[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 927 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  1st Session
                                 S. 927

  To improve the provision of health care and other benefits from the 
 Department of Veterans Affairs for veterans who were exposed to toxic 
                  substances, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 23, 2021

  Mr. Tillis (for himself, Ms. Hassan, Mr. Moran, Ms. Klobuchar, Mrs. 
Blackburn, Ms. Baldwin, and Mrs. Capito) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
  To improve the provision of health care and other benefits from the 
 Department of Veterans Affairs for veterans who were exposed to toxic 
                  substances, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Toxic Exposure in 
the American Military Act'' or the ``TEAM Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS EXPOSED TO 
                            TOXIC SUBSTANCES

Sec. 101. Expansion of health care eligibility for certain individuals 
                            exposed to open burn pits and other toxic 
                            substances.
Sec. 102. Expansion of health care eligibility for veterans awarded 
                            certain medals.
Sec. 103. Presumptions of service connection for diseases associated 
                            with exposure to certain toxic substances.
  TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC SUBSTANCES

Sec. 201. Establishment of Toxic Exposure Review Commission.
Sec. 202. Agreement with National Academies of Sciences, Engineering, 
                            and Medicine concerning the exposure of 
                            humans to toxic substances.
Sec. 203. Collection, analysis, and report on treatment of veterans for 
                            medical conditions related to exposure to 
                            toxic substances.
 TITLE III--IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS 
                REGARDING EXPOSURES TO TOXIC SUBSTANCES

Sec. 301. Publication of list of resources of Department of Veterans 
                            Affairs for veterans exposed to toxic 
                            substances and outreach program for such 
                            veterans and caregivers and survivors of 
                            such veterans.
Sec. 302. Incorporation of toxic exposure questionnaire during primary 
                            care appointments.
Sec. 303. Training of health care personnel of Department of Veterans 
                            Affairs on illnesses related to exposure to 
                            toxic substances.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Active military, naval, or air service.--The term 
        ``active military, naval, or air service'' has the meaning 
        given that term in section 101 of title 38, United States Code.
            (2) Open burn pit.--The term ``open burn pit'' has the 
        meaning given that term in section 201(c) of the Dignified 
        Burial and Other Veterans' Benefits Improvement Act of 2012 
        (Public Law 112-260; 38 U.S.C. 527 note).
            (3) Toxic substance.--The term ``toxic substance'' has the 
        meaning given that term in subparagraph (G)(iii) of section 
        1710(e)(1) of such title, as added by section 101(a)(1).

TITLE I--EXPANSION OF HEALTH CARE AND BENEFITS FOR VETERANS EXPOSED TO 
                            TOXIC SUBSTANCES

SEC. 101. EXPANSION OF HEALTH CARE ELIGIBILITY FOR CERTAIN INDIVIDUALS 
              EXPOSED TO OPEN BURN PITS AND OTHER TOXIC SUBSTANCES.

    (a) Expansion of Health Care Eligibility.--
            (1) In general.--Section 1710(e) of title 38, United States 
        Code, is amended--
                    (A) in paragraph (1), by adding at the end the 
                following new subparagraph:
    ``(G)(i) Subject to paragraph (2), a covered individual is eligible 
for hospital care, medical services, and nursing home care under 
subsection (a)(2)(F) for any illness.
    ``(ii) For purposes of this subparagraph, a covered individual is 
an individual who--
            ``(I) is eligible for inclusion in the Airborne Hazards and 
        Open Burn Pit Registry; or
            ``(II) 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--
                    ``(aa) an open burn pit;
                    ``(bb) a toxic substance; or
                    ``(cc) a site included in a database maintained by 
                the Department of Defense and shared with the 
                Department of Veterans Affairs to serve as the central 
                portal for exposure-related data that compiles, 
                collates, presents, and provides available occupational 
                and environmental exposure information to support the 
                needs of the Department of Defense and the Department 
                of Veterans Affairs.
    ``(iii) In this subparagraph:
            ``(I) The term `Airborne Hazards and Open Burn Pit 
        Registry' means the registry established by the Secretary under 
        section 201 of the Dignified Burial and Other Veterans' 
        Benefits Improvement Act of 2012 (Public Law 112-260; 38 U.S.C. 
        527 note).
            ``(II) The term `open burn pit' has the meaning given that 
        term in section 201(c) of the Dignified Burial and Other 
        Veterans' Benefits Improvement Act of 2012 (Public Law 112-260; 
        38 U.S.C. 527 note).
            ``(III) The term `toxic substance' means a toxicant or a 
        toxin.
            ``(IV) The term `toxicant' means any substance that can 
        injure or kill humans, animals, or plants and that is produced 
        by humans or is a by-product of human activities.
            ``(V) The term `toxin' means any substance that can injure 
        or kill humans, animals, or plants and that is produced 
        naturally.''; and
                    (B) in paragraph (2)(B), by striking ``or (F)'' and 
                inserting ``(F), or (G)''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect on the date that is 90 days after the date of 
        the enactment of this Act.
    (b) Determinations of Exposure.--
            (1) In general.--The Secretary of Veterans Affairs shall, 
        to the extent practicable, establish and maintain a mechanism 
        by which veterans may determine whether or not they have been 
        possibly exposed to an open burn pit or toxic substance 
        described in subclause (II) of subparagraph (G)(ii) of section 
        1710(e)(1) of title 38, United States Code, as added by 
        subsection (a)(1), for purposes of being considered as covered 
        individuals under such subparagraph.
            (2) Approval of secretary.--Any determination made under 
        paragraph (1) shall be subject to the approval of the 
        Secretary.
            (3) Appeals.--The Secretary shall establish a mechanism for 
        appealing a decision made by the Secretary under paragraph (2).
    (c) Report.--
            (1) In general.--Not later than 30 days after the date on 
        which the Secretary of Defense identifies the individuals 
        described in subparagraph (G)(ii)(II) of section 1710(e)(1) of 
        title 38, United States Code, as added by subsection (a)(1), 
        the Secretary of Defense, in consultation with the Secretary of 
        Veterans Affairs, shall submit to the appropriate committees of 
        Congress a report.
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) The duty locations or units of the individuals 
                described in paragraph (1), or other information on 
                groups to which such individuals belong.
                    (B) The evidence considered in identifying 
                individuals who were possibly exposed to an open burn 
                pit, toxic substance, or site as described in 
                subparagraph (G)(ii)(II) of section 1710(e)(1) of title 
                38, United States Code, as added by subsection (a)(1).
                    (C) The criteria used to determine whether an 
                individual was so exposed.
            (3) Appropriate committees of congress.--In this 
        subsection, the term ``appropriate committees of Congress'' 
        means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Armed Services of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Armed Services of the House of 
                Representatives.

SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR VETERANS AWARDED 
              CERTAIN MEDALS.

    (a) In General.--Section 1710(e) of title 38, United States Code, 
as amended by section 101(a)(1), is further amended--
            (1) in paragraph (1), by adding at the end the following 
        new subparagraph:
    ``(H) 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:
            ``(i) The Armed Forces Service Medal.
            ``(ii) The Afghanistan Campaign Medal.
            ``(iii) The Global War on Terrorism Expeditionary Medal.
            ``(iv) The Inherent Resolve Campaign Medal.
            ``(v) The Iraq Campaign Medal.
            ``(vi) The Southwest Asia Service Medal.''; and
            (2) in paragraph (2), by striking ``or (G)'' and inserting 
        ``(G), or (H)''.
    (b) Effective Date.--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.

SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR DISEASES ASSOCIATED 
              WITH EXPOSURE TO CERTAIN TOXIC SUBSTANCES.

    (a) In General.--Subchapter II of chapter 11 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 1119. Presumptions of service connection for diseases associated 
              with exposure to certain toxic substances
    ``(a) Presumptions of Service Connection.--(1) For purposes of 
section 1110 of this title, and subject to section 1113 of this title, 
each disease specified in paragraph (2) becoming manifest as specified 
in that paragraph shall be considered to have been incurred in or 
aggravated by service referred to in that paragraph, notwithstanding 
that there is no record of evidence of such disease during the period 
of such service.
    ``(2) A disease specified in this paragraph is any disease that--
            ``(A) the Secretary determines in regulations prescribed 
        under this section warrants a presumption of service connection 
        by reason of having a positive association with exposure to a 
        toxic substance; and
            ``(B) becomes manifest within the period, if any, 
        prescribed in such regulations in a veteran who was exposed to 
        that toxic substance during active military, naval, or air 
        service.
    ``(3)(A) For purposes of this subsection, the Secretary may presume 
that a veteran who has a disease specified in paragraph (2) was exposed 
to the toxic substance for which the Secretary has determined under 
paragraph (2)(A) warrants a presumption of service connection by reason 
of having a positive association with exposure to the toxic substance, 
notwithstanding that there is no record of evidence of such exposure, 
if the Secretary determines based on one or more of the factors set 
forth in subparagraph (B) that a presumption of exposure is warranted.
    ``(B) The factors set forth in this subparagraph are as follows:
            ``(i) The duty location of the veteran.
            ``(ii) The length of service of the veteran.
            ``(iii) Such other factors as the Secretary considers 
        appropriate.
    ``(b) Determinations Relating to Diseases.--(1) Whenever the 
Secretary determines, on the basis of sound medical and scientific 
evidence, that a positive association exists between the exposure of 
humans to a toxic substance and the occurrence of a disease in humans, 
the Secretary shall prescribe regulations providing that a presumption 
of service connection is warranted for that disease for purposes of 
this section.
    ``(2) In making determinations under paragraph (1), the Secretary 
shall take into account--
            ``(A) reports received by the Secretary from the National 
        Academies of Sciences, Engineering, and Medicine under section 
        202(g) of the Toxic Exposure in the American Military Act; and
            ``(B) all other sound medical and scientific information 
        and analyses available to the Secretary.
    ``(3)(A) In evaluating any report, information, or analysis for 
purposes of making such determinations, the Secretary shall consider 
only scientific studies that are valid in accordance with contemporary 
scientific standards.
    ``(B) The Secretary may define the standards described in 
subparagraph (A) for purposes of that subparagraph.
    ``(c) Response to Reports by the National Academies of Sciences, 
Engineering, and Medicine.--(1) Not later than 60 days after the date 
on which the Secretary receives a report from the National Academies of 
Sciences, Engineering, and Medicine under section 202(g) of the Toxic 
Exposure in the American Military Act, the Secretary shall determine 
whether a presumption of service connection is warranted for each 
disease covered by the report.
    ``(2) If the Secretary determines under paragraph (1) that a 
presumption of service connection is warranted for a disease, the 
Secretary shall, not later than 60 days after making the determination, 
issue proposed regulations setting forth the determination.
    ``(3)(A) If the Secretary makes a determination described in 
subparagraph (B), the Secretary shall, not later than 60 days after 
making the determination, publish in the Federal Register a notice of 
the determination.
    ``(B) A determination described in this subparagraph is a 
determination by the Secretary under paragraph (1) that a presumption 
of service connection is not warranted for a disease as to which the 
National Academies of Sciences, Engineering, and Medicine determined 
that there was--
            ``(i) sufficient evidence of an association between the 
        exposure of humans to a toxic substance and the occurrence of 
        the disease in humans; or
            ``(ii) limited evidence or suggestive evidence of such an 
        association.
    ``(C) Any notice published under subparagraph (A) shall include an 
explanation of the scientific basis for the determination described in 
subparagraph (B).
    ``(D) If a disease already presumed to be service connected under 
this section is subject to a determination described in subparagraph 
(B), the Secretary shall, not later than 60 days after publication of 
the notice under subparagraph (A), issue proposed regulations removing 
the presumption of service connection for the disease.
    ``(4) Not later than 180 days after the date on which the Secretary 
issues any proposed regulations under this subsection, the Secretary 
shall issue final regulations.
    ``(d) Removal of Presumption of Service Connection.--Whenever the 
presumption of service connection for a disease under this section is 
removed under subsection (c)--
            ``(1) a veteran who was awarded compensation for the 
        disease on the basis of the presumption before the effective 
        date of the removal of the presumption shall continue to be 
        entitled to receive compensation on that basis; and
            ``(2) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from the disease on the basis of the presumption before that 
        date shall continue to be entitled to receive dependency and 
        indemnity compensation on that basis.
    ``(e) Reference to National Academies of Sciences, Engineering, and 
Medicine.--In the case that the Secretary enters into an agreement with 
another organization as described in section 202(h)(1) of the Toxic 
Exposure in the American Military Act, any reference in this section to 
the National Academies of Sciences, Engineering, and Medicine shall be 
treated as a reference to the other organization.
    ``(f) Definitions.--In this section:
            ``(1) The term `positive association' means, with respect 
        to an association between exposure to a toxic substance and the 
        occurrence of a disease in humans, that there is credible 
        evidence for the association and such evidence is equal to or 
        outweighs the credible evidence against the association.
            ``(2) The term `toxic substance' has the meaning given that 
        term in section 1710(e)(1)(G)(iii) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 11 of such title is amended by inserting after the item 
relating to section 1118 the following new item:

``1119. Presumptions of service connection for diseases associated with 
                            exposure to certain toxic substances.''.
    (c) Conforming Amendment.--Section 1113 of such title is amended by 
striking ``or 1118'' each place it appears and inserting ``1118, or 
1119''.

  TITLE II--RESEARCH AND REVIEW REGARDING EXPOSURE TO TOXIC SUBSTANCES

SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW COMMISSION.

    (a) In General.--Subchapter III of chapter 5 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 547. Toxic Exposure Review Commission
    ``(a) Establishment.--The Secretary shall establish an independent 
commission to be known as the `Toxic Exposure Review Commission' (in 
this section referred to as the `Commission').
    ``(b) Purpose.--The Commission shall--
            ``(1) advise the Secretary on questions relating to 
        exposure to toxic substances that require scientific research; 
        and
            ``(2) assist in the consideration of possible presumptions 
        of service connection.
    ``(c) Duties.--(1) The Commission shall carry out the following 
duties:
            ``(A) Collect any relevant information from the Department 
        of Defense and other sources to identify possible toxic 
        exposures related 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 under 
        section 202 of the Toxic Exposure in the American Military Act.
            ``(B) Recommend to the Secretary, by majority vote, whether 
        a comprehensive scientific review should be conducted by the 
        National Academies of Sciences, Engineering, and Medicine under 
        an agreement under section 202 of the Toxic Exposure in the 
        American Military Act.
            ``(C) Recommend to the Secretary, by majority vote, whether 
        new, independent studies regarding the health outcomes of 
        exposure to toxic substances, or any other new, independent 
        studies that the Commission deems necessary and appropriate, 
        should be conducted.
            ``(D) 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.
    ``(2)(A) Relevant information may be collected under paragraph 
(1)(A) from the following:
            ``(i) Any Federal agency as the Commission considers 
        necessary to carry out this section.
            ``(ii) 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.
    ``(B) Upon request of the Chair, the head of a Federal agency shall 
furnish information collected under subparagraph (A)(i) to the 
Commission unless such information is classified.
    ``(d) Membership.--(1)(A) The Commission shall be composed of nine 
members, appointed as follows:
            ``(i) Two members appointed by the Speaker of the House of 
        Representatives.
            ``(ii) Two members appointed by the minority leader of the 
        House of Representatives.
            ``(iii) Two members appointed by the majority leader of the 
        Senate.
            ``(iv) Two members appointed by the minority leader of the 
        Senate.
            ``(v) One member appointed by the Secretary.
    ``(B) 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 Toxic Exposure in the American Military Act.
    ``(2) In appointing individuals under paragraph (1)(A), the Speaker 
of the House of Representatives, the minority leader of the House of 
Representatives, the majority leader of the Senate, the minority leader 
of the Senate, and the Secretary shall ensure that at least five 
members of the Commission are scientists or health care professionals--
            ``(A) of whom--
                    ``(i) one has a background in the field of 
                respiratory medicine;
                    ``(ii) one has a background in the field of 
                endocrinology and metabolic medicine;
                    ``(iii) one has a background in hematology;
                    ``(iv) one has a background in oncology; and
                    ``(v) one has a background in occupational and 
                environmental health; and
            ``(B) who are not officials or employees of the Federal 
        Government.
    ``(3) In appointing individuals under paragraph (1)(A), the Speaker 
of the House of Representatives, the minority leader of the House of 
Representatives, the majority leader of the Senate, the minority leader 
of the Senate, and the Secretary shall 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.
    ``(4) In appointing individuals under paragraph (1)(A), the Speaker 
of the House of Representatives, the minority leader of the House of 
Representatives, the majority leader of the Senate, the minority leader 
of the Senate, and the Secretary shall give consideration to including 
in the Commission at least one member who works with survivors of 
illnesses related to exposure to toxic substances and has a background 
in the field of study of exposure to toxic substances.
    ``(e) Meetings.--(1) The Commission shall meet not less frequently 
than twice each year.
    ``(2)(A) Each meeting of the Commission shall be open to the 
public.
    ``(B) All the proceedings, information, and deliberations of the 
Commission shall be available for review by the public.
    ``(C) 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.
    ``(f) Chair and Vice Chair.--At the initial meeting of the 
Commission under subsection (e), the Commission shall select a Chair 
and Vice Chair from among the members of the Commission by a majority 
vote of the members of the Commission.
    ``(g) Period of Appointment; Vacancies.--(1) A member of the 
Commission shall be appointed for a term that may not exceed four 
years.
    ``(2) The Secretary shall ensure that terms of members of the 
Commission are staggered so that no such terms end on the same date.
    ``(3) 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.
    ``(4) In appointing the initial members of the Commission, each 
official who is authorized to appoint two members of the Commission 
shall appoint--
            ``(A) one member whose term expires after two years; and
            ``(B) one member whose term expires after four years.
    ``(h) Pay.--(1) Members of the Commission shall serve without pay.
    ``(2) 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.
    ``(3) Members shall receive travel expenses, including per diem in 
lieu of subsistence, in accordance with sections 5702 and 5703 of title 
5.
    ``(i) Director of Staff.--(1) The Commission shall appoint a 
Director who--
            ``(A) has not served as an employee of the Department 
        during the one-year period preceding the date of such 
        appointment; and
            ``(B) is not otherwise barred or prohibited from serving as 
        Director under Federal ethics laws and regulations, by reason 
        of post-employment conflict of interest.
    ``(2) 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.
    ``(j) Staff.--(1) Subject to paragraphs (2) and (3), the Director, 
with the approval of the Commission, may appoint and fix the pay of 
additional personnel.
    ``(2) 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.
    ``(3)(A) Not more than two-thirds of the personnel employed by or 
detailed to the Commission may be on detail from the Department.
    ``(B) Not more than half of the professional analysts of the 
Commission staff may be persons detailed from the Department to the 
Commission.
    ``(4) 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.
    ``(5) 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 Chair, the head of such agency shall 
furnish such information to the Commission, unless such information is 
classified.
    ``(k) Other Authority.--(1) 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.
    ``(2) 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.
    ``(l) Communications.--(1)(A) Except as provided in subparagraph 
(B), no person may restrict an employee of the Department in 
communicating with the Commission.
    ``(B) Subparagraph (A) does not apply to a communication that is 
unlawful.
    ``(2) All ex parte communications with the Commission shall be made 
part of the public record.
    ``(m) Reference to National Academies of Sciences, Engineering, and 
Medicine.--In the case that the Secretary enters into an agreement with 
another organization as described in section 202(h)(1) of the Toxic 
Exposure in the American Military Act, any reference in this section to 
the National Academies of Sciences, Engineering, and Medicine shall be 
treated as a reference to the other organization.
    ``(n) Toxic Substance Defined.--In this section, the term `toxic 
substance' has the meaning given that term in subparagraph (G)(iii) of 
section 1710(e)(1) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 5 of such title is amended by adding at the end the following 
new item:

``547. Toxic Exposure Review Commission.''.

SEC. 202. AGREEMENT WITH NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, 
              AND MEDICINE CONCERNING THE EXPOSURE OF HUMANS TO TOXIC 
              SUBSTANCES.

    (a) Purpose.--The purpose of this section is to provide for the 
National Academies of Sciences, Engineering, and Medicine (in this 
section referred to as the ``Academies''), 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 diseases and exposure to toxic 
substances.
    (b) Agreement.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        seek to enter into a five-year agreement with the Academies to 
        perform the services covered by this section.
            (2) Timing.--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 this Act.
            (3) Extension.--An agreement under this section may be 
        extended in five-year increments.
    (c) Review of Scientific Evidence.--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 exposure to toxic 
substances during active military, naval, or air service and each 
disease suspected to be associated with such exposure in the human 
population.
    (d) Scientific Determinations Concerning Diseases.--For each 
disease reviewed under subsection (c), the Academies shall determine, 
to the extent that available scientific data permit meaningful 
determinations--
            (1) whether an association exists between exposure to toxic 
        substances and the occurrence of the disease, taking into 
        account the strength of the scientific evidence and the 
        appropriateness of the statistical and epidemiological methods 
        used to detect the association;
            (2) the increased risk of the disease among those exposed 
        to toxic substances during active military, naval, or air 
        service; and
            (3) whether there exists a plausible biological mechanism 
        or other evidence of a causal relationship between the exposure 
        and the occurrence of the disease.
    (e) Cooperation of Federal Agencies.--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.
    (f) Recommendations for Additional Scientific Studies.--
            (1) In general.--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 
        the exposure of humans to toxic substances.
            (2) Considerations.--In making recommendations under 
        paragraph (1), the Academies shall consider--
                    (A) the scientific information that is available at 
                the time of the recommendation;
                    (B) the value and relevance of the information that 
                could result from additional studies; and
                    (C) the cost and feasibility of carrying out such 
                additional studies.
    (g) Reports.--
            (1) Initial report.--
                    (A) In general.--Under an agreement between the 
                Secretary and the Academies under this section, not 
                later than one year after the date of the enactment of 
                this Act, 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.
                    (B) Elements.--The report submitted under 
                subparagraph (A) shall include the following:
                            (i) The determinations described in 
                        subsection (d).
                            (ii) A full explanation of the scientific 
                        evidence and reasoning that led to such 
                        determinations.
                            (iii) Any recommendations of the Academies 
                        under subsection (f).
            (2) Periodic updates.--Under an agreement between the 
        Secretary and the Academies under this section, not less 
        frequently than once every two years after the date on which 
        the initial report is submitted under paragraph (1)(A), 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 updated report on 
        the activities of the Academies under the agreement.
    (h) Alternative Contract Scientific Organization.--
            (1) In general.--If the Secretary is unable within the time 
        period prescribed in subsection (b)(2) 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--
                    (A) is not part of the Federal Government;
                    (B) operates as a not-for-profit entity; and
                    (C) has expertise and objectivity comparable to 
                that of the Academies.
            (2) Treatment.--If the Secretary enters into an agreement 
        with another organization as described in paragraph (1), any 
        reference in this section, section 547 of title 38, United 
        States Code, as added by section 201(a), and section 1119 of 
        such title, as added by section 103(a), to the National 
        Academies of Sciences, Engineering, and Medicine shall be 
        treated as a reference to the other organization.

SEC. 203. COLLECTION, ANALYSIS, AND REPORT ON TREATMENT OF VETERANS FOR 
              MEDICAL CONDITIONS RELATED TO EXPOSURE TO TOXIC 
              SUBSTANCES.

    (a) In General.--The Secretary of Veterans Affairs shall compile 
and analyze, on a continuous basis, all clinical data that--
            (1) is obtained by the 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
            (2) is likely to be scientifically useful in determining 
        the association, if any, between the medical condition of a 
        veteran and exposure to a toxic substance.
    (b) Consent of Patients.--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.
    (c) Annual Report.--Not later than one year after the date of the 
enactment of this Act, and annually thereafter, the Secretary shall 
submit to the Committee on Veterans' Affairs of the Senate, the 
Committee on Veterans' Affairs of the House of Representatives, and the 
Toxic Exposure Review Commission established by section 547 of title 
38, United States Code, as added by section 201(a) of this Act, a 
report containing--
            (1) the data compiled under subsection (a);
            (2) an analysis of such data;
            (3) a description of the types and incidences of medical 
        conditions identified by the Department under such subsection;
            (4) 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
            (5) 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 
        exposure to a toxic substance.

 TITLE III--IMPROVEMENT OF RESOURCES OF DEPARTMENT OF VETERANS AFFAIRS 
                REGARDING EXPOSURES TO TOXIC SUBSTANCES

SEC. 301. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF VETERANS 
              AFFAIRS FOR VETERANS EXPOSED TO TOXIC SUBSTANCES AND 
              OUTREACH PROGRAM FOR SUCH VETERANS AND CAREGIVERS AND 
              SURVIVORS OF SUCH VETERANS.

    (a) Publication of List of Resources.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, and annually thereafter, the 
        Secretary of Veterans Affairs shall publish a list of resources 
        of the Department of Veterans Affairs for--
                    (A) veterans provided disability compensation under 
                chapter 11 of title 38, United States Code, relating to 
                exposure to toxic substances;
                    (B) veterans eligible for hospital care, medical 
                services, and nursing home care under section 
                1710(a)(2)(F) of such title;
                    (C) caregivers of veterans described in 
                subparagraph (A) or (B) who are participating in the 
                program of comprehensive assistance for family 
                caregivers under section 1720G(a) of such title; and
                    (D) survivors of veterans described in subparagraph 
                (A) or (B) (or who would be described in any such 
                subparagraph were the veteran alive) who are receiving 
                death benefits under the laws administered by the 
                Secretary.
            (2) Update.--The Secretary shall periodically update the 
        list published under paragraph (1).
    (b) Outreach.--The Secretary shall develop, with input from the 
community, an informative outreach program for veterans on illnesses 
that may be related to exposure to toxic substances, including outreach 
with respect to benefits and support programs.

SEC. 302. INCORPORATION OF TOXIC EXPOSURE QUESTIONNAIRE DURING PRIMARY 
              CARE APPOINTMENTS.

    (a) In General.--The Secretary of Veterans Affairs shall 
incorporate a clinical questionnaire to help determine potential 
exposure to toxic substances 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 exposure of 
veterans to toxic substances while serving in the Armed Forces.
    (b) Determination of Questions.--The questions included in the 
questionnaire required under subsection (a) shall be determined by the 
Secretary with input from medical professionals.

SEC. 303. TRAINING OF HEALTH CARE PERSONNEL OF DEPARTMENT OF VETERANS 
              AFFAIRS ON ILLNESSES RELATED TO EXPOSURE TO TOXIC 
              SUBSTANCES.

    (a) In General.--The Secretary of Veterans Affairs shall ensure 
that health care personnel of the Department of Veterans Affairs are 
appropriately trained to identify, treat, and assess the impact of 
illnesses related to exposure to toxic substances.
    (b) Elements of Training.--The training required under subsection 
(a) shall--
            (1) provide health care personnel of the Department with 
        specific education with respect to illnesses related to 
        exposure to toxic substances; and
            (2) inform such personnel of how to probe for additional 
        information from veterans regarding exposures to different 
        toxicants.
    (c) Toxicant Defined.--In this section, the term ``toxicant'' has 
the meaning given that term in subparagraph (G)(iii) of section 
1710(e)(1) of title 38, United States Code, as added by section 
101(a)(1).
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