evaluates the conclusions of the Science Review Board and 
        recommends to the Secretary whether to establish or modify a 
        presumption of service connection; and
            ``(4) the Secretary prescribes regulations under section 
        1175 of this title.
    ``(b) Illness Defined.--In this subchapter, the term `illness' 
includes a disease or other condition affecting the health of an 
individual.
    ``(c) Nonapplication of Sunset Requirements.--Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an 
entity established under this subchapter.
``Sec. 1172. Formal Advisory Committee on Toxic Exposure
    ``(a) Establishment.--(1) There is in the Veterans 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 one member shall be appointed from among 
        individuals who are representatives of disabled veterans.
            ``(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) Each member of the Committee shall be appointed for a two-
year term, and may serve not more than three successive terms.
    ``(5) A vacancy in the Committee shall be filled in the manner in 
which the original appointment was made.
    ``(b) Consultation.--The Secretary may consult with, and seek the 
advice of, the Committee with respect to cases in which veterans who, 
during active military, naval, or air 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, or air service.
    ``(2) The assessments under paragraph (1) shall cover suspected and 
known toxic exposures occurring during active military, naval, or air 
service, including by identifying and evaluating new and emerging 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 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 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, or air service under subsection 
(c), the Committee may develop a recommendation for the Secretary 
regarding whether there should be a review of the health effects 
related to the case of exposure conducted by the Science Review Board 
established under section 1173 of this title.
    ``(2) Upon receipt of evidence suggesting that previous findings 
regarding the periods and locations of exposure covered by an existing 
presumption of service connection are no longer supported, the 
Committee may nominate such evidence for evaluation by the Working 
Group to modify the periods and locations.
    ``(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 intends to nominate to the 
        Science Review Board the review recommended by the Committee in 
        the report, and if not, an explanation of why, including 
        citations and sources.
``Sec. 1173. Science Review Board
    ``(a) Establishment.--(1) There is in the Veterans Health 
Administration of the Department the Science Review Board (in this 
section referred to as the `Board').
    ``(2)(A) The members of the Board shall be appointed by the 
Secretary, in consultation with the National Academies of Sciences, 
Engineering, and Medicine, from the general public from among 
individuals who are distinguished in the fields of medicine, biological 
sciences, or health administration.
    ``(B) An individual may not concurrently serve on the Board and the 
Formal Advisory Committee on Toxic Exposure under section 1172 of this 
title.
    ``(C) The Secretary shall determine the number, terms of service, 
and pay and allowances of members of the Board appointed by the 
Secretary.
    ``(b) Duties.--(1) Upon receiving a nomination for the evaluation 
of research on the health effects of toxic exposures of members of the 
active military, naval, or air service or dependents of such members 
made by the Secretary, the Board shall--
            ``(A) evaluate the likelihood that a positive association 
        exists between an illness and a toxic exposure while serving in 
        the active military, naval, or air service; and
            ``(B) assess the toxic exposures and illnesses identified 
        by the Secretary and determine whether the evidence supports a 
        finding of a positive association between the toxic exposure 
        and the illness.
    ``(2) In carrying out paragraph (1)(B), the Board shall review 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.
    ``(3)(A) With respect to an evaluation conducted under this 
subsection, if the Board determines that the evidence for a positive 
association is categorized as either the sufficient or equipoise and 
above categories, the Board shall estimate the size of the positive 
association effect among those exposed by calculating the relative risk 
and exposure prevalence.
    ``(B)(i) The Board shall use the relative risk and exposure 
prevalence calculated under subparagraph (A) to estimate the service-
attributable fraction of illness in a military setting to determine the 
probability of positive association for an individual.
    ``(ii) In calculating the service-attributable fraction of illness, 
the Board shall consider the dose-response relationships.
    ``(4)(A) With respect to an evaluation conducted under this 
subsection, if the Board determines that the evidence for a positive 
association is categorized as the below equipoise category, the Board 
shall develop a recommendation as to whether additional data gathering 
and research are necessary.
    ``(B) If the Board recommends additional data gathering and 
research pursuant to subparagraph (A), the Secretary shall seek to 
enter into an agreement with the National Academies of Sciences, 
Engineering, and Medicine, or another nonprofit, nongovernmental entity 
that the Secretary determines has similar expertise and objectivity as 
the National Academies, to conduct such data gathering and research.
    ``(c) Reports.--(1) For each evaluation conducted under subsection 
(b) where the Board determines that the evidence for positive 
association is categorized as either the sufficient or equipoise and 
above categories, the Board shall submit to the Secretary a report 
identifying the evidence found to reach such positive association 
determinations.
    ``(2) In addition to submitting reports under paragraph (1), the 
Board shall submit to the Secretary reports, at such times and at such 
frequencies as the Board considers appropriate, containing such 
recommendations as the Board may have for additional or new research on 
matters relating to toxic exposures described in subsection (b)(1).
    ``(d) Responses From the Secretary.--(1) In response to each report 
received by the Secretary under subsection (c)(1), the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and the 
House of Representatives, and make publicly available, a report on the 
findings and opinions of the Secretary with respect to the report 
received under such subsection.
    ``(2) Each report submitted under paragraph (1) of this subsection 
shall include, with respect to a report received under subsection 
(c)(1), the following:
            ``(A) The findings and opinions of the Secretary with 
        respect to the report received under subsection (c)(1).
            ``(B) Whether the Secretary intends to nominate to the 
        Working Group, established under section 1174(a) of this title, 
        the work of the Science Review Board covered by the report 
        received under subsection (c)(1) for further action, and if 
        not, an explanation of why, including citations and sources.
``Sec. 1174. Working group on presumptions of service connection
    ``(a) Establishment.--The Secretary shall establish a working group 
(in this section referred to as the `Working Group') to--
            ``(1) evaluate--
                    ``(A) the conclusions of the Science Review Board 
                contained in each report submitted under section 
                1173(c)(1) of this title; and
                    ``(B) evidence nominated by the Formal Advisory 
                Committee on Toxic Exposure under section 1172(d)(2) 
                regarding the periods and locations of exposure covered 
                by an existing presumption of service connection; and
            ``(2) develop and submit to the Secretary a recommendation 
        with respect to whether--
                    ``(A) to establish a presumption of service 
                connection for the toxic exposure and illness covered 
                by the report described in subparagraph (A) of 
                paragraph (1); or
                    ``(B) to modify an existing presumption of service 
                connection described in subparagraph (B) of such 
                paragraph.
    ``(b) Recommendations.--(1) In making a recommendation under 
subsection (a)(2), the Working Group shall--
            ``(A) in cases where the evidence for a positive 
        association is categorized as either the sufficient or 
        equipoise and above categories, as described in subparagraph 
        (A) or (B) of section 1173(b)(2) of this title, weigh such 
        evidence heavily in favor of establishing a presumption of 
        service connection;
            ``(B) take into consideration such factors as may be 
        determined appropriate by the Secretary; and
            ``(C) if the Working Group determines that additional 
        research, studies, or reports are appropriate before making a 
        final recommendation with respect to establishing or modifying 
        a presumption of service connection, submit to the Secretary a 
        description of such appropriate additional research, studies, 
        or reports.
    ``(2) At the same time as when the Working Group submits to the 
Secretary a recommendation under paragraph (2) of subsection (a) with 
respect to an evaluation under paragraph (1) of such subsection, the 
Working Group shall submit to the Committees on Veterans' Affairs of 
the Senate and the House of Representatives a description of such 
recommendation.
    ``(c) Report.--The Secretary shall periodically publish on the 
internet website of the Department a report identifying any factors for 
the Working Group to consider under subsection (b)(1)(B), as determined 
appropriate by the Secretary.
``Sec. 1175. Regulations regarding presumptions of service connection 
              based on toxic exposure
    ``(a) Action Upon Working Group Recommendation.--Not later than 60 
days after the date on which the Secretary receives a recommendation to 
establish or modify a presumption of service connection under section 
1174(a)(2) of this title--
            ``(1) if the Secretary determines that the presumption, or 
        modification, is warranted, the Secretary shall issue proposed 
        regulations setting forth the presumption or revise regulations 
        to carry out such modification; or
            ``(2) if the Secretary determines that the presumption, or 
        modification, is not warranted, the Secretary shall publish in 
        the Federal Register a notice of the determination, including 
        the reasons supporting the determination.
    ``(b) Final Regulation.--Not later than 180 days after the date on 
which the Secretary issues any proposed regulations under subsection 
(a)(1), the Secretary shall issue final regulations. Such regulations 
shall be effective on the date of issuance.
    ``(c) Removal of Presumption.--(1) The Secretary may issue 
regulations to remove an illness from a presumption of service 
connection previously established pursuant to a regulation issued under 
subsection (b).
    ``(2) Whenever an illness is removed from regulations pursuant to 
paragraph (1), or the periods and locations of exposure covered by a 
presumption of service connection are modified under subsection (a)--
            ``(A) a veteran who was awarded compensation for such 
        illness on the basis of the presumption provided under such 
        regulations before the effective date of the removal or 
        modification shall continue to be entitled to receive 
        compensation on that basis; and
            ``(B) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from such illness on the basis of such presumption shall 
        continue to be entitled to receive dependency and indemnity 
        compensation on such basis.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 1165 the following new items:

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

``1171. Procedures to determine presumptions of service connection 
                            based on toxic exposure; definitions.
``1172. Formal Advisory Committee on Toxic Exposure.
``1173. Science Review Board.
``1174. Working group on presumptions of service connection.
``1175. Regulations regarding presumptions of service connection based 
                            on toxic exposure.''.
    (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.''.

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.--Except as provided in subsection (b), 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) 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.--With respect to each claim identified under 
subsection (a), 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 such subsection. 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.
    ``(c) Relation to Other Laws.--The Secretary shall carry out 
subsection (a) to the degree that doing so does not conflict with any 
other provision of law.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 11 of such title is amended by inserting after the item 
relating to section 1165 the following new item:

``1167. Reevaluation of compensation determinations pursuant to changes 
                            in presumptions of service connection.''.
    (c) 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.

    (a) In General.--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 Individual Longitudinal Exposure Record 
Required.--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, or air service, the Secretary 
shall, in adjudicating such claim, consider--
            ``(1) the Individual Longitudinal Exposure Record of the 
        veteran; and
            ``(2) if the Individual Longitudinal Exposure Record of the 
        veteran does not indicate that the veteran was subject to a 
        toxic exposure during active military, naval, or air 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 hazards listed in 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)(A) Subject to subparagraph (B), the substances, chemicals, 
and airborne hazards listed in this paragraph are as follows:
            ``(i) Particulate matter, including the following:
                    ``(I) PM-10.
                    ``(II) PM-2.5.
            ``(ii) Polycyclic aromatic hydrocarbons (PAHs), including 
        the following:
                    ``(I) Acenaphthene.
                    ``(II) Acenaphthylene.
                    ``(III) Anthracene.
                    ``(IV) Benzo(a)anthracene.
                    ``(V) Benzo(a)pyrene.
                    ``(VI) Benzo(b)fluoranthene.
                    ``(VII) Benzo(g,h,i)perylene.
                    ``(VIII) Benzo(k)fluoranthene.
                    ``(IX) Chrysene.
                    ``(X) Dibenz(a,h)anthracene.
                    ``(XI) Fluoranthene.
                    ``(XII) Fluorene.
                    ``(XIII) Indeno(1,2,3-cd)pyrene.
                    ``(XIV) Naphthalene.
                    ``(XV) Phenanthrene.
                    ``(XVI) Pyrene.
            ``(iii) Volatile organic compounds (VOCs), including the 
        following:
                    ``(I) Acetone.
                    ``(II) Acrolein.
                    ``(III) Benzene.
                    ``(IV) Carbon Disulfide.
                    ``(V) Chlorodifluoromethane.
                    ``(VI) Chloromethane.
                    ``(VII) Ethylbenzene.
                    ``(VIII) Hexachlorobutadiene.
                    ``(IX) Hexane.
                    ``(X) m/p-Xylene.
                    ``(XI) Methylene Chloride.
                    ``(XII) Pentane.
                    ``(XIII) Propylene.
                    ``(XIV) Styrene.
                    ``(XV) Toluene.
            ``(iv) Toxic organic halogenated dioxins and furans 
        (dioxins), including the following:
                    ``(I) 1,2,3,4,6,7,8 HPCDD.
                    ``(II) 1,2,3,4,6,7,8 HPCDF.
                    ``(III) 1,2,3,4,7,8,9 HPCDF.
                    ``(IV) 1,2,3,4,7,8 HXCDD.
                    ``(V) 1,2,3,6,7,8 HXCDD.
                    ``(VI) 1,2,3,7,8,9 HXCDD.
                    ``(VII) 1,2,3,4,7,8 HXCDF.
                    ``(VIII) 1,2,3,6,7,8 HXCDF.
                    ``(IX) 1,2,3,7,8,9 HXCDF.
                    ``(X) 1,2,3,7,8 PECDD.
                    ``(XI) 1,2,3,7,8 PECDF.
                    ``(XII) 2,3,4,6,7,8 HXCDF.
                    ``(XIII) 2,3,4,7,8 PECDF.
                    ``(XIV) 2,3,7,8 TCDD.
                    ``(XV) 2,3,7,8 TCDF.
                    ``(XVI) Octachlorodibenzodioxin.
                    ``(XVII) Octachlorodibenzofuran.
            ``(v) Such other substances, chemicals, and airborne 
        hazards as the Secretary, in collaboration with the Secretary 
        of Defense, may determine appropriate.
    ``(B)(i) The Secretary may add to or remove from the list under 
subparagraph (A) as the Secretary, in collaboration with the Secretary 
of Defense, determines appropriate.
    ``(ii) 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 Congress a report identifying 
any additions or removals made pursuant to subparagraph (A) 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, or air service while assigned to a 
                duty station in--
                            ``(i) Bahrain;
                            ``(ii) Iraq;
                            ``(iii) Kuwait;
                            ``(iv) Oman;
                            ``(v) Qatar;
                            ``(vi) Saudi Arabia;
                            ``(vii) Somalia; or
                            ``(viii) United Arab Emirates; or
                    ``(B) on or after September 11, 2001, performed 
                active military, naval, or air service while assigned 
                to a duty station in--
                            ``(i) Afghanistan;
                            ``(ii) Djibouti;
                            ``(iii) Egypt;
                            ``(iv) Jordan;
                            ``(v) Lebanon;
                            ``(vi) Syria;
                            ``(vii) Yemen;
                            ``(viii) Uzbekistan;
                            ``(ix) the Philippines; or
                            ``(x) any other country determined relevant 
                        by the Secretary.
            ``(2) The term `Individual Longitudinal Exposure Record' 
        includes any pilot program or other program used by the 
        Department of Veterans Affairs or the Department of Defense to 
        track how members of the Armed Forces or veterans have been 
        exposed to various occupational or environmental hazards.
            ``(3) The term `toxic exposure risk activity' has the 
        meaning given such term in section 1710(e)(4) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 11 is amended by inserting after the item relating to section 
1118 the following new item:

``1119. Presumptions of toxic exposure.''.

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

    (a) In General.--Subchapter VI of chapter 11, as amended by section 
203 of this Act, 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, or air 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) request a medical opinion 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 requested 
under paragraph (1), the health care provider shall consider the total 
potential exposure through all applicable military deployments, and the 
synergistic, combined effect of all applicable toxic exposure risk 
activities.
    ``(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 such term in 
section 1710(e)(4) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 11 of such title, as amended by title II of this Act, is 
further amended by inserting after the item relating to section 1167, 
as added by such title, the following new item:

``1168. 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.

    (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, 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 
Veterans Act''.
    (b) Palomares.--Section 1112(c)(3)(B), as amended by section 401, 
is further amended by adding at the end the following new clause:
                    ``(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.''.

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, or air 
        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, or air 
        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, or air 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 103, 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) Clerical Amendments.--
            (1) Section heading.--The heading for section 1116 is 
        amended by striking ``the Republic of Vietnam'' and inserting 
        ``certain locations''.
            (2) Table of sections.--The table of sections at the 
        beginning of chapter 11 is amended by striking the item 
        relating to section 1116 and inserting the following new item:

``1116. Presumptions of service connection for diseases associated with 
                            exposure to certain herbicide agents; 
                            presumption of exposure 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.

    (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, to identify Gulf War Illness.''.
    (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 
303(a), 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, or air 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 specified in 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) Clerical Amendment.--The table of sections at the beginning of 
chapter 11, as amended by section 302(b), is further amended by 
inserting after the item relating to section 1119 the following new 
item:

``1120. Presumption of service connection for certain diseases 
                            associated with exposure to burn pits and 
                            other toxins.''.
    (d) 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. COORDINATION BY DEPARTMENT OF VETERANS AFFAIRS OF TOXIC 
              EXPOSURE RESEARCH.

    (a) In General.--Subchapter II of chapter 73 is amended by adding 
at the end the following new section:
``Sec. 7330D. Coordination of toxic exposure research
    ``(a) In General.--The Secretary shall coordinate all research 
activities carried out or funded by the executive branch of the Federal 
Government on the health consequences of toxic exposures experienced 
during service in the Armed Forces.
    ``(b) Strategic Plan.--In carrying out subsection (a), the 
Secretary shall establish a strategic plan, to be known as the Toxic 
Exposure Research Strategic Plan, to ensure that the research 
activities specified in such subsection are collaborative, transparent, 
and highly coordinated.
    ``(c) Report.--Not later than one year after the date of the 
enactment of the Honoring our Promise to Address Comprehensive Toxics 
Act of 2021, and annually thereafter, the Secretary shall submit to the 
Committee on Veterans' Affairs of the House of Representatives and the 
Senate a report on any research activities specified in subsection (a) 
carried out during the year covered by the report.''.
    (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. Coordination of toxic exposure research.''.

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, 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 Committee 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) 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.
    (b) Elements.--The study under subsection (a) shall assess, with 
respect to each veteran included in the study, the following:
            (1) The age of the veteran.
            (2) The period of service and length of service of the 
        veteran in the Armed Forces.
            (3) Any military occupational speciality of the veteran.
            (4) The gender of the veteran.
            (5) 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 located in the 
        United States;
            (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 103(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 103(a)(3).
            (6) The term ``TRICARE program'' has the meaning given that 
        term in section 1072 of such title.

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, or air 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).
    (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.

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, or air service as part of the 
initial screening conducted for an appointment of a veteran with a 
primary care provider of the Department of Veterans Affairs to improve 
understanding by the Department of 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 
                establish a standard training curriculum 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 shall always 
                        review and consider the Individual Longitudinal 
                        Exposure Record program of the Department of 
                        Veterans Affairs 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 
                establish a standard medical training curriculum 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.

           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 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.
            (2) 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.
            (3) 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 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 
        Individual Longitudinal Exposure Record of the member.
    (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 achieves full operation 
capability, as determined by the Secretary of Defense, and every 180 
days thereafter, the Secretary shall, in consultation with the 
Secretary of Veterans Affairs, submit to the appropriate committees of 
Congress a report on the data quality of the databases of the 
Department of Defense that provide the information presented in the 
Individual Longitudinal Exposure Record and the usefulness of the 
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) 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 and the Secretary of 
Veterans Affairs 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.
    (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 and the Secretary of Veterans Affairs jointly consider 
        necessary.
            (2) Benefit of the doubt.--In reviewing evidence provided 
        under paragraph (1), the Secretary of Defense and the Secretary 
        of Veterans Affairs 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 Veterans Affairs, in 
        consultation with 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).
                                                 Union Calendar No. 179

117th CONGRESS

  2d Session

                               H. R. 3967

                      [Report No. 117-249, Part I]

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

                           February 22, 2022

            Reported from the Committee on Veterans' Affairs

                           February 22, 2022

 Committee on Armed Services discharged; committed to the Committee of 
  the Whole House on the State of the Union and ordered to be printed