117 S3003 RS: Comprehensive and Overdue Support for Troops of War Act of 2021
U.S. Senate
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EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents(a)This Act may be cited as the Comprehensive and Overdue Support for Troops of War Act of 2021
or the COST of War Act of 2021
.(b)The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.TITLE I—Expansion of health care for toxic exposure veteransSec. 101. Health care for certain toxic exposure veterans.Sec. 102. Expansion of health care eligibility for certain veterans exposed to open burn pits.Sec. 103. Expansion of health care eligibility for veterans awarded certain medals.Sec. 104. Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities.TITLE II—Reforms to the toxic exposure presumption processSec. 201. Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure.Sec. 202. Technical corrections.TITLE III—Reforms to the service connection process for toxic exposure veteransSec. 301. Presumptions of toxic exposure.Sec. 302. Presumption of exposure to airborne hazards and substances from burn pits.Sec. 303. Medical nexus examinations for toxic exposures.TITLE IV—Expansion of presumptions of service connection for forgotten veteransSec. 401. Mark Takai Atomic Veterans Healthcare Parity Act of 2021.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 the Republic of Vietnam.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—Strengthening Federal research on toxic exposuresSec. 501. Coordination by Department of Veterans Affairs of toxic exposure research.Sec. 502. Collection, analysis, and report on treatment of veterans for medical conditions related to toxic exposure.Sec. 503. Studies relating to veterans who served in Southwest Asia.Sec. 504. Study on health trends of post 9/11 veterans.Sec. 505. Study on cancer rates among veterans.TITLE VI—Improving support to toxic exposure veteransSec. 601. Definitions.Sec. 602. Publication of list of resources of Department of Veterans Affairs for toxic exposure 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 exposure veterans.Sec. 605. SFC Heath Robinson Burn Pit Transparency Act.TITLE VII—Strengthening record-keeping of toxic exposures by Department of DefenseSec. 701. Definitions.Sec. 702. Independent study on Individual Longitudinal Exposure Record.Sec. 703. Biannual report on Individual Longitudinal Exposure Record.Sec. 704. Correction of toxic exposure records.<enum>I</enum><header>Expansion of health care for toxic exposure veterans</header><section id="id7EEC302FB1AC46F0BF6D9C149DE73238" section-type="subsequent-section"><enum>101.</enum><header>Health care for certain toxic exposure veterans</header><subsection id="id9DF8C7B9978D4F6FB427CAC4124A2EE5"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1710(e) of title 38, United States Code, is amended—</text><paragraph id="idF65C2344AEEE43EEB2BA5969AE650F14"><enum>(1)</enum><text>paragraph (1), by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idC9E9BEFF65654F3CA892F3BEE37EDF8C"><subparagraph id="id615CE0256743412B8D0DBF0D2C7BEA0A" indent="up2"><enum>(G)</enum><text>Subject to paragraph (2), any 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, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such toxic exposure risk activity.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="id12E559B7C5044D2B9D315561B99EA7C7"><enum>(2)</enum><text>in paragraph (2)(B)—</text><subparagraph id="id19B1F77273C94BE3BB4CCF8242C9B3DE"><enum>(A)</enum><text>by striking <quote>or (F)</quote> and inserting <quote>(F), or (G)</quote>; and</text></subparagraph><subparagraph id="id7A1F8683BDBA4CF7A34643A8381D48BE"><enum>(B)</enum><text>by striking <quote>service or testing</quote> and inserting <quote>service, testing, or activity</quote>.</text></subparagraph></paragraph></subsection><subsection id="id0b3f137d8f314b1b867b2446f47bcb85"><enum>(b)</enum><header>Definitions</header><text>Section 101 of such title is amended by adding at the end the following new paragraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="ided0e48e95e924f05b1330a165b2a6aff"><paragraph id="idf767db36962c42eab9be652abca22bf1"><enum>(37)</enum><text>The term <term>toxic exposure</term> includes the following:</text><subparagraph id="ide95619ec67464a1c86825fb9cefd0619"><enum>(A)</enum><text>A toxic exposure risk activity.</text></subparagraph><subparagraph id="id8a905d01bb0b4353816034edc236cc5c"><enum>(B)</enum><text>An exposure to a toxic or hazardous substance that is subject to regulation by the Occupational Safety and Health Administration.</text></subparagraph></paragraph><paragraph id="id0f332d0863124bca8fda30a1dd4420bb"><enum>(38)</enum><text>The term <term>toxic exposure veteran</term> means any veteran who—</text><subparagraph id="id0ccd9062194444f2bc2bf3a2a0caab47"><enum>(A)</enum><text>carried out a toxic exposure risk activity; or</text></subparagraph><subparagraph id="idfe183d7608cb40e69a7bc7eff4744ef4"><enum>(B)</enum><text>received or receives hospital care, medical services, or nursing home care pursuant to section 1710(e)(1) of this title.</text></subparagraph></paragraph><paragraph id="id6f9cd397310a48069027f58cd30400e1"><enum>(39)</enum><text>The term <term>toxic exposure risk activity</term> means any activity—</text><subparagraph id="idc4415a0d45e14cb5b1a421ba31210467"><enum>(A)</enum><text>that requires a corresponding entry in the Individual Longitudinal Exposure Record of the veteran who carried out the activity; or</text></subparagraph><subparagraph id="id111147fb167a4d0a922f873065e7ca71"><enum>(B)</enum><text>that the Secretary determines qualifies for purposes of section 1710(e)(1) of this title when taking into account what is reasonably prudent to protect the health of veterans.</text></subparagraph></paragraph><paragraph id="idbce816eb8ea34871bf2d04e7b873d360"><enum>(40)</enum><text>The term <term>Individual Longitudinal Exposure Record</term> 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.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id0ce2ea0edc9342bba6f54c2ea6579341"><enum>102.</enum><header>Expansion of health care eligibility for certain veterans exposed to open burn pits</header><subsection id="id3CA60D2D98944151A4FDB1A7ECC96EEE"><enum>(a)</enum><header>In general</header><text>Section 1710(e) of title 38, United States Code, as amended by section 101(a)(2)(A), is further amended—</text><paragraph id="idD95C5FACB9434B5DB008D737B38DE596"><enum>(1)</enum><text>in paragraph (1), by adding at the end the following new subparagraph: </text><quoted-block style="OLC" display-inline="no-display-inline" id="idCBA8573C26424D9A84931DF0518AB504"><subparagraph indent="up2" id="id79B2F39DBE4848DE8AE6824DFEA69ACA"><enum>(H)</enum><clause commented="no" display-inline="yes-display-inline" id="id70CE3F3D15424933A4A84E1CDBE1EBFD"><enum>(i)</enum><text>Subject to paragraph (2), a covered veteran is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness.</text></clause><clause indent="up1" id="idAAB0FB5A75DA498681137DFC6F5C8B6A"><enum>(ii)</enum><text>For purposes of this subparagraph, a covered veteran is a veteran who—</text><subclause id="id2BB13F99730A4D67898924C35EAF920F"><enum>(I)</enum><text>is eligible for inclusion in the Airborne Hazards and Open Burn Pit Registry; or</text></subclause><subclause id="id7991CEC06E994E3096F9D682AA32253B"><enum>(II)</enum><text>has been identified by the Secretary of Defense to have been possibly exposed, inside or outside the United States, during active duty, active duty for training, or inactive duty training, to an open burn pit.</text></subclause></clause><clause indent="up1" id="id88785A4DCF0B4D5E989BDD489ACCA3A1"><enum>(iii)</enum><text>In this subparagraph:</text><subclause id="id07FAD849B8A4418A8896DA23ADF8C737"><enum>(I)</enum><text>The term <term>Airborne Hazards and Open Burn Pit Registry</term> means the registry established by the Secretary under section 201 of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/260">Public Law 112–260</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/527">38 U.S.C. 527</external-xref> note).</text></subclause><subclause id="id674422E8DE0B4251AD88A77F5717CE70"><enum>(II)</enum><text>The term <term>open burn pit</term> has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/260">Public Law 112–260</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/527">38 U.S.C. 527</external-xref> note).</text></subclause></clause></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph id="idA68B350A70F34657AE53141FBE692C43"><enum>(2)</enum><text>in paragraph (2)(B), as amended by section 101(a)(2)(A), by striking <quote>or (G)</quote> and inserting <quote>(G), or (H)</quote>. </text></paragraph></subsection><subsection id="idF0843E96FB244CF790FE80F1C98CF23B" commented="no" display-inline="no-display-inline"><enum>(b)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall take effect on the date that is 90 days after the date of the enactment of this Act. </text></subsection></section><section id="idB9FB1085A2AB4E0684E5D86463571011"><enum>103.</enum><header>Expansion of health care eligibility for veterans awarded certain medals</header><subsection id="idC089A66C4CD7498FA29824D92D4CD712"><enum>(a)</enum><header>In general</header><text>Section 1710(e) of title 38, United States Code, as amended by section 102(a)(1), is further amended— </text><paragraph id="id761BD6BB197941389B0E0F81234D10D8"><enum>(1)</enum><text>in paragraph (1), by adding at the end the following new subparagraph: </text><quoted-block id="id7983313B46054BE3A34E064746EA2579" style="USC" act-name=""><subparagraph indent="up2" id="idA0F0C4F7177346559E2F5E7918ECB419"><enum>(I)</enum><text>Subject to paragraph (2), a veteran is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness if the veteran was awarded any of the following:</text><clause id="id4531c93dbab640a9af5443b74786ba65"><enum>(i)</enum><text>The Afghanistan Campaign Medal.</text></clause><clause id="ida0f8fe74535f4ac9926c86ef46285ec8"><enum>(ii)</enum><text>The Armed Forces Expeditionary Medal.</text></clause><clause id="idd981e99384de4a098fd2fe73caab12e3"><enum>(iii)</enum><text>The Global War on Terrorism Expeditionary Medal.</text></clause><clause id="id6c17571c480f4246ace219aedc2ebaaa"><enum>(iv)</enum><text>The Inherent Resolve Campaign Medal.</text></clause><clause id="id4b93e48738b64acb8af738d5f2d6afc4"><enum>(v)</enum><text>The Iraqi Campaign Medal.</text></clause><clause id="idd5d2f82dc0aa4dbcb1195a1107e7b3b5"><enum>(vi)</enum><text>The Southwest Asia Service Medal.</text></clause></subparagraph><after-quoted-block>; and </after-quoted-block></quoted-block></paragraph><paragraph id="id027B4C7F4F1E4C288516803E0B45D731"><enum>(2)</enum><text>in paragraph (2)(B), as amended by section 102(a)(2), by striking <quote>or (H)</quote> and inserting <quote>(H), or (I)</quote>. </text></paragraph></subsection><subsection id="id2BAAB3B6CFDB4364A64FF3AD0C9D3C32" commented="no" display-inline="no-display-inline"><enum>(b)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall take effect on the date that is 90 days after the date of the enactment of this Act. </text></subsection></section><section id="idEF54D6871BFD443F90AE44B694260AD2"><enum>104.</enum><header>Study on feasibility and advisability of furnishing hospital care and medical services to dependents of veterans who participated in toxic exposure risk activities</header><subsection id="idFC9BE0635E62473B82012BB51F00F48B"><enum>(a)</enum><header>In general</header><text>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 101(a)(1), for any illness or condition 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 or condition is attributable to such activity. </text></subsection><subsection id="id875DB128C4AC4EA1A6F9B9839A1636B3"><enum>(b)</enum><header>Elements of study</header><text>The study required under subsection (a) shall—</text><paragraph id="id26908469e9aa445186ab39cb3cb5a29d"><enum>(1)</enum><text>assess 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;</text></paragraph><paragraph id="id453f7aa1204d49dda1cc5fc21412e248"><enum>(2)</enum><text>assess the potential cost of furnishing hospital care and medical services to qualifying dependents as described in such subsection;</text></paragraph><paragraph id="ide68ade2bba3a4060b860e4e64682e4cd"><enum>(3)</enum><text>estimate the resources required to furnish such care and services;</text></paragraph><paragraph id="id67c6611b8ca64a828181090de902a387"><enum>(4)</enum><text>assess any stress or other impact furnishing such care and services would have on the claims and appeals system of the Department;</text></paragraph><paragraph id="id88a577f257394be3a8b6ad382ab2b7aa"><enum>(5)</enum><text>estimate the number of qualifying dependents who would be eligible for such care and services; and</text></paragraph><paragraph id="ida538875a1e8a470b8212dbc90fd19173"><enum>(6)</enum><text>assess the feasibility of adjudicating claims for such care and services. </text></paragraph></subsection><subsection id="id20669F4F86BC41378E0475E49DE49FFC"><enum>(c)</enum><header>Phased in application</header><text>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.</text></subsection><subsection id="id9216bd1d2e0943279af699668bbfcec8"><enum>(d)</enum><header>Review of exposure cases regarding liability of Department of Defense</header><text>In conducting the study under subsection (a), the Secretary shall—</text><paragraph id="id0969F1056F0A449F86ADFB25D81E7549"><enum>(1)</enum><text>review known cases of toxic exposure on installations of the Department of Defense in the United States;</text></paragraph><paragraph id="id618254D6FFC14641806D913E4F1ACD4E"><enum>(2)</enum><text>explore the liability of the Department of Defense in each such case; and</text></paragraph><paragraph id="idB90828AA606447A08ADF34B9E6DBEA1C"><enum>(3)</enum><text>assess whether the Department of Defense should provide care and services relating to such toxic exposures under the TRICARE program.</text></paragraph></subsection><subsection id="id1334BD437BC244F2978394802975B3D6"><enum>(e)</enum><header>Report</header><text>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).</text></subsection><subsection id="id342871EAB665489087569D7098F857E8"><enum>(f)</enum><header>Definitions</header><text>In this section:</text><paragraph id="id23A1A7A8080846E7B9AC04C9A1FF997F"><enum>(1)</enum><header>Hospital care and medical services</header><text>The terms <term>hospital care</term> and <term>medical services</term> have the meanings given those terms in section 1701 of title 38, United States Code.</text></paragraph><paragraph id="id8F67CD80924A4ABBAB4C6F18CFD021FD"><enum>(2)</enum><header>Qualifying dependent</header><text>The term <term>qualifying dependent</term> means—</text><subparagraph id="id86DFFA43102C464B887850D3D7D1520D"><enum>(A)</enum><text>a dependent of a veteran described in section 1710(e)(1)(G) of title 38, United States Code, as added by section 101(a)(2) 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;</text></subparagraph><subparagraph id="idDB0932E9BBE9469E9B8675A1168183BD"><enum>(B)</enum><text>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</text></subparagraph><subparagraph id="id1005852B97DB4E31B331882B7FCCFC5E"><enum>(C)</enum><text>a dependent of such a veteran who is not described in subparagraph (A) or (B) but who may have an illness or condition that is connected to the toxic exposure risk activity of the veteran, as determined by the Secretary.</text></subparagraph></paragraph><paragraph id="id2F243FCE489B43BF8AAD7D3B578B6A2A"><enum>(3)</enum><header>TRICARE program</header><text>The term <term>TRICARE program</term> has the meaning given that term in section 1072(7) of title 10, United States Code. </text></paragraph></subsection></section><enum>II</enum><header>Reforms to the toxic exposure presumption process</header><section section-type="subsequent-section" id="H391E203803454E96936F7E77373A4892"><enum>201.</enum><header>Improvements to ability of Department of Veterans Affairs to establish presumptions of service connection based on toxic exposure</header><subsection id="H33ACA64796064128807D46B1B5A2BB1B"><enum>(a)</enum><header>Advisory committees, panels, and boards</header><paragraph id="H27C7EFF1CD91446D820092E8FD0903DD"><enum>(1)</enum><header>Establishment</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">Chapter 11</external-xref> of title 38, United States Code, is amended by adding at the end the following new subchapter:</text><quoted-block style="USC" display-inline="no-display-inline" id="HBABB388C6F60487EB4E7F6819DED2796"><subchapter id="H393066D1BCFE4BD280B285FEC6B43CA0"><enum>VII</enum><header>Research and determinations relating to presumptions of service connection based on toxic exposure</header><section id="HF20AB56461BB44DC95DEBCD8087730D0"><enum>1171.</enum><header>Procedures to determine presumptions of service connection based on toxic exposure; definitions</header><subsection id="idf736c1f78aef4a3baae7998f7c03c8d4"><enum>(a)</enum><header>Procedures </header><text>The Secretary shall determine whether to establish, to modify, or to remove presumptions of service connection based on toxic exposure pursuant to this subchapter, whereby—</text><paragraph id="idf0915a717b124f449080c98f0b6e6c16"><enum>(1)</enum><text>the Toxic Exposure Review Commission advises the Secretary and makes recommendations pursuant to section 1172 of this title;</text></paragraph><paragraph id="idd7c8cd13d6514c4790db3341d25df10c"><enum>(2)</enum><text>the National Academies of Sciences, Engineering, and Medicine, reviews and evaluates the available scientific evidence pursuant to an agreement under section 1173 of this title;</text></paragraph><paragraph id="idae4b59c8862d4e11832f601832f2fb9b"><enum>(3)</enum><text>the working group established under section 1174 of this title evaluates the conclusions of the National Academies of Sciences, Engineering, and Medicine pursuant to the agreement described in paragraph (2) and makes recommendations to the Secretary under such section; and</text></paragraph><paragraph id="id4ef3f5031d0b48be89de6437c9ba6271"><enum>(4)</enum><text>the Secretary prescribes regulations under section 1175 of this title.</text></paragraph></subsection><subsection id="HA96450ED247D458AB615426ACC0AC744"><enum>(b)</enum><header>Illness defined</header><text display-inline="yes-display-inline">In this subchapter, the term <term>illness</term> includes a disease or other condition affecting the health of an individual. </text></subsection><subsection id="H5AF6F7FF08D245BBB61DB34B6D447B6F"><enum>(c)</enum><header>Nonapplication of FACA</header><text display-inline="yes-display-inline">The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to an entity established under this subchapter.</text></subsection></section><section id="H84DC7431CE5140D6835DD52E7389D532"><enum>1172.</enum><header>Toxic Exposure Review Commission</header><subsection id="id7e80842f310644418c4d26bd662143b3"><enum>(a)</enum><header>Establishment</header><text>The Secretary shall establish an independent commission to be known as the <quote>Toxic Exposure Review Commission</quote> (in this section referred to as the <quote>Commission</quote>).</text></subsection><subsection id="id67d2aa74e5074e74b109dc339b11585d"><enum>(b)</enum><header>Purpose</header><text>The Commission shall—</text><paragraph id="id39cb351110d0449fa315730362e5c7fa"><enum>(1)</enum><text>advise the Secretary on questions relating to toxic exposures that require scientific research; and</text></paragraph><paragraph id="id80f150b758454ddba1cf4473aa1e86bb"><enum>(2)</enum><text>assist in the consideration of possible presumptions of service connection relating to toxic exposure.</text></paragraph></subsection><subsection id="idddb9dbb097fd4255a71520c94cf2f5cf"><enum>(c)</enum><header>Duties</header><paragraph commented="no" display-inline="yes-display-inline" id="id812A1B7D820F4A49B0F9DE5644EBEC3C"><enum>(1)</enum><text display-inline="yes-display-inline">The Commission shall carry out the following duties:</text><subparagraph indent="up1" id="idCE10BDB11242491686F29D76C748F653"><enum>(A)</enum><text>Collect any relevant information from the Department of Defense and other sources to identify possible toxic exposures relating to service during active duty, active duty for training, or inactive duty training in order to determine the need for a comprehensive review under an agreement with the National Academies of Sciences, Engineering, and Medicine under section 1173 of this title.</text></subparagraph><subparagraph indent="up1" id="id96EBB8A22C064C39B607ED0A3DDD4CF0"><enum>(B)</enum><text>Recommend to the Secretary, by majority vote, whether a review should be conducted under an agreement with the National Academies of Sciences, Engineering, and Medicine under section 1173 of this title.</text></subparagraph><subparagraph indent="up1" id="idC036D4C8F0744A59B62477FF68DC74DD"><enum>(C)</enum><text>Recommend to the Secretary, by majority vote, whether new, independent studies regarding the health outcomes of toxic exposures, or any other new, independent studies that the Commission deems necessary and appropriate, should be conducted.</text></subparagraph><subparagraph indent="up1" id="id48A6979875CB4895AC70DA64138FEAB3"><enum>(D)</enum><text>Annually report to Congress on progress regarding the duties set forth in subparagraphs (A) through (C), any recommendations made to the Secretary, and any responses of the Secretary to such recommendations.</text></subparagraph></paragraph><paragraph indent="up1" id="idBACA4C84D90045338304C131788B0B3D"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idE170D18201224267B490DC8C39923DFC"><enum>(A)</enum><text>Relevant information may be collected under paragraph (1)(A) from the following:</text><clause indent="up1" id="id5764C8A08B864B2380194122DC374C8F"><enum>(i)</enum><text>Any Federal agency as the Commission considers necessary to carry out this section.</text></clause><clause indent="up1" id="id8FA7886E4B3A46068256E158DC3DD254"><enum>(ii)</enum><text>Public meetings or hearings, which may be held to take such testimony and receive such evidence as the Commission considers advisable to carry out the duties of the Commission.</text></clause></subparagraph><subparagraph indent="up1" id="id062260CE366C4E3A9AA27D54FE71F03C"><enum>(B)</enum><text>Upon request of the chairperson of the Commission, the head of a Federal agency shall furnish information collected under subparagraph (A)(i) to the Commission unless such information is classified.</text></subparagraph></paragraph></subsection><subsection id="IDf94d50eb74244451a4ce75192e2b417e"><enum>(d)</enum><header>Membership</header><paragraph commented="no" display-inline="yes-display-inline" id="idD68A0B15752242BBABBD5CFE796E7DE4"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id7B03017AE9CA4DEB992FD10509B4F603"><enum>(A)</enum><text>The Commission shall be composed of nine members, appointed as follows:</text><clause indent="up2" id="id3692E6E6E42C46B19D68DBBCDD9CB78E" commented="no"><enum>(i)</enum><text>Two members appointed by the majority leader of the Senate.</text></clause><clause indent="up2" id="idEC357D68607347F1B3EDA000036350FF" commented="no"><enum>(ii)</enum><text>Two members appointed by the minority leader of the Senate.</text></clause><clause indent="up2" id="id75CB152B634E49308CF942923EA6DF7A" commented="no"><enum>(iii)</enum><text>Two members appointed by the Speaker of the House of Representatives.</text></clause><clause indent="up2" id="idA21E38680FEE46DDB7CA613D4D7EA649" commented="no"><enum>(iv)</enum><text>Two members appointed by the minority leader of the House of Representatives. </text></clause><clause indent="up2" id="id1AA5719441084D1EA9234DC986E93D07"><enum>(v)</enum><text>One member appointed by the Secretary.</text></clause></subparagraph><subparagraph indent="up2" id="id26263602406C445BB7708D4AB0A84140"><enum>(B)</enum><text>The initial members of the Commission shall be appointed under subparagraph (A) not later than 180 days after the date of the enactment of the <short-title>Comprehensive and Overdue Support for Troops of War Act of 2021</short-title>.</text></subparagraph></paragraph><paragraph indent="up1" id="id67FD912486B34D259223FEF29FFF6D24"><enum>(2)</enum><text>In appointing individuals under paragraph (1)(A), the majority leader of the Senate, the minority leader of the Senate, the Speaker of the House of Representatives, the minority leader of the House of Representatives, and the Secretary shall jointly ensure that at least five members of the Commission are scientists or health care professionals—</text><subparagraph id="idC025B8B551BA4BA19CF58C7EE1DFFB07"><enum>(A)</enum><text>of whom—</text><clause id="idD7A9D23764F64203925E9C5B952AB8A9"><enum>(i)</enum><text>one has a background in the field of respiratory medicine;</text></clause><clause id="idF67EE6492AD9414EB54EFB5F2577F56B"><enum>(ii)</enum><text>one has a background in the field of endocrinology and metabolic medicine;</text></clause><clause id="id98359D353FDE406290E37B507F91BEE4"><enum>(iii)</enum><text>one has a background in hematology;</text></clause><clause id="id4DF04B831EBD4E36981B05BC15484DD7"><enum>(iv)</enum><text>one has a background in oncology; and</text></clause><clause id="id47B73BAFCE644FC29358EA988953DCB4"><enum>(v)</enum><text>one has a background in occupational and environmental health; and</text></clause></subparagraph><subparagraph id="id45B88A05A1764870847FC4FA5A941A80"><enum>(B)</enum><text>who are not officials or employees of the Federal Government.</text></subparagraph></paragraph><paragraph indent="up1" id="id3D08228D5D5944B0A074A39F1AD0D85D"><enum>(3)</enum><text>In appointing individuals under paragraph (1)(A), the majority leader of the Senate, the minority leader of the Senate, the Speaker of the House of Representatives, the minority leader of the House of Representatives, and the Secretary shall jointly ensure that at least two members of the Commission represent an organization recognized by the Secretary for the representation of veterans under section 5902 of this title.</text></paragraph><paragraph indent="up1" id="id78445E746A13432B8C4C77CE2F406C15"><enum>(4)</enum><text>In appointing individuals under paragraph (1)(A), the majority leader of the Senate, the minority leader of the Senate, the Speaker of the House of Representatives, the minority leader of the House of Representatives, and the Secretary shall jointly give consideration to including in the Commission at least one member who works with survivors of illnesses relating to toxic exposures and has a background in the field of study of toxic exposures.</text></paragraph></subsection><subsection id="IDe3a4079e4afe43d9beb2e5cd5f0198d5"><enum>(e)</enum><header>Meetings</header><paragraph commented="no" display-inline="yes-display-inline" id="id6CEDCA61142A401D91D03FD26013D579"><enum>(1)</enum><text display-inline="yes-display-inline">The Commission shall meet not less frequently than twice each year.</text></paragraph><paragraph indent="up1" id="id16B2ADF8610D4085AFE0ECF98DD17F26"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id1AC42FF5FFCC420D99C8259E31BAC9F8"><enum>(A)</enum><text>Each meeting of the Commission shall be open to the public.</text></subparagraph><subparagraph indent="up1" id="id04F11021B7C640409FCD6B065D8AD50B"><enum>(B)</enum><text>All the proceedings, information, and deliberations of the Commission shall be available for review by the public.</text></subparagraph><subparagraph indent="up1" id="id2924324BBFD0470AACD60EC82DBCADD5"><enum>(C)</enum><text>Meetings of the Commission may be carried out through the use of telephonic or other appropriate telecommunication technology if the Commission determines that such technology will allow the members to communicate simultaneously.</text></subparagraph></paragraph></subsection><subsection id="ID41a4e51b3068440bb07ba45ec9206fab"><enum>(f)</enum><header>Chairperson and vice chair</header><text>At the initial meeting of the Commission under subsection (e), the Commission shall select a chairperson and vice chairperson from among the members of the Commission by a majority vote of the members of the Commission.</text></subsection><subsection id="IDfe064cc36ea9435e8e51a96c4934374b"><enum>(g)</enum><header>Period of appointment; vacancies</header><paragraph commented="no" display-inline="yes-display-inline" id="id30D307BEC72249D58DA8C0C442E6D2EF"><enum>(1)</enum><text>A member of the Commission shall be appointed for a term that may not exceed four years.</text></paragraph><paragraph indent="up1" id="id5F0D01B810DB461FAD7323A96B0E5CAB"><enum>(2)</enum><text>The Secretary shall ensure that terms of members of the Commission are staggered so that no such terms end on the same date.</text></paragraph><paragraph indent="up1" id="idA6F77F2115054E34BBDF2C58234440AC"><enum>(3)</enum><text>A vacancy in the Commission shall be filled in the same manner as the original appointment, but the individual appointed to fill the vacancy shall serve only for the unexpired portion of the term for which the individual’s predecessor was appointed.</text></paragraph><paragraph indent="up1" id="id8565C38159F64046ABD9CCFA137E2614"><enum>(4)</enum><text>In appointing the initial members of the Commission, each official who is authorized to appoint two members of the Commission shall appoint—</text><subparagraph id="idDACE074843D444A487ED26867F94E68E"><enum>(A)</enum><text>one member whose term expires after two years; and</text></subparagraph><subparagraph id="id4747BED6EA1D4275AA5DF171F5F72914"><enum>(B)</enum><text>one member whose term expires after four years.</text></subparagraph></paragraph></subsection><subsection id="ID644b07899564457181c0d84dbec74289"><enum>(h)</enum><header>Pay</header><paragraph commented="no" display-inline="yes-display-inline" id="id6707A11320764F8C8F9E72C9148D0E36"><enum>(1)</enum><text>Members of the Commission shall serve without pay.</text></paragraph><paragraph indent="up1" id="id68FB11FF27E042C9931A70890753C3B1"><enum>(2)</enum><text>Each member of the Commission who is an officer or employee of the United States shall serve without compensation in addition to that received for service as an officer or employee of the United States. </text></paragraph><paragraph indent="up1" id="id34D611FCF9DB45F6BA84EED5A3A947F4"><enum>(3)</enum><text>Members shall receive travel expenses, including per diem in lieu of subsistence, in accordance with sections 5702 and 5703 of title 5.</text></paragraph></subsection><subsection id="IDd9c29a14ff6c4df6b4247d13b1794aa4"><enum>(i)</enum><header>Director of staff</header><paragraph commented="no" display-inline="yes-display-inline" id="id2A3853E72B5D488AA610742BE73C0680"><enum>(1)</enum><text>The Commission shall appoint a Director who—</text><subparagraph indent="up1" id="id7C6D042C82A94E76A0DC037961CB4F22"><enum>(A)</enum><text>has not served as an employee of the Department during the one-year period preceding the date of such appointment; and</text></subparagraph><subparagraph indent="up1" id="id555960B400F84C42A6E5D908BB8D2373"><enum>(B)</enum><text>is not otherwise barred or prohibited from serving as Director under Federal ethics laws and regulations, by reason of post-employment conflict of interest.</text></subparagraph></paragraph><paragraph indent="up1" id="id33FA6736611A4DCAA65B529166231910"><enum>(2)</enum><text>The Director shall be paid at the rate of basic pay payable for level IV of the Executive Schedule under section 5315 of title 5.</text></paragraph></subsection><subsection id="IDe325166c1cc14c85a51dd6cecfe62924"><enum>(j)</enum><header>Staff</header><paragraph commented="no" display-inline="yes-display-inline" id="id2BC2240447254253A72AC3DFD20A741F"><enum>(1)</enum><text>Subject to paragraphs (2) and (3), the Director, with the approval of the Commission, may appoint and fix the pay of additional personnel.</text></paragraph><paragraph indent="up1" id="id9FCAF29E0CC84399B9DD54414762ED18"><enum>(2)</enum><text>The Director may make such appointments without regard to the provisions of title 5 governing appointments in the competitive service, and any personnel so appointed may be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of that title relating to classification and General Schedule pay rates, except that an individual so appointed may not receive pay in excess of the annual rate of basic pay payable for GS–15 of the General Schedule.</text></paragraph><paragraph indent="up1" id="id0B2E92F95C484D839B89AE5F47FDC7CC"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id66FB5600517B46D7A0F3D4E446690D95"><enum>(A)</enum><text>Not more than two-thirds of the personnel employed by or detailed to the Commission may be on detail from the Department.</text></subparagraph><subparagraph indent="up1" id="idFBF6C731D4274F28BD0310385F5A27F2"><enum>(B)</enum><text>Not more than half of the professional analysts of the Commission staff may be persons detailed from the Department to the Commission.</text></subparagraph></paragraph><paragraph indent="up1" id="idF9CFB4E78E9D412EA1DD651512EEAB5B"><enum>(4)</enum><text>Subject to paragraph (3), the head of any Federal agency, upon the request of the Director, may detail any of the personnel of that agency to the Commission to assist the Commission in carrying out its duties under this section.</text></paragraph><paragraph indent="up1" id="id4038B50E45864E519BFFEF73B94EA564"><enum>(5)</enum><text>The Commission may secure directly from any Federal agency such information as the Commission considers necessary to carry out this section. Upon request of the chairperson of the Commission, the head of such agency shall furnish such information to the Commission, unless such information is classified.</text></paragraph></subsection><subsection id="ID97aafc6f7be54a6ebd906720962753f7"><enum>(k)</enum><header>Other authority</header><paragraph commented="no" display-inline="yes-display-inline" id="id63A1C8D2EA5B416D802A018D43F8B099"><enum>(1)</enum><text>The Commission may procure by contract, to the extent funds are available, the temporary or intermittent services of experts or consultants pursuant to section 3109 of title 5.</text></paragraph><paragraph indent="up1" id="idA2E86C21A0774E5B9FEC37165E71F955"><enum>(2)</enum><text>To the extent funds are available, the Commission may lease real property and acquire personal property either of its own accord or in consultation with the General Services Administration.</text></paragraph></subsection><subsection id="ID58b322085fd442cf95d10068c06f8355"><enum>(l)</enum><header>Communications</header><paragraph commented="no" display-inline="yes-display-inline" id="idFA4CDD53257C4F89A31E475B1EF0D33E"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id0B0542F3185B40E6ABBB0FCC42FB7133"><enum>(A)</enum><text>Except as provided in subparagraph (B), no person may restrict an employee of the Department in communicating with the Commission.</text></subparagraph><subparagraph indent="up2" id="id60D14560D7284D67B9A03BAADA49C36A"><enum>(B)</enum><text>Subparagraph (A) does not apply to a communication that is unlawful.</text></subparagraph></paragraph><paragraph indent="up1" id="id85EBA6067C0F4FD0B61D2052A869A146"><enum>(2)</enum><text>All ex parte communications with the Commission shall be made part of the public record.</text></paragraph></subsection><subsection id="ideede578ebe294392b025f6e2a6cdedf2"><enum>(m)</enum><header>Responses by Secretary</header><text>In response to each report submitted to the Secretary by the Commission under subsection (c)(1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives and make available to the public a report on—</text><paragraph id="id834d926d50b84ff59374fc76a2819026"><enum>(1)</enum><text>the findings and opinions of the Secretary with respect to the report most recently submitted under subsection (c)(1);</text></paragraph><paragraph id="idec7882c84cf04737a0c516366375db66"><enum>(2)</enum><text>whether the Secretary intends to nominate for review under an agreement with the National Academies of Sciences, Engineering, and Medicine under section 1173 of this title the review recommended by the Committee in the report, and if not, an explanation of why, including citations and sources; and</text></paragraph><paragraph id="id193e15cb62744aa68a98aa827eb2ec09"><enum>(3)</enum><text>whether the Secretary intends to follow any other recommendation made by the Commission. </text></paragraph></subsection></section><section id="id2dc41f1fb17b4f45b23c3b0babc2eb6c"><enum>1173.</enum><header>Science review agreement</header><subsection id="idd0897cf99ab74b9c932b955ed9b909c3"><enum>(a)</enum><header>Purpose</header><text>The purpose of this section is to provide for the National Academies of Sciences, Engineering, and Medicine (in this section referred to as the <quote>Academies</quote>), an independent nonprofit scientific organization with appropriate expertise that is not part of the Federal Government, to review and evaluate the available scientific evidence regarding associations between illnesses and toxic exposures.</text></subsection><subsection id="id17743f1e678f457099393555cebcb200"><enum>(b)</enum><header>Agreement</header><paragraph commented="no" display-inline="yes-display-inline" id="id550B609124184A358BA02F29854E8ABB"><enum>(1)</enum><text>The Secretary shall seek to enter into a 10-year agreement with the Academies to perform the services covered by this section.</text></paragraph><paragraph id="id1e8e848fb2134b7b9c8c87d49497ffbd" indent="up1"><enum>(2)</enum><text>The Secretary shall seek to enter into an agreement described in paragraph (1) not later than 60 days after the date of the enactment of the <short-title>Comprehensive and Overdue Support for Troops of War Act of 2021</short-title>.</text></paragraph><paragraph id="id7F2B329EBA874A469083FDAB152AE725" indent="up1"><enum>(3)</enum><text>An agreement under this section may be extended in five-year or 10-year increments. </text></paragraph></subsection><subsection id="id5335d943e7514de19444373bd43bf7d4"><enum>(c)</enum><header>Review of scientific evidence</header><text>Under an agreement between the Secretary and the Academies under this section, the Academies shall review and summarize the scientific evidence, and assess the strength thereof, concerning the association between toxic exposures during active military, naval, or air service and each illness suspected to be associated with such exposure in the human population.</text></subsection><subsection id="idbeec979f1a17417fb6f3d5838b00f0aa"><enum>(d)</enum><header>Scientific determinations concerning illnesses</header><text>For each illness reviewed under subsection (c), the Academies shall determine, to the extent that available scientific data permit meaningful determinations—</text><paragraph id="idb9ff804113964c4c96335a42564c6b87"><enum>(1)</enum><text>whether an association exists between a toxic exposure and the occurrence of the illness, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association;</text></paragraph><paragraph id="ided9305e279614092bc9d531d2c8a0a28"><enum>(2)</enum><text>the increased risk of the illness among those subject to toxic exposures during active military, naval, or air service; and</text></paragraph><paragraph id="idcb244acd03ca43eab4fa23568178665a"><enum>(3)</enum><text>whether there exists a plausible biological mechanism or other evidence of a causal relationship between the toxic exposure and the occurrence of the illness. </text></paragraph></subsection><subsection id="idC814AE7689D64AAEBE48AF73D11FF2DF"><enum>(e)</enum><header>Cooperation of Federal agencies</header><text>The head of each relevant Federal agency, including the Secretary of Defense, shall cooperate fully with the Academies in performing the services covered by this section.</text></subsection><subsection id="idcdfeb652729941daa603d6890ced14f9"><enum>(f)</enum><header>Recommendations for additional scientific studies</header><paragraph commented="no" display-inline="yes-display-inline" id="id92E084F833D44FE698D875A4C6AD21AA"><enum>(1)</enum><text>Under an agreement between the Secretary and the Academies under this section, the Academies shall make any recommendations for additional scientific studies to resolve areas of continuing scientific uncertainty relating to toxic exposures.</text></paragraph><paragraph id="id3a77da128eb24a62ab363329a336db62" indent="up1"><enum>(2)</enum><text>In making recommendations under paragraph (1), the Academies shall consider—</text><subparagraph id="id1bc6b6df8eb1448985ecb2eeaf5d99a4"><enum>(A)</enum><text>the scientific information that is available at the time of the recommendation;</text></subparagraph><subparagraph id="idb55abda2bca249d39e16b7f49c1d5108"><enum>(B)</enum><text>the value and relevance of the information that could result from additional studies; and</text></subparagraph><subparagraph id="id9565fd5dcbd54668b346e99af198d501"><enum>(C)</enum><text>the cost and feasibility of carrying out such additional studies. </text></subparagraph></paragraph></subsection><subsection id="idf08096f957be45b5a88b9d561f949dc0"><enum>(g)</enum><header>Reports</header><paragraph commented="no" display-inline="yes-display-inline" id="id00C88DCCC36E4709AFDF2EEEDA35060C"><enum>(1)</enum><text>Under an agreement between the Secretary and the Academies under this section, for each review conducted under subsection (c), the Academies shall submit to the Secretary, the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives an initial report on the activities of the Academies under the agreement.</text></paragraph><paragraph indent="up1" id="idC02056A4BF964CFDA90743D86EA0AC07"><enum>(2)</enum><text>The report submitted under paragraph (1) shall include the following:</text><subparagraph id="idB9A311E4A9564C0C8E0BDA6863A3E15E"><enum>(A)</enum><text>The determinations described in subsection (d).</text></subparagraph><subparagraph id="id3024301AE8B54A2F9A9A15F843305101"><enum>(B)</enum><text>A full explanation of the scientific evidence and reasoning that led to such determinations.</text></subparagraph><subparagraph id="id4FC2A0045D184FCC94068C347A15B658"><enum>(C)</enum><text>Any recommendations of the Academies under subsection (f). </text></subparagraph></paragraph></subsection><subsection id="id30de3c764fb44b4288287cc9a624c873"><enum>(h)</enum><header>Alternative contract scientific organization</header><paragraph commented="no" display-inline="yes-display-inline" id="idAACC6E2A381C404B9F51958C0C23EA87"><enum>(1)</enum><text display-inline="yes-display-inline">If the Secretary is unable to enter into an agreement with the Academies for the purposes of this section on terms acceptable to the Secretary, the Secretary shall seek to enter into an agreement for the purposes of this section with another appropriate scientific organization that—</text><subparagraph id="idb43ad42695bc4c1eaf2da83e163442bd" indent="up1"><enum>(A)</enum><text>is not part of the Federal Government;</text></subparagraph><subparagraph id="id12e262d5fa164cc1ade28422ef7753a1" indent="up1"><enum>(B)</enum><text>operates as a not-for-profit entity; and</text></subparagraph><subparagraph id="ide8bda99898944e488d430760824750d5" indent="up1"><enum>(C)</enum><text>has expertise and objectivity comparable to that of the Academies.</text></subparagraph></paragraph><paragraph id="idb6c443b4f0634373bb50d79bffb9a989" commented="no" display-inline="no-display-inline" indent="up1"><enum>(2)</enum><text>If the Secretary enters into an agreement with another organization as described in paragraph (1), any reference in this subchapter to the National Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization. </text></paragraph></subsection></section><section id="HCC898952C7CD427E8A238D27786C4F34"><enum>1174.</enum><header>Working group on presumptions of service connection</header><subsection id="id452bbc34ce4d46d789cd9409beef7b03"><enum>(a)</enum><header>Establishment</header><text>The Secretary shall establish a working group (in this section referred to as the <quote>Working Group</quote>)—</text><paragraph id="id064bfe79df734cb6a2db213c16846d27"><enum>(1)</enum><text>to evaluate the conclusions of the National Academies of Sciences, Engineering, and Medicine contained in each report submitted under section 1173(g) of this title; and</text></paragraph><paragraph id="id913f0ba297eb4de386a2a02ced76e155"><enum>(2)</enum><text>to develop and submit to the Secretary a recommendation within 60 days of the Secretary’s receipt of a report under section 1173(g) of this title with respect to whether—</text><subparagraph id="idcac53f097d094590af197255a12b0995"><enum>(A)</enum><text>to establish a presumption of service connection between each toxic exposure and illness covered by a report described in paragraph (1); or</text></subparagraph><subparagraph id="id5e20531ce449485aa46255255c403d65"><enum>(B)</enum><text>to modify an existing presumption of service connection covered by a report described in paragraph (1).</text></subparagraph></paragraph></subsection><subsection id="idf18bf2e33a934180b194294d670b3d52"><enum>(b)</enum><header>Recommendations</header><paragraph commented="no" display-inline="yes-display-inline" id="id04C6B3653A4D41E0B859E5C7609FCE52"><enum>(1)</enum><text>In making a recommendation under subsection (a)(2), the Working Group shall, 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 additional research, studies, or reports.</text></paragraph><paragraph id="id373cc08c03ac4ebfb25c70147448040f" indent="up1"><enum>(2)</enum><text>In making a recommendation under subsection (a)(2), the Working Group shall consider only the positive association between a toxic exposure and an illness. </text></paragraph><paragraph indent="up1" id="id97582B7D809F42468167DCC1A4C781D7"><enum>(3)</enum><text>Concurrent with the submittal of a recommendation to the Secretary under subsection (a)(2), the Working Group shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a description of such recommendation.</text></paragraph></subsection></section><section id="H4048B65F30EF4D2A84E323584ADED957"><enum>1175.</enum><header>Regulations regarding presumptions of service connection based on toxic exposure</header><subsection id="H1243A87718D84656B50B8D4FF5F8D4FF"><enum>(a)</enum><header>Action upon Working Group recommendation</header><text display-inline="yes-display-inline">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—</text><paragraph id="HA02ABA66F531483286255752C059E525"><enum>(1)</enum><text display-inline="yes-display-inline">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</text></paragraph><paragraph id="id00c634a113284f4d9f84637a0f5bc44a"><enum>(2)</enum><text>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, and all materials the Secretary relied upon for the determination. </text></paragraph></subsection><subsection id="H940DBBC4B050410F8D93724C39761AD5"><enum>(b)</enum><header>Final regulation</header><text display-inline="yes-display-inline">Not later than 90 days after the date on which the Secretary issues any proposed regulations under subsection (a)(1), the Secretary shall issue final regulations. Such regulations shall be effective on the date of issuance.</text></subsection><subsection id="id147b788706cd45bf8cce1692eb63f67b"><enum>(c)</enum><header>Removal of presumption</header><paragraph commented="no" display-inline="yes-display-inline" id="id1C5CD789811A4EBEAC665CEB0C23EA7D"><enum>(1)</enum><text>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).</text></paragraph><paragraph indent="up1" id="idD7689ABC0EF1493EB798C0E1767A2887"><enum>(2)</enum><text>Whenever an illness is removed from regulations pursuant to paragraph (1), or the periods or locations of exposure covered by a presumption of service connection are modified under subsection (a)—</text><subparagraph id="idED3D436DAF994CFB9026D5A5FB89C81D"><enum>(A)</enum><text>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</text></subparagraph><subparagraph id="id90BE8FA0623E49259D2A08456D0C08C0"><enum>(B)</enum><text>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.</text></subparagraph></paragraph></subsection></section></subchapter><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="HBEFC3F5855174B6C9596FBA4FA0A1912"><enum>(2)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of such chapter is amended by adding at the end the following new items:</text><quoted-block style="USC" display-inline="no-display-inline" id="HB1500DEF64DF4931B8B68F1E56FBF49C"><toc><toc-entry level="subchapter" idref="H393066D1BCFE4BD280B285FEC6B43CA0">SUBCHAPTER VII—Research and determinations relating to presumptions of service connection based on toxic exposure </toc-entry><toc-entry level="section" idref="HF20AB56461BB44DC95DEBCD8087730D0">1171. Procedures to determine presumptions of service connection based on toxic exposure; definitions. </toc-entry><toc-entry level="section" idref="H84DC7431CE5140D6835DD52E7389D532">1172. Toxic Exposure Review Commission. </toc-entry><toc-entry level="section" idref="id2dc41f1fb17b4f45b23c3b0babc2eb6c">1173. Science review agreement. </toc-entry><toc-entry level="section" idref="HCC898952C7CD427E8A238D27786C4F34">1174. Working group on presumptions of service connection. </toc-entry><toc-entry level="section" idref="H4048B65F30EF4D2A84E323584ADED957">1175. Regulations regarding presumptions of service connection based on toxic exposure.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H1B328904532D4FC3A9AABDA05FD9941B"><enum>(b)</enum><header>Establishment of working group</header><text>Not later than 120 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish the working group required by section 1174(a) of title 38, United States Code, as added by subsection (a).</text></subsection><subsection id="idE811D20F9333443CA663E046C363EB0A"><enum>(c)</enum><header>Conforming amendments</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">Chapter 11</external-xref> of title 38, United States Code, is amended—</text><paragraph id="H66D507A5B705477AA2F8B2D70533C063"><enum>(1)</enum><text>in section 1116—</text><subparagraph id="HF0D9234D21D54DB4A1A6172EA7AC30BB"><enum>(A)</enum><text>by striking subsections (b), (c), (d), and (e);</text></subparagraph><subparagraph commented="no" id="H02F9C963F99348E6BAAEB948F1AF206B"><enum>(B)</enum><text>by inserting after subsection (a) the following new subsection (b):</text><quoted-block style="USC" display-inline="no-display-inline" id="HA43F3475FC6C44D29CD40ABE04C7BCCC"><subsection commented="no" id="H097D0BF245E54E69A796476A8A27CF9A"><enum>(b)</enum><text display-inline="yes-display-inline">The Secretary shall ensure that any determination made on or after the date of the enactment of the <short-title>Comprehensive and Overdue Support for Troops of War Act of 2021</short-title> 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 (<external-xref legal-doc="public-law" parsable-cite="pl/102/4">Public Law 102–4</external-xref>).</text></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph id="HF74FFAA266B240D6818435D8C789BF50"><enum>(C)</enum><text>by redesignating subsection (f) as subsection (c).</text></subparagraph></paragraph><paragraph commented="no" id="H147344790FA942CABB6D1A0B12CD2719"><enum>(2)</enum><text>in section 1116B(b)(2)(A), by inserting <quote>pursuant to subchapter VII of this chapter,</quote> before <quote>the Secretary determines</quote>; and</text></paragraph><paragraph commented="no" id="HEA957265D90C4C2ABD3B05D1415E044A"><enum>(3)</enum><text>in section 1118—</text><subparagraph commented="no" id="H063598E780FB421199B254CBEB834757"><enum>(A)</enum><text>by striking subsections (b) through (e); and</text></subparagraph><subparagraph commented="no" id="H6C0975383E8C4768AD5A124F5DE1512E"><enum>(B)</enum><text>by inserting after subsection (a) the following new subsection (b):</text><quoted-block style="USC" display-inline="no-display-inline" id="H2FBEDD1346FA476AAC06F0C045958A4C"><subsection commented="no" id="H42013608281D477E8C267F65274C5661"><enum>(b)</enum><text display-inline="yes-display-inline">The Secretary shall ensure that any determination made on or after the date of the enactment of the <short-title>Comprehensive and Overdue Support for Troops of War Act of 2021</short-title> regarding a presumption of service connection based on a toxic exposure under this section is made pursuant to subchapter VII of this chapter.</text></subsection><after-quoted-block>. </after-quoted-block></quoted-block></subparagraph></paragraph></subsection></section><section id="id9C393F6139AE416B942A50928F366B29"><enum>202.</enum><header>Technical corrections</header><subsection id="id25061F9D73734CA2B54DAD417685EFA7"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter VI of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, is amended—</text><paragraph id="id58C7F68090A34F3DBB6ACB1E8871892D"><enum>(1)</enum><text display-inline="yes-display-inline">by redesignating section 1165 as section 1166; and</text></paragraph><paragraph id="idC12277256B3642D4978EFF0A2035BAD5"><enum>(2)</enum><text>by redesignating the section 1164 that was added by section 5501(a)(1) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (<external-xref legal-doc="public-law" parsable-cite="pl/116/315">Public Law 116–315</external-xref>) as section 1165. </text></paragraph></subsection><subsection id="idB7702B2FC8D9417984BFCA17E6EFAB6C"><enum>(b)</enum><header>Conforming clerical amendments</header><text>The table of sections at the beginning of such chapter is amended by striking the items relating to the section 1164 that was added by section 5501(a)(1) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (<external-xref legal-doc="public-law" parsable-cite="pl/116/315">Public Law 116–315</external-xref>) and section 1165 and inserting the following new items:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id369D6DB9D2EA4A059A3EF2CD8BAD3A84"><toc><toc-entry level="section" bold="off">1165. Specialized teams to evaluate claims involving military sexual trauma.</toc-entry><toc-entry level="section" bold="off">1166. Choice of sex of medical examiner for certain disabilities.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><enum>III</enum><header>Reforms to the service connection process for toxic exposure veterans</header><section id="ida80640af0922400f8ca02d92c48f32ce"><enum>301.</enum><header>Presumptions of toxic exposure</header><subsection id="id3364F96BED3D47B7BA0F63A1EF78AD73"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, is amended by adding at the end the following new section:</text><quoted-block style="USC" display-inline="no-display-inline" id="idDC0870B90A1B4D17AC612AC43661D483"><section id="id8817d67980fe47c08034194941e58234"><enum>1119.</enum><header>Presumptions of toxic exposure</header><subsection id="ida7461fe9d81b415598da56d69c7a21ef"><enum>(a)</enum><header>Presumption of toxic exposure</header><text>Except as provided in section 1120 of this title, if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with indication of a toxic exposure that occurred during active military, naval, or air service, the Secretary shall presume that the veteran was subject to such toxic exposure—</text><paragraph id="id7bc1029bee014fdca9de9dd7ecd420ad"><enum>(1)</enum><text>if the Individual Longitudinal Exposure Record of the veteran includes evidence of the toxic exposure; or</text></paragraph><paragraph id="id3db527f661dd4b3294733a7196a78460"><enum>(2)</enum><text>in a case in which the Individual Longitudinal Exposure Record of the veteran does not indicate that the veteran was subject to the claimed toxic exposure during active military, naval, or air service, if credible evidence of the facts, places, and circumstances of the service of the veteran in the active military, naval, or air service, including evidence of the veteran’s unit assignments, military specialty, or date and location of service, shows the veteran was subject to the claimed toxic exposure during such service. </text></paragraph></subsection><subsection id="idab94ed8da98c4e1baeac319bd50450cd"><enum>(b)</enum><header>Role of lay statements</header><text>In a case described in subsection (a)(2), the Secretary shall accept as credible evidence under such subsection a lay statement by the veteran or another that is consistent with the other credible evidence of the facts, places, and circumstances of the veteran’s service in the active military, naval, or air service.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id99FCB19F3C0542D5BC0933E3400950BE"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 11 of such title is amended by inserting after the item relating to section 1118 the following new item: </text><quoted-block style="USC" id="idf70e3e8d-6c24-43d9-90c8-9a91060eccba"><toc><toc-entry level="section" idref="id8817d67980fe47c08034194941e58234">1119. Presumptions of toxic exposure.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id31365B4E789F462A9EC505A5E02BD937" commented="no" display-inline="no-display-inline"><enum>(c)</enum><header>Conforming amendment</header><text>Section 1113 of such title is amended by striking <quote>or 1118</quote> each place it appears and inserting <quote>1118, or 1119</quote>.</text></subsection></section><section id="id77E7C820894A4EF68B6E41CAF9FB5F99"><enum>302.</enum><header>Presumption of exposure to airborne hazards and substances from burn pits</header><subsection id="id0E7767C620EA44C6ABDC152E048D941C"><enum>(a)</enum><header>In general</header><text>Subchapter II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, as amended by section 301(a), is further amended by adding at the end the following new section:</text><quoted-block style="USC" display-inline="no-display-inline" id="id32FC37EF061049F2B7BAAB7A0055AB46"><section id="id30EFBB88A18B4561903DABCFCCF2A62A"><enum>1120.</enum><header>Presumption of exposure to certain airborne hazards and substances from participation in contingency operations</header><subsection id="id7f05ab7a57714aeea7b4a0297d4ab38f"><enum>(a)</enum><header>In general</header><text>For purposes of section 1110 and chapter 17 of this title, any veteran described in subsection (b) shall be presumed to have been exposed to the substances, chemicals, and hazards listed in subsection (c), unless there is affirmative evidence to establish that the veteran was not exposed to any such substances, chemicals, or hazards during that service.</text></subsection><subsection id="id8A10D68F4B0A4CF086862E8B370B4AE3"><enum>(b)</enum><header>Veterans described</header><paragraph commented="no" display-inline="yes-display-inline" id="id5680D62D557549399AA71CC332E7B8B0"><enum>(1)</enum><text>A veteran described in this paragraph is any veteran who—</text><subparagraph id="idA23F6E8D50DE46A686D85410AE4F7CD1" indent="up1"><enum>(A)</enum><text>during active military, naval, or air service, was deployed in support of a contingency operation while so serving and as part of such deployment served in a covered location during a corresponding period set forth under paragraph (2); or</text></subparagraph><subparagraph id="id2EAFC5CC44F9420AB3F7E0658ADBD773" indent="up1"><enum>(B)</enum><text>on or after August 2, 1990, was awarded any of the following:</text><clause id="id71D0B7066E474C8786E9CA60FFA37CCD"><enum>(i)</enum><text>The Afghanistan Campaign Medal.</text></clause><clause id="idA1812DAA070D4DC199F7B931469742EE"><enum>(ii)</enum><text>The Armed Forces Expeditionary Medal.</text></clause><clause id="idC57CB8C0F7DA4BBBBF46C43F329B2D40"><enum>(iii)</enum><text>The Global War On Terrorism Expeditionary Medal.</text></clause><clause id="id64A3D417C8814B1890BE5BBBB851A40C"><enum>(iv)</enum><text>The Inherent Resolve Campaign Medal.</text></clause><clause id="id0391F0B9B2BF4105A4CB809020F8074B"><enum>(v)</enum><text>The Iraqi Campaign Medal.</text></clause><clause id="id6D137CE950BB4442A9B50D7805E55268"><enum>(vi)</enum><text>The Southwest Asia Service Medal. </text></clause></subparagraph></paragraph><paragraph id="idf53e543f0dd343bcb4a5ac61f120c5e0" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idda58b442d0064e388fda56fb95c6b234"><enum>(A)</enum><text>The covered locations and corresponding periods set forth under this subsection are as follows:</text><clause id="id5e83be64fbf94e1893cb1270d252b26d" indent="up1"><enum>(i)</enum><text>Iraq and the following periods:</text><subclause id="id173a373b5640414db6147e8fbe20eac6"><enum>(I)</enum><text>The period beginning on August 2, 1990, and ending on February 28, 1991.</text></subclause><subclause id="idf91c0f9f2c954d3ba44bac7b4837983e"><enum>(II)</enum><text>The period beginning on March 19, 2003, and ending on such date as the Secretary determines burn pits are no longer used in Iraq.</text></subclause></clause><clause id="id1648d15bbd564cc88e91615e196111c2" indent="up1"><enum>(ii)</enum><text>The Southwest Asia Theater of operations, other than Iraq, and the period beginning on August 2, 1990, and ending on such date as the Secretary determines burn pits are no longer used in such location, including the following:</text><subclause id="ide0e6de064a714054819f180f65342516"><enum>(I)</enum><text>Kuwait.</text></subclause><subclause id="ide4fc50cc21c54daebe8e3fd1e8007f7c"><enum>(II)</enum><text>Saudi Arabia.</text></subclause><subclause id="id06f661cf489d411ab785171cace2e69d"><enum>(III)</enum><text>Oman.</text></subclause><subclause id="idc45aaf75bb75449b9274a7385ad5e026"><enum>(IV)</enum><text>Qatar.</text></subclause></clause><clause id="id7f4f11054aa34d488f7026341528491c" indent="up1"><enum>(iii)</enum><text>Afghanistan and the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Afghanistan.</text></clause><clause id="id3f1a0739e8e04c62af63f641006c3f08" indent="up1"><enum>(iv)</enum><text>Djibouti and the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Djibouti.</text></clause><clause id="id4cb7863d09804644b956d8ca06efdaec" indent="up1"><enum>(v)</enum><text>Syria and the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Syria.</text></clause><clause id="id495fe4c3a10f4e02a96c484d39d98d7a" indent="up1"><enum>(vi)</enum><text>Jordan and the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Jordan.</text></clause><clause id="id5889b5bb324c4cdbabe793cdb3f7237c" indent="up1"><enum>(vii)</enum><text>Egypt and the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Egypt.</text></clause><clause id="id4fcf3b4dfdba4312b61275d862d37dbb" indent="up1"><enum>(viii)</enum><text>Lebanon and the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Lebanon.</text></clause><clause id="idc5665c4a414e4d58a1abc3c903aa8dd3" indent="up1"><enum>(ix)</enum><text>Yemen and the period beginning on September 11, 2001, and ending on such date as the Secretary determines burn pits are no longer used in Yemen.</text></clause><clause id="id1b1a8ced8d0e4b45aee5e30af215450a" indent="up1"><enum>(x)</enum><text>Such other locations as are set forth by the Airborne Hazards and Open Burn Pit Registry established under section 201 of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/260">Public Law 112–260</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/527">38 U.S.C. 527</external-xref> note) and corresponding periods set forth in such registry.</text></clause><clause id="ide13ccdbc81664e20af9cff2c5410f94b" indent="up1"><enum>(xi)</enum><text>Such other locations and corresponding periods as the Secretary, in collaboration with the Secretary of Defense, may determine appropriate in a report the Secretary of Veterans Affairs shall submit to Congress not later than two years after the date of the enactment of the Veterans Burn Pits Exposure Recognition Act of 2021 and not less frequently than once every two years thereafter.</text></clause></subparagraph><subparagraph id="id1e997b7ad5b14585ac15c6cfa3c83d72" indent="up1"><enum>(B)</enum><text>A location set forth under this paragraph shall not include any body of water around or any airspace above such location.</text></subparagraph></paragraph></subsection><subsection id="id99b2f591-55df-42ac-8d35-b1a786980530" changed="not-changed"><enum>(c)</enum><header>Substances, chemicals, and airborne hazards</header><paragraph commented="no" display-inline="yes-display-inline" id="idc7c3e750-5020-4857-8477-ce7d26572587" changed="not-changed"><enum>(1)</enum><text>Subject to paragraph (2), the substances, chemicals, and airborne hazards listed in this subsection are as follows:</text><subparagraph id="ida2f19f0f-b07d-4ddc-9a2f-dee6e4566692" indent="up1" changed="not-changed"><enum>(A)</enum><text>Particulate matter, including the following:</text><clause id="id9fb782d6-0854-46b7-8551-e22b2138b254" changed="not-changed"><enum>(i)</enum><text>PM-10.</text></clause><clause id="id78740247-6147-4432-b054-9992b1c4496c" changed="not-changed"><enum>(ii)</enum><text>PM-2.5.</text></clause></subparagraph><subparagraph id="id3118d06f-f8ac-4e60-8d7b-a0f32277fb74" indent="up1" changed="not-changed"><enum>(B)</enum><text>Polycyclic aromatic hydrocarbons (PAHs), including the following:</text><clause id="idf9cc55b6-b1a0-4b7b-ab0e-93935f714e8d" changed="not-changed"><enum>(i)</enum><text>Acenaphthene.</text></clause><clause id="idea1e1ecd-eb4a-4b31-afaa-40604ca40f8c" changed="not-changed"><enum>(ii)</enum><text>Acenaphthylene.</text></clause><clause id="id26ef73e9-4e71-4134-82c0-f830b207532f" changed="not-changed"><enum>(iii)</enum><text>Anthracene.</text></clause><clause id="idaf820f7e-e0db-4040-8a78-beca2d9d7e16" changed="not-changed"><enum>(iv)</enum><text>Benzo(a)anthracene.</text></clause><clause id="id216f32ca-fb4d-446a-9e47-342a3c2802b1" changed="not-changed"><enum>(v)</enum><text>Benzo(a)pyrene.</text></clause><clause id="id0314f8b3-7c3d-404f-8bc9-391dc82b3c2d" changed="not-changed"><enum>(vi)</enum><text>Benzo(b)fluoroanthene.</text></clause><clause id="id4dca0b8a-2c30-4ca2-8f76-c05b9ad7df1e" changed="not-changed"><enum>(vii)</enum><text>Benzo(g,h,i)perylene.</text></clause><clause id="idc447f2f3-c1bb-4e12-8eed-ac8087749c9f" changed="not-changed"><enum>(viii)</enum><text>Benzo(k)fluoroanthene.</text></clause><clause id="id8b7433d1-a170-4d28-b68c-093b5715af06" changed="not-changed"><enum>(ix)</enum><text>Chrysene.</text></clause><clause id="idefbbe27a-986a-4ac7-9a32-3923133e0988" changed="not-changed"><enum>(x)</enum><text>Dibenz(a,h)anthracene.</text></clause><clause id="id7e4afafa-2aae-4c8f-9edb-b70ca1550138" changed="not-changed"><enum>(xi)</enum><text>Fluoranthene.</text></clause><clause id="id9c1f6306-83e7-4ebc-825e-e1785c50724b" changed="not-changed"><enum>(xii)</enum><text>Fluorene.</text></clause><clause id="id70ebbd8b-be35-40db-a5ae-f461f1421e36" changed="not-changed"><enum>(xiii)</enum><text>Indeno(1,2,3-cd)pyrene.</text></clause><clause id="id49fa8802-8ac0-4101-962c-6a0131cd2b1b" changed="not-changed"><enum>(xiv)</enum><text>Naphthalene.</text></clause><clause id="idd5e6f435-36cf-4591-8fea-36436ade012c" changed="not-changed"><enum>(xv)</enum><text>Phenanthrene.</text></clause><clause id="id8a37a4bd-17bc-40be-9340-782025fdce51" changed="not-changed"><enum>(xvi)</enum><text>Pyrene.</text></clause></subparagraph><subparagraph id="idf89b6409-0c17-4ace-8bbf-37990650e292" indent="up1" changed="not-changed"><enum>(C)</enum><text>Volatile organic compounds (VOCs), including the following:</text><clause id="id8bf5fe1a-7505-45ef-9f17-db271fa69dd9" changed="not-changed"><enum>(i)</enum><text>Acetone.</text></clause><clause id="id39839ece-0b30-45ab-b7c8-19a41e29d090" changed="not-changed"><enum>(ii)</enum><text>Acrolein.</text></clause><clause id="id2a3d810d-e9c3-45a1-b9a7-0eb28e21b4b7" changed="not-changed"><enum>(iii)</enum><text>Benzene.</text></clause><clause id="id29cd4907-ab6f-41f3-8b81-8732a9d1a35a" changed="not-changed"><enum>(iv)</enum><text>Carbon Disulfide.</text></clause><clause id="ide7e860d8-e1c7-4957-9a8c-b4f594db8247" changed="not-changed"><enum>(v)</enum><text>Chlorodifluoromethane.</text></clause><clause id="ide5be1707-29b3-42c5-b59d-4cc8ed562678" changed="not-changed"><enum>(vi)</enum><text>Chloromethane.</text></clause><clause id="id16cb63ee-db1e-4c13-bcd2-9223db869a9a" changed="not-changed"><enum>(vii)</enum><text>Ethylbenzene.</text></clause><clause id="id8e6e18ca-b7c2-4f29-82c1-c45c7e9ecdd6" changed="not-changed"><enum>(viii)</enum><text>Hexane.</text></clause><clause id="id91a564a5-5418-4c08-b839-7a975557679f" changed="not-changed"><enum>(ix)</enum><text>Hexachlorobutadiene.</text></clause><clause id="id9d476d26-6ff9-4a2e-8ff0-88e8d40e907b" changed="not-changed"><enum>(x)</enum><text>m/p-Xylene.</text></clause><clause id="idc24949dc-1df2-4566-891d-2a609438cd39" changed="not-changed"><enum>(xi)</enum><text>Methylene Chloride.</text></clause><clause id="idd6a01add-7922-4a16-b20c-becbd2ff2bc5" changed="not-changed"><enum>(xii)</enum><text>Pentane.</text></clause><clause id="id18a19a3a-ab08-4b90-a3f7-bbbba92a0463" changed="not-changed"><enum>(xiii)</enum><text>Propylene.</text></clause><clause id="id22606f05-f75a-4601-838d-bfb1bd5bf6c7" changed="not-changed"><enum>(xiv)</enum><text>Styrene.</text></clause><clause id="id7d7db1cd-6409-4a82-92ff-592b5621de08" changed="not-changed"><enum>(xv)</enum><text>Toluene.</text></clause></subparagraph><subparagraph id="id8e5f8158-c482-4024-b32e-0b59d1ac4641" indent="up1" changed="not-changed"><enum>(D)</enum><text>Toxic organic halogenated dioxins and furans (dioxins), including the following:</text><clause id="id9af9a91b-8280-4dd9-8b30-8c711f88495f" changed="not-changed"><enum>(i)</enum><text>1,2,3,4,6,7,8 HPCDD.</text></clause><clause id="id8771c077-e218-4d3f-b950-1d71aa07f8ea" changed="not-changed"><enum>(ii)</enum><text>1,2,3,4,6,7,8 HPCDF.</text></clause><clause id="id312e1275-9f37-437b-bff5-5adf1424b781" changed="not-changed"><enum>(iii)</enum><text>1,2,3,4,7,8,9 HPCDF.</text></clause><clause id="id0ce6b49b-7288-4742-88d2-bfe777779d18" changed="not-changed"><enum>(iv)</enum><text>1,2,3,4,7,8 HXCDD.</text></clause><clause id="id19b578f1-becb-448c-a16d-848e11221ce7" changed="not-changed"><enum>(v)</enum><text>1,2,3,4,7,8 HXCDF.</text></clause><clause id="idb0019ee7-79a8-454b-866e-dcd92d909763" changed="not-changed"><enum>(vi)</enum><text>1,2,3,6,7,8 HXCDD.</text></clause><clause id="id90c3e236-0cfb-49fd-a8b1-d09977b48897" changed="not-changed"><enum>(vii)</enum><text>1,2,3,6,7,8 HXCDF.</text></clause><clause id="ide029186f-aae4-4d8e-995b-76b79c9685fa" changed="not-changed"><enum>(viii)</enum><text>1,2,3,7,8,9 HXCDD.</text></clause><clause id="ide54d6364-12ca-48a2-ae3f-0f106a9d5815" changed="not-changed"><enum>(ix)</enum><text>1,2,3,7,8,9 HXCDF.</text></clause><clause id="id51a9bc77-6d41-443d-a43d-d0f2c0e02ef2" changed="not-changed"><enum>(x)</enum><text>1,2,3,7,8 PECDD.</text></clause><clause id="idce398579-feb2-4ea0-9aff-9647e7e81c06" changed="not-changed"><enum>(xi)</enum><text>1,2,3,7,8 PECDF.</text></clause><clause id="id5c2c8cbc-5b6c-45d9-8b8f-a955a5e5ced0" changed="not-changed"><enum>(xii)</enum><text>2,3,4,6,7,8 HXCDF.</text></clause><clause id="id7c26ec87-66f4-477b-9a82-85e496289810" changed="not-changed"><enum>(xiii)</enum><text>2,3,4,7,8 PECDF.</text></clause><clause id="id0da0dcbf-9e67-443a-bc0d-342cc42fb671" changed="not-changed"><enum>(xiv)</enum><text>2,3,7,8 TCDD.</text></clause><clause id="id0f07da65-6a11-4563-b2ed-8946e8ef288b" changed="not-changed"><enum>(xv)</enum><text>2,3,7,8 TCDF.</text></clause><clause id="iddc7f8d87-2780-4c2b-95e1-d167ff4e00b3" changed="not-changed"><enum>(xvi)</enum><text>octachlorodibenzodioxin.</text></clause><clause id="id88188844-2775-4eda-8525-71fe6e4f252e" changed="not-changed"><enum>(xvii)</enum><text>octachlorodibenzofuran.</text></clause></subparagraph><subparagraph id="idc12d2767-2fe0-42fa-9545-6d0db8241588" indent="up1" changed="not-changed"><enum>(E)</enum><text>Such other substances, chemicals, and airborne hazards as the Secretary, in collaboration with the Secretary of Defense, may add under paragraph (2).</text></subparagraph></paragraph><paragraph indent="up1" id="id2b38af6b-caf7-4a46-87ba-c630fe7e92dd" changed="not-changed"><enum>(2)</enum><text>The Secretary may add to or remove from the list under paragraph (1) as the Secretary determines appropriate in a report the Secretary shall submit to Congress not later than two years after the date of the enactment of the <short-title>Comprehensive and Overdue Support for Troops of War Act of 2021</short-title>, and not less frequently than once every two years thereafter.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idBD84C365A6414231B47691DC024FAB3A" changed="not-changed"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 11 of such title, as amended by section 301(b), is further amended by inserting after the item relating to section 1119 the following new item: </text><quoted-block style="USC" id="id36C5BF1EF4874D2B800AD1D144353675"><toc><toc-entry level="section">1120. Presumption of exposure to certain airborne hazards and substances from participation in contingency operations.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id552DA8F7471E43F5A7DCF56A726E1A18" commented="no" display-inline="no-display-inline"><enum>(c)</enum><header>Conforming amendment</header><text>Section 1113 of such title, as amended by section 301, is amended by striking <quote>or 1119</quote> each place it appears and inserting <quote>1119, or 1120</quote>. </text></subsection></section><section id="id2419330ecced4cda80a5548800e33f06"><enum>303.</enum><header>Medical nexus examinations for toxic exposures</header><subsection id="idb013fb6867df4c23bcf29354a3b131dc"><enum>(a)</enum><header>In general</header><text>Subchapter VI of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, as amended by title II of this Act, is further amended by adding at the end the following new section:</text><quoted-block style="USC" display-inline="no-display-inline" id="idea0e3899-06da-4efc-aa86-8c8253983d4d"><section id="idbdd8b6f5a2124517ad52afe514013483"><enum>1168.</enum><header>Medical nexus examinations for toxic exposures</header><subsection id="idaa92e9c3c8b84876b0540bf9e9147d1d"><enum>(a)</enum><header>In general</header><text>Except as provided in subsection (c), if a covered veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title relating to a toxic exposure or exposure to a substance, chemical, or hazard listed in section 1120(c) of this title during active military, naval, or air service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall—</text><paragraph id="id1858AF59C4A147D7B0FCDB54FBF8A3E3"><enum>(1)</enum><text>provide the veteran with a medical examination of the claimed disability relating to such exposure;</text></paragraph><paragraph id="iddcff39ab15b54a54b28f7291108890d3"><enum>(2)</enum><text>provide the veteran the option to have the examination provided under paragraph (1) conducted by a specialist in the field of medicine which covers the specifically claimed disability; and</text></paragraph><paragraph id="id1bb1e099c733444f801f72b422aa3e67"><enum>(3)</enum><text>request a medical opinion, as part of the medical examination provided under paragraph (1), as to whether it is at least as likely as not that there is a nexus between the claimed disability and the exposure.</text></paragraph></subsection><subsection id="id635C3950798A45FA8451FA6583C6AF41"><enum>(b)</enum><header>Covered veterans</header><text>For purposes of this section, a covered veteran is—</text><paragraph id="idCBDA6786BAAA4D9FB951782FFF68F404"><enum>(1)</enum><text>a veteran presumed under section 1119(a) of this title to have been subject to a toxic exposure; or</text></paragraph><paragraph id="id1C5E8628B52D4DE395872E90B380D22B"><enum>(2)</enum><text>a veteran presumed under subsection (a) of section 1120 of this title to have been exposed to a substance, chemical, or hazard listed in subsection (c) of such section.</text></paragraph></subsection><subsection id="id3E228AF7C60F46FDB3189FC052BC7811"><enum>(c)</enum><header>Exception</header><text>Subsection (a) shall not apply in a case in which a covered veteran claims a disability that is clearly unrelated to the claimed exposure.</text></subsection><subsection id="id04F9E5EAE6A34E748DF5AC5B927A0AD3"><enum>(d)</enum><header>Considerations in provision of medical opinions</header><text>When providing the Secretary with a medical opinion requested under subsection (a)(3), the examiner shall consider the total potential exposure through all applicable military deployments, and the synergistic, combined effect of all applicable toxic exposure risk activities.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id457709e9-696d-4801-ba71-f146eb887287" changed="not-changed"><enum>(b)</enum><header>Clerical amendment</header><text>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: </text><quoted-block style="USC" id="ide6d5b181-279e-432f-8bcc-c69750e1b564"><toc><toc-entry level="section">1168. Medical nexus examinations for toxic exposures.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><enum>IV</enum><header>Expansion of presumptions of service connection for forgotten veterans</header><section id="idbf3bab69940b425ca00dc2dd2d48ebd6"><enum>401.</enum><header>Mark Takai Atomic Veterans Healthcare Parity Act of 2021</header><text display-inline="no-display-inline">Section 1112(c)(3)(B) of title 38, United States Code, is amended by adding at the end the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id216678bdadd64d3ea19c3dbbc3a118b8"><clause id="idea40761e71864218bd3766999014c1ea" indent="up1"><enum>(v)</enum><text>Cleanup of Enewetak Atoll during the period beginning on January 1, 1977, and ending on December 31, 1980.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id18f7ca55f2124dfa8aa8a7a1884070f4"><enum>402.</enum><header>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</header><text display-inline="no-display-inline">Section 1112(c)(3)(B) of title 38, United States Code, as amended by section 401, is further amended by adding at the end the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id0c100229d9364a7caee53239e7c8b2c3"><clause id="id331041656b7d4c23afaaea7c599a6e4c" indent="up1"><enum>(vi)</enum><text>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.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id8fcf3f80d2314e5888f459166bb6e14d"><enum>403.</enum><header>Presumptions of service connection for diseases associated with exposures to certain herbicide agents for veterans who served in certain locations</header><subsection id="id75137772fec249aa8d988efcf4a89bfa"><enum>(a)</enum><header>In general</header><text>Section 1116 of title 38, United States Code, as amended by section 201, is further amended—</text><paragraph id="ida82259f571104180b6c6bf32682c4bda"><enum>(1)</enum><text>by striking <quote>, 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</quote> each place it appears and inserting <quote>performed covered service</quote>;</text></paragraph><paragraph id="id3cba2ad96f6a456d81231746981e6deb"><enum>(2)</enum><text>by striking <quote>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</quote> each place it appears and inserting <quote>performed covered service</quote>; and</text></paragraph><paragraph id="id3dfc18cd591d4e1ca5b4d3d1c3cf946f"><enum>(3)</enum><text>by adding at the end the following new subsection:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id5977ea23d87e4284bc1b2d8fee887ed2"><subsection id="id0c420d8db4c24ee3a6a687b4061e1275"><enum>(d)</enum><text>In this section, the term <term>covered service</term> means active military, naval, or air service—</text><paragraph id="id236a46914cf94e60810944579745baa3"><enum>(1)</enum><text>performed in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975;</text></paragraph><paragraph id="id751bdeee11764663bcdc597bddb6d425"><enum>(2)</enum><text>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;</text></paragraph><paragraph id="id99ec50e6fa0944158ff24e987326786f"><enum>(3)</enum><text>performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969;</text></paragraph><paragraph id="idc24251632673412bb021cd708107a18d"><enum>(4)</enum><text>performed in Cambodia at Mimot or Krek, Kompon Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or</text></paragraph><paragraph id="id7973e13ade264a3a8a268b6cd7d1f53d"><enum>(5)</enum><text>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.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id56ad08deacdf485e9ed8ca2c9a36a423"><enum>(b)</enum><header>Eligibility for hospital care and medical services</header><text>Section 1710(e)(4) is amended by amending subparagraph (A) to read as follows:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id30885365e6f047e0831a9a8d9de7105a"><subparagraph id="idb8ec870a5e274abe8417eb2b02fe78cf" indent="up1"><enum>(A)</enum><text>The term <term>Vietnam-era herbicide-exposed veteran</term> means a veteran who—</text><clause id="id800e64828bc342b7a07699665178609f"><enum>(i)</enum><text>performed covered service, as defined in section 1116(c) of this title; or</text></clause><clause id="id091aba2239494d119303e8801c1ea379"><enum>(ii)</enum><text>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.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id8dd5470105f74361a7fbce7664fbd60e"><enum>(c)</enum><header>Clerical amendments</header><paragraph id="ida09768775a3942e0946a6e7c7d7dc0e8"><enum>(1)</enum><header>Section heading</header><text>The heading for section 1116 is amended by striking and <quote><header-in-text style="USC" level="section">the Republic of Vietnam</header-in-text></quote> and inserting <quote><header-in-text style="USC" level="section">certain locations</header-in-text></quote>.</text></paragraph><paragraph id="ideb69e8aba04f447abdee3a9d10f0a59d"><enum>(2)</enum><header>Table of sections</header><text>The table of sections at the beginning of chapter 11 of such title is amended by striking the item relating to section 1116 and inserting the following new item:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id589C98BFCC844D0C9A9DDBB568E704E6"><toc><toc-entry level="section" bold="off">1116. Presumptions of service connection for diseases associated with exposure to certain herbicide agents; presumption of exposure for veterans who served in certain locations.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section><section id="id20af1480852b43c3b4d06eb104dd6b0d"><enum>404.</enum><header>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 the Republic of Vietnam</header><text display-inline="no-display-inline">Section 1116(a)(2) of title 38, United States Code, as amended by section 9109 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 (<external-xref legal-doc="public-law" parsable-cite="pl/116/283">Public Law 116–283</external-xref>), is further amended by adding at the end the following new subparagraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id8b3f8d06ca144e8882553087b18fd5e1"><subparagraph id="id9594dad7c1c44a3787f8c72d08d893b8" indent="up1"><enum>(L)</enum><text>Hypertension.</text></subparagraph><subparagraph id="idfeec1609c11a4ecc9cfa5060fa9a8fe5" indent="up1"><enum>(M)</enum><text>Monoclonal gammopathy of undetermined significance.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section id="id987516b0a3174a219bbee8cfaddefed8"><enum>405.</enum><header>Improving compensation for disabilities occurring in Persian Gulf War veterans</header><subsection id="idb2b861e368eb44f7adb9697023aa415c"><enum>(a)</enum><header>Reduction in threshold of eligibility</header><text>Subsection (a)(1) of section 1117 of title 38, United States Code, is amended by striking <quote>became manifest—</quote> and all that follows through the period at the end and inserting <quote>became manifest to a degree of 10 percent or more at any time.</quote>.</text></subsection><subsection id="id3e6e2478f5424adf85d66d5d2540c41e"><enum>(b)</enum><header>Permanent extension of period of eligibility</header><paragraph id="idcfa366850e29456190fd64d135997770"><enum>(1)</enum><header>In general</header><text>Such section is amended by striking subsection (b).</text></paragraph><paragraph id="idd011dc12a6884fd89580f69388d2621d"><enum>(2)</enum><header>Conforming amendments</header><text>Such section, as amended by paragraph (1), is further amended—</text><subparagraph id="idd3c2e384886a439a9141b3b1a0ca62dc"><enum>(A)</enum><text>by redesignating subsections (c) and (d) as subsections (b) and (c), respectively; and </text></subparagraph><subparagraph id="id320605AC571F4A4398119E180422DD45"><enum>(B)</enum><text>in subsection (a)(2)(C), by striking <quote>under subsection (d)</quote> and inserting <quote>under subsection (c)</quote>.</text></subparagraph></paragraph></subsection><subsection id="id3b855060c7cc47cba85ffb78f9fc185f"><enum>(c)</enum><header>Establishing singular disability based questionnaire</header><text>Such section, as amended by subsection (b), is further amended by inserting after subsection (c) the following new subsection (d):</text><quoted-block style="OLC" display-inline="no-display-inline" id="idb332feef65d6433e8922be2eebcb4409"><subsection id="idf1f864f4d91140cd8e0b07ec1347df35"><enum>(d)</enum><text>The Secretary shall develop a Disability Benefits Questionnaire (DBQ), or successor questionnaire, such that if a Persian Gulf veteran presents with any one symptom associated with Gulf War Illness, use of such questionnaire is mandatory for health care personnel of the Department for the identification of Gulf War Illness.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id10f39ea55d874bc3a939a21261fb33d8"><enum>(d)</enum><header>Training</header><text display-inline="yes-display-inline">Such section is amended by adding at the end the following new subsection:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id2405073e02b0415a8c85d29a8dc03d8f"><subsection id="idd2108da192904b15960b8617374e3aa5"><enum>(i)</enum><paragraph commented="no" display-inline="yes-display-inline" id="id5fb83517c7594c65a144eec3666db4f2"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="id4b564091dab04558b7dd11dc0ac2cc68" indent="up1"><enum>(2)</enum><text>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).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id91C8FF7AB35F420AB4A767BBEEEB9E6D"><enum>406.</enum><header>Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins</header><subsection id="idD24F2DF325D94922BA3B8B96AF9B7E34"><enum>(a)</enum><header>In general</header><text>Subchapter II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, as amended by section 302(a), is further amended by inserting after section 1120 the following new section: </text><quoted-block id="id42E5990E746C45719D671098F00DD894" display-inline="no-display-inline" style="USC" act-name=""><section id="id3830967659F643CD96771F03FFC86216" section-type="subsequent-section"><enum>1120A.</enum><header>Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins</header><subsection id="id467D80DA92244FCDBA82723A12712E63"><enum>(a)</enum><header>Presumption of service connection</header><text>For the purposes of section 1110 of this title, and subject to section 1113 of this title, a disease specified in subsection (c) 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.</text></subsection><subsection id="id6377947A07FD4B6EAB2389165E0FFDD7"><enum>(b)</enum><header>Covered veterans</header><text>For purposes of this section, a covered veteran is a veteran presumed under subsection (a) of section 1120 of this title to have been exposed to a substance, chemical, or hazard listed in subsection (c) of such section.</text></subsection><subsection id="H9FD07563DF534CD8A0CA0BBD136EE9C6"><enum>(c)</enum><header>Diseases specified</header><text display-inline="yes-display-inline">The diseases specified in this subsection are the following:</text><paragraph id="HF065B1364B83470499B0982841065766"><enum>(1)</enum><text display-inline="yes-display-inline">Asthma that was diagnosed after—</text><subparagraph id="id16423ECC50CA4666A11A98093B6EBEB6"><enum>(A)</enum><text display-inline="yes-display-inline">a deployment described in subparagraph (A) of section 1120(b)(1) of this title; or</text></subparagraph><subparagraph id="idD2CB3E079DA74E40AD3A5088977C35DD"><enum>(B)</enum><text>a period of service for which a medal set forth under subparagraph (B) of such section was awarded.</text></subparagraph></paragraph><paragraph id="idfc4df09f7e0345f5a306cb70eb455e09"><enum>(2)</enum><text>Chronic obstructive pulmonary disease.</text></paragraph><paragraph id="idc1fae26a2f1f4d95a7296f24ff212d62"><enum>(3)</enum><text>Chronic bronchitis.</text></paragraph><paragraph id="id2d5a3bfd8c594cd997f3e9732946bc70"><enum>(4)</enum><text>Constrictive bronchiolitis or obliterative bronchiolitis.</text></paragraph><paragraph id="id423f3f8f9d964b75a7aaeaae50f36b6f"><enum>(5)</enum><text>Emphysema.</text></paragraph><paragraph id="id23fb233eb5294545a749636b09ba1239"><enum>(6)</enum><text>Pleuritis.</text></paragraph><paragraph id="idf0a2901e15f1475da3f07e9ea555f248"><enum>(7)</enum><text>Pulmonary fibrosis.</text></paragraph><paragraph id="id0dea4d4c8839444aa8a6f6e8a8f11f4f"><enum>(8)</enum><text>Interstitial lung disease.</text></paragraph><paragraph id="idcc72a8571f2e423ab609d3812459ad86"><enum>(9)</enum><text>Sarcoidosis.</text></paragraph><paragraph id="idf4c426c5ec73404db4952454d5cc5139"><enum>(10)</enum><text>Respiratory cancer of any type.</text></paragraph><paragraph id="id91710ecd1f974bb8aa9173bc84d73cb2"><enum>(11)</enum><text>Glioblastoma. </text></paragraph><paragraph id="id1fd1545a19534aab9d6fd5cb15b16133"><enum>(12)</enum><text>Rhinitis.</text></paragraph><paragraph id="id86a3bb0da3f94e0aab19ce213ac645e9"><enum>(13)</enum><text>Sinusitis. </text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id44006512F7974E25B9168D7C4F2DC93D"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, as amended by section 302(b), is further amended by inserting after the item relating to section 1120 the following new item:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id6365C9B53DCF4568AD1893FB0CBB8A9D"><toc><toc-entry level="section" bold="off">1120A. Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idA5F6D1DF2D874157BA43703B6F4FBF55" commented="no" display-inline="no-display-inline"><enum>(c)</enum><header>Conforming amendment</header><text>Section 1113 of such title, as amended by section 302, is further amended by striking <quote>or 1120</quote> each place it appears and inserting <quote>1120, or 1120A</quote>. </text></subsection></section><enum>V</enum><header>Strengthening Federal research on toxic exposures</header><section id="id86791CB4144A481FA578FA6B466FDF77"><enum>501.</enum><header>Coordination by Department of Veterans Affairs of toxic exposure research</header><subsection id="idC705C7F1F01F4378A643B9ABA06CB91B"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/73">chapter 73</external-xref> of title 38, United States Code, is amended by adding at the end the following new section:</text><quoted-block style="USC" display-inline="no-display-inline" id="id423F1050E86B4A919D7DC6CBF47F6CC9"><section id="idDB3B4ACF5D02420FA3F81F99E5646A92"><enum>7330D.</enum><header>Coordination of toxic exposure research</header><subsection id="idF71410867EF541F882CE21B9D8FF3789"><enum>(a)</enum><header>In general</header><text>The Secretary shall coordinate all research activities undertaken or funded by the Executive Branch of the Federal Government on the health consequences of toxic exposures experienced during service in the Armed Forces.</text></subsection><subsection id="idbfbd1a9ceb8d41259c2d6e02894cd539"><enum>(b)</enum><header>Strategic plan</header><text>In carrying out subsection (a), the Secretary shall establish a strategic plan, to be known as the <quote>Toxic Exposure Research Strategic Plan</quote>, to ensure that the research activities described in such subsection are collaborative, transparent, and highly coordinated.</text></subsection><subsection id="idef12f78d6f154b44bdfd811be5bb8c5e"><enum>(c)</enum><header>Report</header><text>Not later than one year after the date of the enactment of the <short-title>Comprehensive and Overdue Support for Troops of War Act of 2021</short-title>, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on all research activities described in subsection (a) undertaken during the year covered by the report.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idF56F9CF2444047E58281FE03996C93D7"><enum>(b)</enum><header>Clerical amendment</header><text>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:</text><quoted-block style="USC" id="id320bab26-81c2-4387-acb6-0e95b195910d"><toc><toc-entry level="section" idref="idDB3B4ACF5D02420FA3F81F99E5646A92">7330D. Coordination of toxic exposure research.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id8ea864437c2f49b994639c9296f6a0bc"><enum>502.</enum><header>Collection, analysis, and report on treatment of veterans for medical conditions related to toxic exposure</header><subsection id="id80274aa2379d44cbb6c36580a658c2c6"><enum>(a)</enum><header>In general</header><text>The Secretary of Veterans Affairs shall compile and analyze, on a continuous basis, all clinical data that—</text><paragraph id="id80B43706C95A42958B8DA68D851D4A51"><enum>(1)</enum><text>is obtained by the Department of Veterans Affairs in connection with hospital care, medical services, and nursing home care furnished under section 1710(a)(2)(F) of title 38, United States Code; and </text></paragraph><paragraph id="id5E72D6F5DE9246658E705CF6480509A0"><enum>(2)</enum><text>is likely to be scientifically useful in determining the association, if any, between the medical condition of a veteran and a toxic exposure.</text></paragraph></subsection><subsection id="id5CA891DD94BF4C89BA1BD2D36D567AF4"><enum>(b)</enum><header>Consent of patients</header><text>Compilation and analysis by the Secretary of clinical data of a veteran under subsection (a) shall be conducted, and such data shall be used, consistent with the informed consent of the veteran and in compliance with all applicable Federal law.</text></subsection><subsection id="idbed7f38674474247a5b935aae04f080c"><enum>(c)</enum><header>Annual report</header><text>Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report containing—</text><paragraph id="ide7aa14b332cd4905b807599a7d2efddc"><enum>(1)</enum><text>the data compiled under subsection (a);</text></paragraph><paragraph id="ide75d3e013ef24250bb615ea8cd0d3c56"><enum>(2)</enum><text>an analysis of such data;</text></paragraph><paragraph id="idf0e8095107cc4acdb1693f49f4e113eb"><enum>(3)</enum><text>a description of the types and incidences of medical conditions identified by the Department under such subsection;</text></paragraph><paragraph id="id4ad140e8c60f4cd08314e75728b66257"><enum>(4)</enum><text>the explanation of the Secretary for the incidence of such medical conditions and other explanations for the incidence of such conditions as the Secretary considers reasonable; and</text></paragraph><paragraph id="ida01fe870718241668ce7803f1549c325" commented="no" display-inline="no-display-inline"><enum>(5)</enum><text>the views of the Secretary on the scientific validity of drawing conclusions from the incidence of such medical conditions, as evidenced by the data compiled under subsection (a), regarding any association between such conditions and a toxic exposure.</text></paragraph></subsection><subsection display-inline="no-display-inline" commented="no" id="id2A93631EFCD34004A231EEE60BE54CA2"><enum>(d)</enum><header>Toxic exposure defined</header><text>In this section, the term <term>toxic exposure</term> has the meaning given that term in section 101(37) of title 38, United States Code.</text></subsection></section><section id="H587201182E7A4001B0D11AFD6535B97B"><enum>503.</enum><header>Studies relating to veterans who served in Southwest Asia</header><subsection id="H77A08A11D2BE4C57A315A08628CD3AD0"><enum>(a)</enum><header>Analysis</header><paragraph id="id473A73E5A4554103A8993049DE3B941A"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, in coordination with the Secretary of Defense, shall conduct an updated analysis of total and respiratory disease mortality in covered veterans.</text></paragraph><paragraph id="id9E812FB1D37E42459B156D1CBB9C19CC"><enum>(2)</enum><header>Elements</header><text display-inline="yes-display-inline">The analysis required by paragraph (1) shall include, to the extent practicable, the following:</text><subparagraph id="H9F3314BFF81B48CB8BE8F1C1A69220FC"><enum>(A)</enum><text display-inline="yes-display-inline">Metrics of airborne exposures.</text></subparagraph><subparagraph id="H5DEAD10FCB0C41D0971ABB9804A457A9"><enum>(B)</enum><text>The location and timing of deployments.</text></subparagraph><subparagraph id="H35314AB6681E4769A450E2AEF0966EB5"><enum>(C)</enum><text>The military occupational specialty.</text></subparagraph><subparagraph id="H154925E7D1804921ABC380F037639DE7"><enum>(D)</enum><text>The Armed Force in which the veteran served.</text></subparagraph><subparagraph id="HE6DD60F5CBD94A4EB53E5BDB3E385719"><enum>(E)</enum><text>Pre-existing health status, including with respect to asthma.</text></subparagraph><subparagraph id="H561609F1DEA145DD865553E6C678064E"><enum>(F)</enum><text>Relevant personal information, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity.</text></subparagraph></paragraph></subsection><subsection id="H3FAFE39133F542EE8064BC3F209F4444"><enum>(b)</enum><header>Epidemiological study</header><text display-inline="yes-display-inline">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 uses the following:</text><paragraph id="H7862166CE8DB4263AAA82A6F84451197"><enum>(1)</enum><text display-inline="yes-display-inline">Improved spatio-temporal estimates of ambient air pollution exposures using advances in retrospective exposure assessment.</text></paragraph><paragraph id="H12009F5058244DCEAABC9CC9A99B0821"><enum>(2)</enum><text display-inline="yes-display-inline">Detailed information on the study subjects obtained through medical records, administrative data, and other existing sources, that include—</text><subparagraph id="HF9A711C4F0F74478BE81007B8FF41AFE"><enum>(A)</enum><text display-inline="yes-display-inline">personal characteristics, including cigarette and e-cigarette smoking history, diet, sex, gender, age, race, and ethnicity;</text></subparagraph><subparagraph id="H816BC2E1F7CB4BF38BEE3F8CCF60BB5B"><enum>(B)</enum><text>deployment history, including locations, periods, and number of deployments;</text></subparagraph><subparagraph id="HA4E5AFC3143B437990CBD3250003EC68"><enum>(C)</enum><text>biospecimen data; and</text></subparagraph><subparagraph id="H1E9176894C96446D8542496462E70F5E"><enum>(D)</enum><text>supplementary health status and outcomes data, including imaging and physiological parameters.</text></subparagraph></paragraph></subsection><subsection id="HCE4D23C9C5C042BABCC448444D5B792D"><enum>(c)</enum><header>Toxicology study</header><paragraph id="id9102D7AD6AC94E8BA0A3BE1F3463FD5A"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 exposures of healthy, young members of the Armed Forces, as well as potentially susceptible members, with preexisting health conditions.</text></paragraph><paragraph id="id9D7233DA1F52479FAC9BCE2F4BED09AE"><enum>(2)</enum><header>Elements</header><text display-inline="yes-display-inline">The study required under paragraph (1) shall—</text><subparagraph id="H683FA7DCCEB549C3AAF7A3E323A84395"><enum>(A)</enum><text display-inline="yes-display-inline">analyze the study results for mechanistic markers and clinically relevant outcomes; and</text></subparagraph><subparagraph id="HEC4408B5B8A44E5194F3089E3111A784"><enum>(B)</enum><text display-inline="yes-display-inline">validate serum, tissue, and other biomarkers of exposure, susceptibility, or effect.</text></subparagraph></paragraph></subsection><subsection id="H0210CC73B91947358FE4A6F92D82E262"><enum>(d)</enum><header>Covered veteran defined</header><text>In this section, the term <term>covered veteran</term> means any veteran who—</text><paragraph id="H76E222F3675847879B1E79C9CC9C4F8E"><enum>(1)</enum><text display-inline="yes-display-inline">on or after August 2, 1990, served on active duty in—</text><subparagraph id="HD826573145CB4DE49D83C09E02D1D869"><enum>(A)</enum><text>Bahrain;</text></subparagraph><subparagraph id="HCF6C9788650348C58B0C098809C9778E"><enum>(B)</enum><text>Iraq;</text></subparagraph><subparagraph id="H4265343B028D44F9AFA2B9E66F2F76AD"><enum>(C)</enum><text>Kuwait;</text></subparagraph><subparagraph id="HAF6E328964B84C589381D375BEB7AAA2"><enum>(D)</enum><text>Oman;</text></subparagraph><subparagraph id="H61F670B736624AD88DFFA1A2706442C9"><enum>(E)</enum><text>Qatar;</text></subparagraph><subparagraph id="H8881260685F2430B850CBF8DD350BDD4"><enum>(F)</enum><text>Saudi Arabia; </text></subparagraph><subparagraph id="H802B4E7B86B848F2B1AC6BE6D211B6E5"><enum>(G)</enum><text>Somalia; or</text></subparagraph><subparagraph id="H438F20F263214C1AAFB7DD48B3E5DB22"><enum>(H)</enum><text>the United Arab Emirates; or</text></subparagraph></paragraph><paragraph id="HFEB6E2A014304AB2B27830FCDD3224DF"><enum>(2)</enum><text display-inline="yes-display-inline">on or after September 11, 2001, served on active duty in—</text><subparagraph id="H2CCB2EC47F0D4D37B70F02B470202B92"><enum>(A)</enum><text>Afghanistan;</text></subparagraph><subparagraph id="HA24E035AFDCC45D99E56AFCF3DD906B5"><enum>(B)</enum><text>Djibouti;</text></subparagraph><subparagraph id="H11B1C4228055457D95C936E340AB99F3"><enum>(C)</enum><text>Egypt;</text></subparagraph><subparagraph id="H87A2C5A86A044BDDB1D7568447729AEB"><enum>(D)</enum><text>Jordan;</text></subparagraph><subparagraph id="H4A3FE253F9DC433DA311A89F714B236A"><enum>(E)</enum><text>Lebanon;</text></subparagraph><subparagraph id="HA89C69899C2E4978898BE32964EF3F86"><enum>(F)</enum><text>Syria; or</text></subparagraph><subparagraph id="H585D55172794474D86359CACFB82BDF9"><enum>(G)</enum><text>Yemen. </text></subparagraph></paragraph></subsection></section><section id="idfd0a2fce05e54a78a6659b1c5d7e44e6"><enum>504.</enum><header>Study on health trends of post 9/11 veterans</header><text display-inline="no-display-inline">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.</text></section><section id="id085277CB19374815863A77D09373941B"><enum>505.</enum><header>Study on cancer rates among veterans</header><subsection id="id7BE06D00545E4AD19F1ECB16EC44B884"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subsection><subsection id="ide6bb14a5ca144f758291fd580bbbbc15"><enum>(b)</enum><header>Elements</header><text>The study required by subsection (a) shall assess, with respect to each veteran included in the study, the following:</text><paragraph id="idb5125016bf744adf8df22f527f25de11"><enum>(1)</enum><text>The age of the veteran.</text></paragraph><paragraph id="id26c814722891444b941de0fa011c0d6f"><enum>(2)</enum><text>The period of service and length of service of the veteran in the Armed Forces.</text></paragraph><paragraph id="idfe7da20042aa444491398e652db0c647"><enum>(3)</enum><text>The military occupational speciality or specialties of the veteran.</text></paragraph><paragraph id="id802a1f471d7a4f639e1d00e19bd47f56"><enum>(4)</enum><text>The gender of the veteran.</text></paragraph><paragraph id="idfde8f4b0f97d4710a01ece3dd0d718ef" commented="no" display-inline="no-display-inline"><enum>(5)</enum><text>The type or types of cancer that the veteran has. </text></paragraph></subsection></section><enum>VI</enum><header>Improving support to toxic exposure veterans</header><section id="id8901a1a6b35a4fb795ad6d8cc1af4fb5"><enum>601.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title, the terms <term>active military, naval, or air service</term>, <term>toxic exposure</term>, and <term>toxic exposure veteran</term> have the meanings given those terms in section 101 of title 38, United States Code.</text></section><section id="id8CC85DA2293F458995F762A10F138E6C"><enum>602.</enum><header>Publication of list of resources of Department of Veterans Affairs for toxic exposure veterans and outreach program for such veterans and caregivers and survivors of such veterans</header><subsection id="id1940a04770e54670a4dd423ae362e7ae"><enum>(a)</enum><header>Publication of list of resources</header><paragraph id="id3d1098a049be4c91bb45af610f91544d"><enum>(1)</enum><header>In general</header><text>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—</text><subparagraph id="ida4ffb6122fd04a2ca6bf30b7c8dcd3ef"><enum>(A)</enum><text>toxic exposure veterans;</text></subparagraph><subparagraph id="idf996d632f43548f3aab83b25c6b0fc39"><enum>(B)</enum><text>families and caregivers of toxic exposure veterans; and</text></subparagraph><subparagraph id="idab8dd98f654f499c89933ebad316bdf7"><enum>(C)</enum><text>survivors of toxic exposure veterans (or who would be toxic exposure veterans were the veterans alive) who are receiving death benefits under the laws administered by the Secretary.</text></subparagraph></paragraph><paragraph id="id262bbb3847b344b8abc80fd835f0216c"><enum>(2)</enum><header>Update</header><text>The Secretary shall periodically update the list published under paragraph (1).</text></paragraph></subsection><subsection id="id7738136ffd674153849ac868c0cdd703" commented="no" display-inline="no-display-inline"><enum>(b)</enum><header>Outreach</header><text>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.</text></subsection></section><section id="id316e7810d2374574a447268687b9dc0d"><enum>603.</enum><header>Incorporation of toxic exposure questionnaire during primary care appointments</header><subsection id="idd7b94b985b6c43229b9544e31d11d536"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="idb5e886dfcc224b77825d27bfb27e9fc3" commented="no" display-inline="no-display-inline"><enum>(b)</enum><header>Determination of questions</header><text>The questions included in the questionnaire required under subsection (a) shall be determined by the Secretary with input from medical professionals. </text></subsection></section><section id="idF5753AC2B00A42C181F0A2B420CE6A48"><enum>604.</enum><header>Training for personnel of the Department of Veterans Affairs with respect to toxic exposure veterans</header><subsection id="id40B46E36343C474788CE57C994B20060"><enum>(a)</enum><header>Health care personnel</header><text>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 exposure veterans of illnesses related to toxic exposure and inform such personnel of how to ask for additional information from veterans regarding different toxic exposures.</text></subsection><subsection id="idab236cc2023641a28809b70c599d5a7c"><enum>(b)</enum><header>Benefits personnel</header><paragraph id="idD29B93FA49CE452B968353F8E565FCF1"><enum>(1)</enum><header>In general</header><text>The Secretary shall establish a training program 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. </text></paragraph><paragraph id="idA7530BDF9041465A88D4D52E36A933A1" commented="no" display-inline="no-display-inline"><enum>(2)</enum><header>Annual training</header><text>Training provided to processors under paragraph (1) shall be provided not less frequently than annually.</text></paragraph></subsection></section><section id="H9C6EFC31F5EA4983BEF9C45D5CAF0171"><enum>605.</enum><header>SFC Heath Robinson Burn Pit Transparency Act</header><subsection id="idD9ED33A3F9714B4DA63ACCA00B83C971"><enum>(a)</enum><header>Short title</header><text>This section may be cited as the <quote><short-title>SFC Heath Robinson Burn Pit Transparency Act</short-title></quote>. </text></subsection><subsection id="HA1255E9DF6FF45609AF9192C6D353406"><enum>(b)</enum><header>Quarterly notifications</header><paragraph id="H698243EECA8549239387DF0AF5DE00C7"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">On a quarterly basis, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees a report on each reported case of burn pit exposure by a covered veteran reported during the previous quarter.</text></paragraph><paragraph id="id8F23B8E7CA4D4EA18BA4A744106EB35B"><enum>(2)</enum><header>Elements</header><text display-inline="yes-display-inline">Each report submitted under paragraph (1) shall include, with respect to each reported case of burn pit exposure of a covered veteran included in the report, the following:</text><subparagraph id="HFC19F2F84D814B5F882EFBBA1F5E6545"><enum>(A)</enum><text display-inline="yes-display-inline">Notice of the case, including the medical facility at which the case was reported.</text></subparagraph><subparagraph id="H9AD2F4D76CC84F09994E23F51DA2DECA"><enum>(B)</enum><text display-inline="yes-display-inline">Notice of, as available—</text><clause commented="no" id="H489502ADFD5A442E82C7D45C8E160440"><enum>(i)</enum><text display-inline="yes-display-inline">the enrollment status of the covered veteran with respect to the patient enrollment system of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code;</text></clause><clause commented="no" id="H303BE6D9E7784182ABC312E7E8256C9A"><enum>(ii)</enum><text display-inline="yes-display-inline">a summary of all health care visits by the covered veteran at the medical facility at which the case was reported that are related to the case;</text></clause><clause id="HD413E2AC402345EE91DC6AA47363C616"><enum>(iii)</enum><text>the demographics of the covered veteran, including age, sex, and race;</text></clause><clause commented="no" id="H2605AB1FF3DD40BCA66499EDD7458E54"><enum>(iv)</enum><text>any non-Department of Veterans Affairs health care benefits that the covered veteran receives;</text></clause><clause id="H817F0523987E4E7082CED9C5B1E18BBD"><enum>(v)</enum><text>the Armed Force in which the covered veteran served and the rank of the covered veteran;</text></clause><clause id="HDDA50DBFBDDF4B189B65A02E4E6DF3B6"><enum>(vi)</enum><text>the period in which the covered veteran served;</text></clause><clause id="id4234c01d58744119bb94140b73002331"><enum>(vii)</enum><text>each location that the covered veteran reported as being a location at which the veteran was exposed to toxic airborne chemicals and fumes from an open burn pit; </text></clause><clause id="H2374BE3596824663992E761EED52BC6C"><enum>(viii)</enum><text>the medical diagnoses of the covered veteran and the treatment provided to the veteran; and</text></clause><clause id="H1D439E41FF8045ADAD672967D5D11C8F"><enum>(ix)</enum><text display-inline="yes-display-inline">whether the covered veteran is registered in the Airborne Hazards and Open Burn Pit Registry.</text></clause></subparagraph></paragraph><paragraph commented="no" id="H59F1594993004692861B0525C01DD8DF"><enum>(3)</enum><header>Protection of information</header><text display-inline="yes-display-inline">The Secretary shall ensure that the reports submitted under paragraph (1) do not include the identity of covered veterans or contain other personally identifiable data.</text></paragraph></subsection><subsection id="H4336C6793CA5498B8D424241D390C5EC"><enum>(c)</enum><header>Annual report on cases</header><paragraph id="HD67E338E7D0343B8BAA4B22CC477DF1A"><enum>(1)</enum><header>In general</header><text>Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, in collaboration with the Secretary of Defense, shall submit to the appropriate congressional committees a report detailing the following:</text><subparagraph id="H3C1C147A7E044030B72B59E9F910EDF3"><enum>(A)</enum><text display-inline="yes-display-inline">The total number of covered veterans.</text></subparagraph><subparagraph commented="no" id="H4ECCBE35724440EFB6FCB85E99205D51"><enum>(B)</enum><text display-inline="yes-display-inline">The total number of claims for disability compensation under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, approved and the total number denied by the Secretary of Veterans Affairs with respect to a covered veteran, and for each such denial, the rationale of the denial.</text></subparagraph><subparagraph id="HD80D0B7F5BE940A5971E66CFF27C7670"><enum>(C)</enum><text>A comprehensive list of—</text><clause id="H5F4E803BD7BD4295A0B8ED4D3375F03F"><enum>(i)</enum><text>the conditions for which covered veterans seek treatment; and</text></clause><clause id="id3fea0f531c0945f2abe509a320da1e31"><enum>(ii)</enum><text>the locations that the covered veterans reported as being locations at which the veterans were exposed to toxic airborne chemicals and fumes from open burn pits. </text></clause></subparagraph><subparagraph commented="no" id="HD9F483B3F60D4DA5B005927A42C2EDC7"><enum>(D)</enum><text display-inline="yes-display-inline">Identification of any illnesses relating to exposure to open burn pits that formed the basis for the Secretary to award benefits, including entitlement to service connection or an increase in disability rating.</text></subparagraph><subparagraph id="ideb35d83ae64a4b818881cc6bf4b88cb2"><enum>(E)</enum><text>The total number of covered veterans who died after seeking care for an illness relating to exposure to an open burn pit. </text></subparagraph><subparagraph id="HCA5D27EE3D38428CB50789F886D7F42B"><enum>(F)</enum><text>Any updates or trends with respect to the information described in subparagraphs (A), (B), (C), (D), and (E) that the Secretary determines appropriate.</text></subparagraph></paragraph><paragraph commented="no" id="H18794404769044FBAC2C8B31FDD3852A"><enum>(2)</enum><header>Matters included in first report</header><text display-inline="yes-display-inline">The Secretary shall include in the first report under paragraph (1) information specified in subsection (b)(2) with respect to reported cases of burn pit exposure made during the period beginning January 1, 1990, and ending on the day before the date of the enactment of this Act.</text></paragraph></subsection><subsection id="H8556E03E966E4778862D512CBF890497"><enum>(d)</enum><header>Comptroller General report</header><text display-inline="yes-display-inline">Not later than 180 days after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the appropriate congressional committees a report containing an assessment of the effectiveness of any memorandum of understanding or memorandum of agreement entered into by the Secretary of Veterans Affairs with respect to—</text><paragraph id="HC5C0973FC60F46448E8D58AF11DBF657"><enum>(1)</enum><text display-inline="yes-display-inline">the processing of reported cases of burn pit exposure; and</text></paragraph><paragraph id="H1D857C9E74214D128C2DB55E6869925E"><enum>(2)</enum><text>the coordination of care and provision of health care relating to such cases at medical facilities of the Department of Veterans Affairs and at non-Department facilities.</text></paragraph></subsection><subsection id="HD09D307CF0664E04BCAD49C50236D046"><enum>(e)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="H4204B577E3004E5CB4B2ACE4D845AFF8"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>Airborne Hazards and Open Burn Pit Registry</term> means the registry established by the Secretary of Veterans Affairs under section 201 of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/260">Public Law 112–260</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/527">38 U.S.C. 527</external-xref> note). </text></paragraph><paragraph id="H4FBDB3DBCD7B4696B93FF266E0E5F3B7"><enum>(2)</enum><text>The term <term>appropriate congressional committees</term> means—</text><subparagraph id="HACCC87E15B9946E3AB1CD87F52201142"><enum>(A)</enum><text display-inline="yes-display-inline">the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and</text></subparagraph><subparagraph id="H43E71D9FEFC34E928A0481BE20B770AC"><enum>(B)</enum><text>The Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives.</text></subparagraph></paragraph><paragraph commented="no" id="HB9B5C9B7E8994B73AF039ABBEA3789F3"><enum>(3)</enum><text>The term <term>covered veteran</term> means a veteran who presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H100DE10DC3EB46B19CB1E6C6F7E12D25"><enum>(4)</enum><text display-inline="yes-display-inline">The term <term>open burn pit</term> has the meaning given that term in section 201(c) of the Dignified Burial and Other Veterans' Benefits Improvement Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/260">Public Law 112–260</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/527">38 U.S.C. 527</external-xref> note).</text></paragraph><paragraph id="H1C0B2A68AAD0424AA4AB8CD6C0F08B69" commented="no" display-inline="no-display-inline"><enum>(5)</enum><text display-inline="yes-display-inline">The term <term>reported case of burn pit exposure</term> means each instance in which a veteran presents at a medical facility of the Department of Veterans Affairs (or in a non-Department facility pursuant to section 1703 or 1703A of title 38, United States Code) for treatment that the veteran describes as being related to, or ancillary to, the exposure of the veteran to toxic airborne chemicals and fumes caused by open burn pits at any time while serving in the Armed Forces. </text></paragraph></subsection></section><enum>VII</enum><header>Strengthening record-keeping of toxic exposures by Department of Defense</header><section id="idee26c13058104794aac7f45b07313f2c"><enum>701.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text><paragraph id="id21907043b67e4a5aa39d3299c5f72632"><enum>(1)</enum><header>Individual longitudinal exposure record</header><text>The term <term>Individual Longitudinal Exposure Record</term> has the meaning given that term in section 101(40) of title 38, United States Code, as added by section 101(b). </text></paragraph><paragraph id="id0eb6cc0f34d44fc9aeb634a5e36a5ef1"><enum>(2)</enum><header>Toxic exposure</header><text>The term <term>toxic exposure</term> has the meaning given that term in section 101(37) of such title, as so added.</text></paragraph></section><section id="idD13A712DC5C34F5C978CBE52FEB9C020"><enum>702.</enum><header>Independent study on Individual Longitudinal Exposure Record</header><subsection id="idf5375458086a4bc185530bbd9d21cb61"><enum>(a)</enum><header>In general</header><text>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 evaluate—</text><paragraph id="idA3919CCE5EF747C59BC0099DBB3AA0A6"><enum>(1)</enum><text>the quality of the location data, occupational and environmental exposure data, and health surveillance data; and</text></paragraph><paragraph id="id1307e007964c488d8dc620d4bc42373c"><enum>(2)</enum><text>whether a member of the Armed Forces can be reasonably assured that any toxic exposure experienced by the member during service in the Armed Forces will be accurately reflected in the Individual Longitudinal Exposure Record of the member.</text></paragraph></subsection><subsection id="idb6f6c876ae6a47dfa5416bd1327cb120"><enum>(b)</enum><header>Independent research entity described</header><text>An independent research entity described in this subsection is a federally funded research and development center with appropriate expertise and analytical capability to carry out the study required under subsection (a). </text></subsection></section><section id="idc9e89bfc387046f0aed1c8c3c563382f"><enum>703.</enum><header>Biannual report on Individual Longitudinal Exposure Record</header><subsection id="id7c3862ee6d874827b2ec2960e80d68c6"><enum>(a)</enum><header>In general</header><text>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 of Defense 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.</text></subsection><subsection id="iddb6eb5dacc6b467d9be565499c6bb311"><enum>(b)</enum><header>Elements</header><text>Each report required by subsection (a) shall include, for the period covered by the report, the following:</text><paragraph id="id62823b21119d42e7966a24340aea2707"><enum>(1)</enum><text>An identification of toxic exposures that may not be fully captured by the current systems of the Department of Defense for environmental and occupational health monitoring, and recommendations for how to improve those systems.</text></paragraph><paragraph id="idf59fef812db6479b900cf86d8231cd1a"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="idf2de86c09151448a909f94c2dbd77c87"><enum>(c)</enum><header>Appropriate committees of Congress defined</header><text>In this section, the term <term>appropriate committees of Congress</term> means—</text><paragraph id="idc00724efcfb64e2a9d4f6baca97268e7"><enum>(1)</enum><text>the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and</text></paragraph><paragraph id="ide979c31e20874e449aaab039ac944fbd"><enum>(2)</enum><text>the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives.</text></paragraph></subsection></section><section id="id9a31be37f5304b178fd8404f2c2db719"><enum>704.</enum><header>Correction of toxic exposure records</header><subsection id="id4f269bcb86714c8881736d14e7d132ea"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="id2611b09464404288835881ff16f79cf5"><enum>(b)</enum><header>Evidence</header><paragraph id="idF43F5CC32DE644A9A018E1DC21CB3635"><enum>(1)</enum><header>In general</header><text>To update a record under subsection (a), a member of the Armed Forces or veteran, as the case may be, must provide such evidence as the Secretary of Defense and the Secretary of Veterans Affairs jointly consider sufficient.</text></paragraph><paragraph id="id5f4a63c8296046528180e31acd946203"><enum>(2)</enum><header>Regulations</header><text>The Secretary of Veterans Affairs shall prescribe by regulation the evidence considered sufficient under paragraph (1). </text></paragraph></subsection></section>October 19, 2021Read twice and placed on the calendar