<enum>I</enum><header>Expansion of health care and benefits for veterans exposed to toxic substances</header><section id="id0ce2ea0edc9342bba6f54c2ea6579341"><enum>101.</enum><header>Expansion of health care eligibility for certain individuals exposed to open burn pits and other toxic substances</header><subsection id="id3FD6EED54AB1472595F8759F2093FF93"><enum>(a)</enum><header>Expansion of health care eligibility</header><paragraph id="id3CA60D2D98944151A4FDB1A7ECC96EEE"><enum>(1)</enum><header>In general</header><text>Section 1710(e) of title 38, United States Code, is amended—</text><subparagraph id="idD95C5FACB9434B5DB008D737B38DE596"><enum>(A)</enum><text>in paragraph (1), by adding at the end the following new subparagraph: </text><quoted-block id="id38161221F9414E3A830E6CCF1892E0C6" style="USC" act-name=""><subparagraph indent="up2" id="id79B2F39DBE4848DE8AE6824DFEA69ACA"><enum>(G)</enum><clause commented="no" display-inline="yes-display-inline" id="id70CE3F3D15424933A4A84E1CDBE1EBFD"><enum>(i)</enum><text>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.</text></clause><clause indent="up1" id="idAAB0FB5A75DA498681137DFC6F5C8B6A"><enum>(ii)</enum><text>For purposes of this subparagraph, a covered individual is an individual 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—</text><item id="idC4D03EDDA151434DA4FCC687E6C67F1C"><enum>(aa)</enum><text>an open burn pit; </text></item><item id="idD8B5FAB6E18C4E83AB98641FBC09C145"><enum>(bb)</enum><text>a toxic substance; or</text></item><item id="id9B0049965A2742A9AF2766D66F656D89"><enum>(cc)</enum><text>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. </text></item></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><subclause id="idA3D482517DEE4402A7D52F1F57DD1C52"><enum>(III)</enum><text>The term <term>toxic substance</term> means a toxicant or a toxin.</text></subclause><subclause id="id5F451006A77A4AEBB73365895F70CF13"><enum>(IV)</enum><text>The term <term>toxicant</term> 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. </text></subclause><subclause id="idF1F47311F1E644EA8912D18607434D0A"><enum>(V)</enum><text>The term <term>toxin</term> means any substance that can injure or kill humans, animals, or plants and that is produced naturally.</text></subclause></clause></subparagraph><after-quoted-block>; and </after-quoted-block></quoted-block></subparagraph><subparagraph id="idA68B350A70F34657AE53141FBE692C43"><enum>(B)</enum><text>in paragraph (2)(B), by striking <quote>or (F)</quote> and inserting <quote>(F), or (G)</quote>. </text></subparagraph></paragraph><paragraph id="idF0843E96FB244CF790FE80F1C98CF23B"><enum>(2)</enum><header>Effective date</header><text>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. </text></paragraph></subsection><subsection id="id6D83B2DE88174AEABA993A2FDBE44772" commented="no"><enum>(b)</enum><header>Determinations of exposure</header><paragraph commented="no" id="idAC24348AF7C448EAAC6E486754EAAB3B"><enum>(1)</enum><header>In general</header><text>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. </text></paragraph><paragraph commented="no" id="id8BAF61FE07484C49B634280BA97C0C58"><enum>(2)</enum><header>Approval of Secretary</header><text>Any determination made under paragraph (1) shall be subject to the approval of the Secretary. </text></paragraph><paragraph commented="no" id="idC758F97A85E940318244685A0BCF6B0F"><enum>(3)</enum><header>Appeals</header><text>The Secretary shall establish a mechanism for appealing a decision made by the Secretary under paragraph (2).</text></paragraph></subsection><subsection id="id37970F240728487ABAAA21D40A964FFC"><enum>(c)</enum><header>Report</header><paragraph id="id9962B37E7D4A477F82284A2271549E62"><enum>(1)</enum><header>In general</header><text>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. </text></paragraph><paragraph id="idF5671117395C44D0B5E603C03EA670BA"><enum>(2)</enum><header>Elements</header><text>The report required by paragraph (1) shall include the following: </text><subparagraph id="idAFFA3863EDA8472F9AB7923A85EBEC79"><enum>(A)</enum><text>The duty locations or units of the individuals described in paragraph (1), or other information on groups to which such individuals belong. </text></subparagraph><subparagraph id="id86469880D2E9443997B51F2AE856971F"><enum>(B)</enum><text>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). </text></subparagraph><subparagraph id="id223D69D3DB81451CA19115208C7EAB29"><enum>(C)</enum><text>The criteria used to determine whether an individual was so exposed. </text></subparagraph></paragraph><paragraph id="id5261E1F1DFD24F669CEFF0FAE9EB34B8"><enum>(3)</enum><header>Appropriate committees of Congress</header><text>In this subsection, the term <term>appropriate committees of Congress</term> means—</text><subparagraph id="id5214224EA7494D8AA49E6F46CF99891A"><enum>(A)</enum><text>the Committee on Veterans' Affairs and the Committee on Armed Services of the Senate; and </text></subparagraph><subparagraph id="id241771213AFF48A0932A545DE900BCB7"><enum>(B)</enum><text>the Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives. </text></subparagraph></paragraph></subsection></section><section id="idB9FB1085A2AB4E0684E5D86463571011"><enum>102.</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 101(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>(H)</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="id0CF28BE955EA427A94E88186EC7E1E46"><enum>(i)</enum><text>The Armed Forces Service Medal. </text></clause><clause id="idDD08C9EE57E94B738DCADBA4146A95FE"><enum>(ii)</enum><text>The Afghanistan Campaign Medal.</text></clause><clause id="idB529D87A99FE4147A6AB403A3D8D6279"><enum>(iii)</enum><text>The Global War on Terrorism Expeditionary Medal. </text></clause><clause id="idFA397665946341D1AF32DE2366C16E9B"><enum>(iv)</enum><text>The Inherent Resolve Campaign Medal. </text></clause><clause id="idBAA70CDD591347069642EF55E6C41B12"><enum>(v)</enum><text>The Iraq Campaign Medal.</text></clause><clause id="idB0A18EE2E206453D9911E7AF98B279D6"><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), by striking <quote>or (G)</quote> and inserting <quote>(G), or (H)</quote>. </text></paragraph></subsection><subsection id="id2BAAB3B6CFDB4364A64FF3AD0C9D3C32"><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="id26BFBF42F0054041A88C416EFC799812"><enum>103.</enum><header>Presumptions of service connection for diseases associated with exposure to certain toxic substances</header><subsection id="idE71C00F9EBB24C39B399F9DE8F7B17FE"><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, is amended by adding at the end the following new section: </text><quoted-block id="id56E3A8469ACF44438602E5DB1D59D20D" style="USC" act-name=""><section id="idE2427D5308DD4DA3A02D78F1651CD9BB"><enum>1119.</enum><header>Presumptions of service connection for diseases associated with exposure to certain toxic substances</header><subsection id="id80BF02CBE43840338E256CBA33F2E81C"><enum>(a)</enum><header>Presumptions of service connection</header><paragraph commented="no" display-inline="yes-display-inline" id="id2C2B26CC2F2A469BA978D7EF2E26011E"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="idF3D1A90574B8478C8833567CBC165979" indent="up1"><enum>(2)</enum><text>A disease specified in this paragraph is any disease that—</text><subparagraph id="id2B9E8CBA6F9F4BE3B7CB3E0321FA4C5A"><enum>(A)</enum><text>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 </text></subparagraph><subparagraph id="id18D74152376749DDA6AFA62E8E84DB72"><enum>(B)</enum><text>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.</text></subparagraph></paragraph><paragraph indent="up1" id="id56B3714F50B84B418730FBE89B80587F"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idB5237C2526DC4206921AF2F6DA2BDA22"><enum>(A)</enum><text>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.</text></subparagraph><subparagraph indent="up1" id="idFFDA4521F9A141A5B2A1F4A06CE9562A"><enum>(B)</enum><text> The factors set forth in this subparagraph are as follows: </text><clause id="id5E5A4BF60C3B4E1BB1BDA798C0A1A0C9"><enum>(i)</enum><text>The duty location of the veteran. </text></clause><clause id="id09BD8278D0F14DAE8A9C5683C197457D"><enum>(ii)</enum><text>The length of service of the veteran. </text></clause><clause id="id4C913AFDC42E422CAF28727D72D6EBA2"><enum>(iii)</enum><text>Such other factors as the Secretary considers appropriate. </text></clause></subparagraph></paragraph></subsection><subsection id="id48307B23E2434E5BA85F8BAD317654DF"><enum>(b)</enum><header>Determinations relating to diseases</header><paragraph commented="no" display-inline="yes-display-inline" id="idA2D53F04602842CDB5CAC0FBF8492CF8"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="id6B69035D6DCF4D3C82A942F46B253BBF" indent="up1"><enum>(2)</enum><text>In making determinations under paragraph (1), the Secretary shall take into account—</text><subparagraph id="idB88B7755BEF044C682BA3F48CB298998"><enum>(A)</enum><text>reports received by the Secretary from the National Academies of Sciences, Engineering, and Medicine under section 202(g) of the <short-title>Toxic Exposure in the American Military Act</short-title>; and</text></subparagraph><subparagraph id="idE4A9BAAACBAB434F8CA33F944C0A5899"><enum>(B)</enum><text>all other sound medical and scientific information and analyses available to the Secretary.</text></subparagraph></paragraph><paragraph indent="up1" id="id6A5EAE1E8D834140B1AF0FADE5D888ED"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id8BA58C02BD6048F9AD72F07FB46D5B25"><enum>(A)</enum><text>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.</text></subparagraph><subparagraph indent="up1" id="idA29ADE21977D411B937457A59D8043D3"><enum>(B)</enum><text>The Secretary may define the standards described in subparagraph (A) for purposes of that subparagraph. </text></subparagraph></paragraph></subsection><subsection id="id82D1B4FC4A8A44C4BDA76A8BDCF41464"><enum>(c)</enum><header>Response to reports by the National Academies of Sciences, Engineering, and Medicine</header><paragraph commented="no" display-inline="yes-display-inline" id="id356F353429C442339097C73F516E21BB"><enum>(1)</enum><text>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 <short-title>Toxic Exposure in the American Military Act</short-title>, the Secretary shall determine whether a presumption of service connection is warranted for each disease covered by the report. </text></paragraph><paragraph id="id63928385796248F58C9C098751107932" indent="up1"><enum>(2)</enum><text>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.</text></paragraph><paragraph indent="up1" id="idC8A8CFDB06BC476B9D9B7A00E62765E3"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id6BBAFB2083BA47758255105FBA627354"><enum>(A)</enum><text>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. </text></subparagraph><subparagraph indent="up1" id="id7F9F779769664B0FAE447DE76BA879E5"><enum>(B)</enum><text>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—</text><clause id="id8340A78DB1BA428BBE3995FD73F44C65"><enum>(i)</enum><text>sufficient evidence of an association between the exposure of humans to a toxic substance and the occurrence of the disease in humans; or</text></clause><clause id="idDCA2F763DD654A3ABFADF38AEFA4BA60"><enum>(ii)</enum><text>limited evidence or suggestive evidence of such an association. </text></clause></subparagraph><subparagraph indent="up1" id="idFE476D05814344399954B4CBF852C14B"><enum>(C)</enum><text>Any notice published under subparagraph (A) shall include an explanation of the scientific basis for the determination described in subparagraph (B).</text></subparagraph><subparagraph indent="up1" id="id69096CF81D2E4E9D9FEE810EC9BCF699"><enum>(D)</enum><text>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.</text></subparagraph></paragraph><paragraph indent="up1" id="idD5EFAEB2749A49189DA6C5BF70C64F1C"><enum>(4)</enum><text>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.</text></paragraph></subsection><subsection id="idA18DC6C9C5094C5BA3868718C2E00587"><enum>(d)</enum><header>Removal of presumption of service connection</header><text>Whenever the presumption of service connection for a disease under this section is removed under subsection (c)—</text><paragraph id="idB7C191A4EC5A477EA5FADB8CC1B9D368"><enum>(1)</enum><text>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</text></paragraph><paragraph id="idCC79C02E5A0342DAAC8C2D24E3E4D6B8"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="id59DEAAB816CC4CEA8C204C0CBC86143C"><enum>(e)</enum><header>Reference to National Academies of Sciences, Engineering, and Medicine</header><text>In the case that the Secretary enters into an agreement with another organization as described in section 202(h)(1) of the <short-title>Toxic Exposure in the American Military Act</short-title>, any reference in this section to the National Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization.</text></subsection><subsection id="idCBE6EF03B0EB416E820846478629C482"><enum>(f)</enum><header>Definitions</header><text>In this section:</text><paragraph id="idb51c3201b65e48c7aed510d62da5a8e1" commented="no"><enum>(1)</enum><text>The term <term>positive association</term> 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. </text></paragraph><paragraph id="id17157A74C82C45E08FD1DCD85B624895"><enum>(2)</enum><text>The term <term>toxic substance</term> has the meaning given that term in section 1710(e)(1)(G)(iii) of this title.</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 chapter 11 of such title is amended by inserting after the item relating to section 1118 the following new item:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id6365C9B53DCF4568AD1893FB0CBB8A9D"><toc><toc-entry level="section" bold="off">1119. Presumptions of service connection for diseases associated with exposure to certain toxic substances.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idDDF1B6BA85EC40F1A53AA426E247B182" 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>

112 S927 IS: Toxic Exposure in the American Military Act U.S. Senate 2021-03-23 text/xml 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.

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.

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).

<enum>I</enum><header>Expansion of health care and benefits for veterans exposed to toxic substances</header><section id="id0ce2ea0edc9342bba6f54c2ea6579341"><enum>101.</enum><header>Expansion of health care eligibility for certain individuals exposed to open burn pits and other toxic substances</header><subsection id="id3FD6EED54AB1472595F8759F2093FF93"><enum>(a)</enum><header>Expansion of health care eligibility</header><paragraph id="id3CA60D2D98944151A4FDB1A7ECC96EEE"><enum>(1)</enum><header>In general</header><text>Section 1710(e) of title 38, United States Code, is amended—</text><subparagraph id="idD95C5FACB9434B5DB008D737B38DE596"><enum>(A)</enum><text>in paragraph (1), by adding at the end the following new subparagraph: </text><quoted-block id="id38161221F9414E3A830E6CCF1892E0C6" style="USC" act-name=""><subparagraph indent="up2" id="id79B2F39DBE4848DE8AE6824DFEA69ACA"><enum>(G)</enum><clause commented="no" display-inline="yes-display-inline" id="id70CE3F3D15424933A4A84E1CDBE1EBFD"><enum>(i)</enum><text>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.</text></clause><clause indent="up1" id="idAAB0FB5A75DA498681137DFC6F5C8B6A"><enum>(ii)</enum><text>For purposes of this subparagraph, a covered individual is an individual 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—</text><item id="idC4D03EDDA151434DA4FCC687E6C67F1C"><enum>(aa)</enum><text>an open burn pit; </text></item><item id="idD8B5FAB6E18C4E83AB98641FBC09C145"><enum>(bb)</enum><text>a toxic substance; or</text></item><item id="id9B0049965A2742A9AF2766D66F656D89"><enum>(cc)</enum><text>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. </text></item></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><subclause id="idA3D482517DEE4402A7D52F1F57DD1C52"><enum>(III)</enum><text>The term <term>toxic substance</term> means a toxicant or a toxin.</text></subclause><subclause id="id5F451006A77A4AEBB73365895F70CF13"><enum>(IV)</enum><text>The term <term>toxicant</term> 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. </text></subclause><subclause id="idF1F47311F1E644EA8912D18607434D0A"><enum>(V)</enum><text>The term <term>toxin</term> means any substance that can injure or kill humans, animals, or plants and that is produced naturally.</text></subclause></clause></subparagraph><after-quoted-block>; and </after-quoted-block></quoted-block></subparagraph><subparagraph id="idA68B350A70F34657AE53141FBE692C43"><enum>(B)</enum><text>in paragraph (2)(B), by striking <quote>or (F)</quote> and inserting <quote>(F), or (G)</quote>. </text></subparagraph></paragraph><paragraph id="idF0843E96FB244CF790FE80F1C98CF23B"><enum>(2)</enum><header>Effective date</header><text>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. </text></paragraph></subsection><subsection id="id6D83B2DE88174AEABA993A2FDBE44772" commented="no"><enum>(b)</enum><header>Determinations of exposure</header><paragraph commented="no" id="idAC24348AF7C448EAAC6E486754EAAB3B"><enum>(1)</enum><header>In general</header><text>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. </text></paragraph><paragraph commented="no" id="id8BAF61FE07484C49B634280BA97C0C58"><enum>(2)</enum><header>Approval of Secretary</header><text>Any determination made under paragraph (1) shall be subject to the approval of the Secretary. </text></paragraph><paragraph commented="no" id="idC758F97A85E940318244685A0BCF6B0F"><enum>(3)</enum><header>Appeals</header><text>The Secretary shall establish a mechanism for appealing a decision made by the Secretary under paragraph (2).</text></paragraph></subsection><subsection id="id37970F240728487ABAAA21D40A964FFC"><enum>(c)</enum><header>Report</header><paragraph id="id9962B37E7D4A477F82284A2271549E62"><enum>(1)</enum><header>In general</header><text>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. </text></paragraph><paragraph id="idF5671117395C44D0B5E603C03EA670BA"><enum>(2)</enum><header>Elements</header><text>The report required by paragraph (1) shall include the following: </text><subparagraph id="idAFFA3863EDA8472F9AB7923A85EBEC79"><enum>(A)</enum><text>The duty locations or units of the individuals described in paragraph (1), or other information on groups to which such individuals belong. </text></subparagraph><subparagraph id="id86469880D2E9443997B51F2AE856971F"><enum>(B)</enum><text>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). </text></subparagraph><subparagraph id="id223D69D3DB81451CA19115208C7EAB29"><enum>(C)</enum><text>The criteria used to determine whether an individual was so exposed. </text></subparagraph></paragraph><paragraph id="id5261E1F1DFD24F669CEFF0FAE9EB34B8"><enum>(3)</enum><header>Appropriate committees of Congress</header><text>In this subsection, the term <term>appropriate committees of Congress</term> means—</text><subparagraph id="id5214224EA7494D8AA49E6F46CF99891A"><enum>(A)</enum><text>the Committee on Veterans' Affairs and the Committee on Armed Services of the Senate; and </text></subparagraph><subparagraph id="id241771213AFF48A0932A545DE900BCB7"><enum>(B)</enum><text>the Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives. </text></subparagraph></paragraph></subsection></section><section id="idB9FB1085A2AB4E0684E5D86463571011"><enum>102.</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 101(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>(H)</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="id0CF28BE955EA427A94E88186EC7E1E46"><enum>(i)</enum><text>The Armed Forces Service Medal. </text></clause><clause id="idDD08C9EE57E94B738DCADBA4146A95FE"><enum>(ii)</enum><text>The Afghanistan Campaign Medal.</text></clause><clause id="idB529D87A99FE4147A6AB403A3D8D6279"><enum>(iii)</enum><text>The Global War on Terrorism Expeditionary Medal. </text></clause><clause id="idFA397665946341D1AF32DE2366C16E9B"><enum>(iv)</enum><text>The Inherent Resolve Campaign Medal. </text></clause><clause id="idBAA70CDD591347069642EF55E6C41B12"><enum>(v)</enum><text>The Iraq Campaign Medal.</text></clause><clause id="idB0A18EE2E206453D9911E7AF98B279D6"><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), by striking <quote>or (G)</quote> and inserting <quote>(G), or (H)</quote>. </text></paragraph></subsection><subsection id="id2BAAB3B6CFDB4364A64FF3AD0C9D3C32"><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="id26BFBF42F0054041A88C416EFC799812"><enum>103.</enum><header>Presumptions of service connection for diseases associated with exposure to certain toxic substances</header><subsection id="idE71C00F9EBB24C39B399F9DE8F7B17FE"><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, is amended by adding at the end the following new section: </text><quoted-block id="id56E3A8469ACF44438602E5DB1D59D20D" style="USC" act-name=""><section id="idE2427D5308DD4DA3A02D78F1651CD9BB"><enum>1119.</enum><header>Presumptions of service connection for diseases associated with exposure to certain toxic substances</header><subsection id="id80BF02CBE43840338E256CBA33F2E81C"><enum>(a)</enum><header>Presumptions of service connection</header><paragraph commented="no" display-inline="yes-display-inline" id="id2C2B26CC2F2A469BA978D7EF2E26011E"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="idF3D1A90574B8478C8833567CBC165979" indent="up1"><enum>(2)</enum><text>A disease specified in this paragraph is any disease that—</text><subparagraph id="id2B9E8CBA6F9F4BE3B7CB3E0321FA4C5A"><enum>(A)</enum><text>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 </text></subparagraph><subparagraph id="id18D74152376749DDA6AFA62E8E84DB72"><enum>(B)</enum><text>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.</text></subparagraph></paragraph><paragraph indent="up1" id="id56B3714F50B84B418730FBE89B80587F"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idB5237C2526DC4206921AF2F6DA2BDA22"><enum>(A)</enum><text>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.</text></subparagraph><subparagraph indent="up1" id="idFFDA4521F9A141A5B2A1F4A06CE9562A"><enum>(B)</enum><text> The factors set forth in this subparagraph are as follows: </text><clause id="id5E5A4BF60C3B4E1BB1BDA798C0A1A0C9"><enum>(i)</enum><text>The duty location of the veteran. </text></clause><clause id="id09BD8278D0F14DAE8A9C5683C197457D"><enum>(ii)</enum><text>The length of service of the veteran. </text></clause><clause id="id4C913AFDC42E422CAF28727D72D6EBA2"><enum>(iii)</enum><text>Such other factors as the Secretary considers appropriate. </text></clause></subparagraph></paragraph></subsection><subsection id="id48307B23E2434E5BA85F8BAD317654DF"><enum>(b)</enum><header>Determinations relating to diseases</header><paragraph commented="no" display-inline="yes-display-inline" id="idA2D53F04602842CDB5CAC0FBF8492CF8"><enum>(1)</enum><text>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.</text></paragraph><paragraph id="id6B69035D6DCF4D3C82A942F46B253BBF" indent="up1"><enum>(2)</enum><text>In making determinations under paragraph (1), the Secretary shall take into account—</text><subparagraph id="idB88B7755BEF044C682BA3F48CB298998"><enum>(A)</enum><text>reports received by the Secretary from the National Academies of Sciences, Engineering, and Medicine under section 202(g) of the <short-title>Toxic Exposure in the American Military Act</short-title>; and</text></subparagraph><subparagraph id="idE4A9BAAACBAB434F8CA33F944C0A5899"><enum>(B)</enum><text>all other sound medical and scientific information and analyses available to the Secretary.</text></subparagraph></paragraph><paragraph indent="up1" id="id6A5EAE1E8D834140B1AF0FADE5D888ED"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id8BA58C02BD6048F9AD72F07FB46D5B25"><enum>(A)</enum><text>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.</text></subparagraph><subparagraph indent="up1" id="idA29ADE21977D411B937457A59D8043D3"><enum>(B)</enum><text>The Secretary may define the standards described in subparagraph (A) for purposes of that subparagraph. </text></subparagraph></paragraph></subsection><subsection id="id82D1B4FC4A8A44C4BDA76A8BDCF41464"><enum>(c)</enum><header>Response to reports by the National Academies of Sciences, Engineering, and Medicine</header><paragraph commented="no" display-inline="yes-display-inline" id="id356F353429C442339097C73F516E21BB"><enum>(1)</enum><text>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 <short-title>Toxic Exposure in the American Military Act</short-title>, the Secretary shall determine whether a presumption of service connection is warranted for each disease covered by the report. </text></paragraph><paragraph id="id63928385796248F58C9C098751107932" indent="up1"><enum>(2)</enum><text>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.</text></paragraph><paragraph indent="up1" id="idC8A8CFDB06BC476B9D9B7A00E62765E3"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id6BBAFB2083BA47758255105FBA627354"><enum>(A)</enum><text>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. </text></subparagraph><subparagraph indent="up1" id="id7F9F779769664B0FAE447DE76BA879E5"><enum>(B)</enum><text>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—</text><clause id="id8340A78DB1BA428BBE3995FD73F44C65"><enum>(i)</enum><text>sufficient evidence of an association between the exposure of humans to a toxic substance and the occurrence of the disease in humans; or</text></clause><clause id="idDCA2F763DD654A3ABFADF38AEFA4BA60"><enum>(ii)</enum><text>limited evidence or suggestive evidence of such an association. </text></clause></subparagraph><subparagraph indent="up1" id="idFE476D05814344399954B4CBF852C14B"><enum>(C)</enum><text>Any notice published under subparagraph (A) shall include an explanation of the scientific basis for the determination described in subparagraph (B).</text></subparagraph><subparagraph indent="up1" id="id69096CF81D2E4E9D9FEE810EC9BCF699"><enum>(D)</enum><text>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.</text></subparagraph></paragraph><paragraph indent="up1" id="idD5EFAEB2749A49189DA6C5BF70C64F1C"><enum>(4)</enum><text>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.</text></paragraph></subsection><subsection id="idA18DC6C9C5094C5BA3868718C2E00587"><enum>(d)</enum><header>Removal of presumption of service connection</header><text>Whenever the presumption of service connection for a disease under this section is removed under subsection (c)—</text><paragraph id="idB7C191A4EC5A477EA5FADB8CC1B9D368"><enum>(1)</enum><text>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</text></paragraph><paragraph id="idCC79C02E5A0342DAAC8C2D24E3E4D6B8"><enum>(2)</enum><text>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.</text></paragraph></subsection><subsection id="id59DEAAB816CC4CEA8C204C0CBC86143C"><enum>(e)</enum><header>Reference to National Academies of Sciences, Engineering, and Medicine</header><text>In the case that the Secretary enters into an agreement with another organization as described in section 202(h)(1) of the <short-title>Toxic Exposure in the American Military Act</short-title>, any reference in this section to the National Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization.</text></subsection><subsection id="idCBE6EF03B0EB416E820846478629C482"><enum>(f)</enum><header>Definitions</header><text>In this section:</text><paragraph id="idb51c3201b65e48c7aed510d62da5a8e1" commented="no"><enum>(1)</enum><text>The term <term>positive association</term> 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. </text></paragraph><paragraph id="id17157A74C82C45E08FD1DCD85B624895"><enum>(2)</enum><text>The term <term>toxic substance</term> has the meaning given that term in section 1710(e)(1)(G)(iii) of this title.</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 chapter 11 of such title is amended by inserting after the item relating to section 1118 the following new item:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id6365C9B53DCF4568AD1893FB0CBB8A9D"><toc><toc-entry level="section" bold="off">1119. Presumptions of service connection for diseases associated with exposure to certain toxic substances.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="idDDF1B6BA85EC40F1A53AA426E247B182" 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><enum>II</enum><header>Research and review regarding exposure to toxic substances</header><section id="id0c2b9fc9b5b848d29767fb69652dcbcd"><enum>201.</enum><header>Establishment of Toxic Exposure Review Commission</header><subsection id="id41BCD6A411E24617860DC7C79077BD57"><enum>(a)</enum><header>In general</header><text>Subchapter III of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/5">chapter 5</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="idE8E53BBCDC8D4992B3F2DDB79842F408"><section id="id4054B190798E429E889D07ECC4E791BE"><enum>547.</enum><header>Toxic Exposure Review Commission</header><subsection id="id6b434f2b4b8849a1ac2ce01a7fd465f4"><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="idef2cd0af731d4011880b8bc160a95f7d"><enum>(b)</enum><header>Purpose</header><text>The Commission shall— </text><paragraph id="idB4D87782C2344B519E8B7518F987D359"><enum>(1)</enum><text>advise the Secretary on questions relating to exposure to toxic substances that require scientific research; and</text></paragraph><paragraph id="idB55E7A2C97E7496D9DF2DBBE6B05869A"><enum>(2)</enum><text>assist in the consideration of possible presumptions of service connection.</text></paragraph></subsection><subsection id="idACC2ABD936724A6D99454E7D82CD923D"><enum>(c)</enum><header>Duties</header><paragraph commented="no" display-inline="yes-display-inline" id="id6A86815030F44CA7B9BC43C05285B4B9"><enum>(1)</enum><text>The Commission shall carry out the following duties:</text><subparagraph id="idf989dafa7ab84f879ad4ba79c3a10483" indent="up1"><enum>(A)</enum><text>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 <short-title>Toxic Exposure in the American Military Act</short-title>. </text></subparagraph><subparagraph id="id620CF08BA5ED4C9F87031FD0D1FD0368" indent="up1"><enum>(B)</enum><text>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 <short-title>Toxic Exposure in the American Military Act</short-title>.</text></subparagraph><subparagraph id="idAAB0D18C1DD548A4A2344CF8DA65CAA6" indent="up1"><enum>(C)</enum><text>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.</text></subparagraph><subparagraph id="id9343B09091B944FF8ADEE8893951809D" indent="up1"><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 id="idD218B139A7D34D89B7AF311FC27E027C" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id7DBE744E6F4640668F3D449067212C59"><enum>(A)</enum><text>Relevant information may be collected under paragraph (1)(A) from the following:</text><clause id="id0411FF0FC8F04E1E9EFBB8501213A611" indent="up1"><enum>(i)</enum><text>Any Federal agency as the Commission considers necessary to carry out this section.</text></clause><clause id="id037F7041BB1043EE989B73234A6BE3FF" indent="up1"><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="idCF935151CAE2454AAA9A4FD5DC072015"><enum>(B)</enum><text>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.</text></subparagraph></paragraph></subsection><subsection id="idbf1c5cce3cca4d5c9f6741163e5815ad"><enum>(d)</enum><header>Membership</header><paragraph commented="no" display-inline="yes-display-inline" id="id996DDB7757834B3CA33AF7DED9277076"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id753C46E3FCBF4671A1CA9FDB80FE09E2"><enum>(A)</enum><text>The Commission shall be composed of nine members, appointed as follows:</text><clause id="idc1703ad2648742fbaab852fffbf84479" indent="up2"><enum>(i)</enum><text>Two members appointed by the Speaker of the House of Representatives.</text></clause><clause id="id69eaa67ad49d4e718424a325ff8a3ce8" indent="up2"><enum>(ii)</enum><text>Two members appointed by the minority leader of the House of Representatives.</text></clause><clause id="id93dd4a3b4ffa4e92bb2e97f9aa08741a" indent="up2"><enum>(iii)</enum><text>Two members appointed by the majority leader of the Senate.</text></clause><clause id="id62fd20f30ada40f09921d16906b20953" indent="up2"><enum>(iv)</enum><text>Two members appointed by the minority leader of the Senate.</text></clause><clause id="idd9cf160ae7b5456e9035ed3fd8719d65" indent="up2"><enum>(v)</enum><text>One member appointed by the Secretary. </text></clause></subparagraph><subparagraph id="id47e07ec7374c425e941a41e85d58345a" indent="up2"><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>Toxic Exposure in the American Military Act</short-title>.</text></subparagraph></paragraph><paragraph indent="up1" id="id871FA1897DDC4E89ABD226B90FA0FA88"><enum>(2)</enum><text>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—</text><subparagraph id="idEB3128B69E6D49AB8CE34F15FBE5EF29"><enum>(A)</enum><text>of whom—</text><clause id="idCA05B877F69B48FF8EC0985DBEABCBA0"><enum>(i)</enum><text>one has a background in the field of respiratory medicine; </text></clause><clause id="idDB25D69BEE9A4AEC87CA370B7F2845C2"><enum>(ii)</enum><text>one has a background in the field of endocrinology and metabolic medicine;</text></clause><clause id="idABE2607E87AD458A8E9D583C7ABBAF4E"><enum>(iii)</enum><text>one has a background in hematology; </text></clause><clause id="id00D61912C9E6443FA79F5177CB8B73EB"><enum>(iv)</enum><text>one has a background in oncology; and </text></clause><clause id="id77BE271F5AFC42C9958E61017B5817B7"><enum>(v)</enum><text>one has a background in occupational and environmental health; and</text></clause></subparagraph><subparagraph id="idC4893F6530524D16AB0562396EE04D73"><enum>(B)</enum><text>who are not officials or employees of the Federal Government. </text></subparagraph></paragraph><paragraph indent="up1" id="id8F716A940D944D63A1C04C5D9A9A2812"><enum>(3)</enum><text>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. </text></paragraph><paragraph indent="up1" id="idA2B6AA5BD71C4D9699BA44FD456A2062"><enum>(4)</enum><text>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.</text></paragraph></subsection><subsection id="idd0d84ead879948438ed2c9c26def0b26"><enum>(e)</enum><header>Meetings</header><paragraph commented="no" display-inline="yes-display-inline" id="id09BCFAD7BF4444A2A4F3E43847E257D4"><enum>(1)</enum><text>The Commission shall meet not less frequently than twice each year.</text></paragraph><paragraph id="id21d9f6cc5e374cb685acd10b68d0a6cb" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idD028A645930A48AB9F5DAB6C08258989"><enum>(A)</enum><text>Each meeting of the Commission shall be open to the public.</text></subparagraph><subparagraph indent="up1" id="id2E7080EC260948AB88505D15BF8515E7"><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="id84EFA422085B465B8411261AEEB8EB3E"><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="ID79CF96D103FD4274ADF268D788E44827"><enum>(f)</enum><header>Chair and Vice Chair</header><text>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. </text></subsection><subsection id="id2628cbc7d5174761abd9a5fa1f6b4ae3"><enum>(g)</enum><header>Period of appointment; vacancies</header><paragraph commented="no" display-inline="yes-display-inline" id="idFBD5941BB4154690B4C6831EF1FAD72B"><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="id2FDC9FFD5A7A4B598B1422EA0D8ABC2B"><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="id13F41FDF7F59433BB371B7116A0C55B8"><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="id09CCA22D8FFF4880B5A1484B9FF08328"><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="id5B62ED8BD8B64266BE7FD03B13D016B9"><enum>(A)</enum><text>one member whose term expires after two years; and </text></subparagraph><subparagraph id="id151CE2D0910040D2B1371F954A83F865"><enum>(B)</enum><text>one member whose term expires after four years. </text></subparagraph></paragraph></subsection><subsection id="id9a6e0399fce84b9aa4f18b2968f8b0e2"><enum>(h)</enum><header>Pay</header><paragraph commented="no" display-inline="yes-display-inline" id="idCFFA754757F84728AB9ADE5DF1E706B1"><enum>(1)</enum><text>Members of the Commission shall serve without pay.</text></paragraph><paragraph id="id54AF580C4E8449BF88D45BF42022799C" indent="up1"><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="idA416D0A0FED1423A815D8A0C77D22C5B"><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="idea90dbaf82ac4c7e8781a3008888479a"><enum>(i)</enum><header>Director of staff</header><paragraph commented="no" display-inline="yes-display-inline" id="idFFF635C6CF564E77AF64F8F55D092F1E"><enum>(1)</enum><text>The Commission shall appoint a Director who—</text><subparagraph id="id819fe9c153da429897dab55336404e36" indent="up1"><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 id="idfffad2956d0f4849826ecf8e4c435cbf" indent="up1"><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 id="id15cc9794f4bf487eadac5f8520c5449d" indent="up1"><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="id2ed15e9d4e07413896d372c4338dfd35"><enum>(j)</enum><header>Staff</header><paragraph commented="no" display-inline="yes-display-inline" id="id6F4EEA1A0FE24BABB7B712EA57E353AB"><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 id="idE7896F958F4F49EF91872F7FC1AB2EDB" indent="up1"><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="idD8104108213F42FE9F90BA0863F57D0F"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id3AF12C0A00EE47F4AF454F4683F69891"><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="idDD571AA9148F47EA858F3D79838ECB8E"><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 id="id2dcae3d6f8654f3fb59a261253e28c33" indent="up1"><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 id="ide030dc94541049b3a195d9f3a911a9dd" indent="up1"><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 Chair, the head of such agency shall furnish such information to the Commission, unless such information is classified.</text></paragraph></subsection><subsection id="iddae110befc7c4cf58072a3263c3ec30a"><enum>(k)</enum><header>Other authority</header><paragraph commented="no" display-inline="yes-display-inline" id="id8195C1DCB2034DD28664F42D9B4C1569"><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 id="id0DDC090AD20945DFA90E0C32959D4D8A" indent="up1"><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="id0f066a51483648198c026f3f5abe54bc"><enum>(l)</enum><header>Communications</header><paragraph commented="no" display-inline="yes-display-inline" id="idD084B63137A94C0B847FB675364E9243"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id0479845BA75D467D91A15354C59C696C"><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 id="idcb8aa3d406ac480bb67a1507ec81e412" indent="up2"><enum>(B)</enum><text>Subparagraph (A) does not apply to a communication that is unlawful.</text></subparagraph></paragraph><paragraph id="id5b072e3278fe45f6bd20611f1d24fc1a" indent="up1"><enum>(2)</enum><text>All ex parte communications with the Commission shall be made part of the public record.</text></paragraph></subsection><subsection id="idA299163BD47542E795E41099F7087772"><enum>(m)</enum><header>Reference to National Academies of Sciences, Engineering, and Medicine</header><text>In the case that the Secretary enters into an agreement with another organization as described in section 202(h)(1) of the <short-title>Toxic Exposure in the American Military Act</short-title>, any reference in this section to the National Academies of Sciences, Engineering, and Medicine shall be treated as a reference to the other organization. </text></subsection><subsection id="idB35C1E84BB4D44A28ACA66099DA78952"><enum>(n)</enum><header>Toxic substance defined</header><text>In this section, the term <term>toxic substance</term> has the meaning given that term in subparagraph (G)(iii) of section 1710(e)(1) of this title.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id264AF706FB9740BA86512B5BB869D6C0"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 5 of such title is amended by adding at the end the following new item:</text><quoted-block style="USC" id="id51b28416-61ce-4120-90af-90e22839c99d"><toc><toc-entry level="section" idref="id4054B190798E429E889D07ECC4E791BE">547. Toxic Exposure Review Commission.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section><section id="id2dc41f1fb17b4f45b23c3b0babc2eb6c"><enum>202.</enum><header>Agreement with National Academies of Sciences, Engineering, and Medicine concerning the exposure of humans to toxic substances</header><subsection id="id2344eb55c81e441dbcc0c6f0bdafa3cd"><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 diseases and exposure to toxic substances.</text></subsection><subsection id="id17743f1e678f457099393555cebcb200"><enum>(b)</enum><header>Agreement</header><paragraph id="id19268b43e7c14e53815fd5d6d786df63"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph><paragraph id="id1e8e848fb2134b7b9c8c87d49497ffbd"><enum>(2)</enum><header>Timing</header><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 this Act.</text></paragraph><paragraph id="id7F2B329EBA874A469083FDAB152AE725"><enum>(3)</enum><header>Extension</header><text>An agreement under this section may be extended in five-year increments. </text></paragraph></subsection><subsection id="id4964ef57451a4db5a01f8a6211520c67"><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 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.</text></subsection><subsection id="idfb2dc445ad9f4607bcf52c0cc29f8fab"><enum>(d)</enum><header>Scientific determinations concerning diseases</header><text>For each disease reviewed under subsection (c), the Academies shall determine, to the extent that available scientific data permit meaningful determinations—</text><paragraph id="ide984538016424b239788b15e0342682e"><enum>(1)</enum><text>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;</text></paragraph><paragraph id="ide27d6fc107a4431190a559e837fb2853"><enum>(2)</enum><text>the increased risk of the disease among those exposed to toxic substances during active military, naval, or air service; and </text></paragraph><paragraph id="id84baf556751c44c984654ec09533eeb3"><enum>(3)</enum><text>whether there exists a plausible biological mechanism or other evidence of a causal relationship between the exposure and the occurrence of the disease.</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 id="id07d7ce9c6307488c84453aaa18c61d2a"><enum>(1)</enum><header>In general</header><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 the exposure of humans to toxic substances.</text></paragraph><paragraph id="id3a77da128eb24a62ab363329a336db62"><enum>(2)</enum><header>Considerations</header><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="id652b55ace79b4fcdb9f9bc9649864135"><enum>(g)</enum><header>Reports</header><paragraph id="id4e4c426ae9f44f6aaec3fee8347f2fd7"><enum>(1)</enum><header>Initial report</header><subparagraph id="id798356c43ecb40d5b679d52ceec16c58"><enum>(A)</enum><header>In general</header><text>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.</text></subparagraph><subparagraph id="idd9aa99c99fe543b88bf1838c57ee20fc"><enum>(B)</enum><header>Elements</header><text>The report submitted under subparagraph (A) shall include the following:</text><clause id="id528841ba3bdd466597cffdf47ab401e6"><enum>(i)</enum><text>The determinations described in subsection (d).</text></clause><clause id="id28770e6090d74825b32f96e1d150ad87"><enum>(ii)</enum><text>A full explanation of the scientific evidence and reasoning that led to such determinations. </text></clause><clause id="id09f60483ca5f4092926dc3984d9baa1c"><enum>(iii)</enum><text>Any recommendations of the Academies under subsection (f).</text></clause></subparagraph></paragraph><paragraph id="id0b58854f47f84ca88d1be346a1153bc7"><enum>(2)</enum><header>Periodic updates</header><text>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.</text></paragraph></subsection><subsection id="id30de3c764fb44b4288287cc9a624c873"><enum>(h)</enum><header>Alternative contract scientific organization</header><paragraph id="id883b37b5391e4e0cb2a1ec8221c1de74"><enum>(1)</enum><header>In general</header><text>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—</text><subparagraph id="idb43ad42695bc4c1eaf2da83e163442bd"><enum>(A)</enum><text>is not part of the Federal Government;</text></subparagraph><subparagraph id="id12e262d5fa164cc1ade28422ef7753a1"><enum>(B)</enum><text>operates as a not-for-profit entity; and</text></subparagraph><subparagraph id="ide8bda99898944e488d430760824750d5"><enum>(C)</enum><text>has expertise and objectivity comparable to that of the Academies.</text></subparagraph></paragraph><paragraph id="idb6c443b4f0634373bb50d79bffb9a989"><enum>(2)</enum><header>Treatment</header><text>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.</text></paragraph></subsection></section><section id="id8ea864437c2f49b994639c9296f6a0bc"><enum>203.</enum><header>Collection, analysis, and report on treatment of veterans for medical conditions related to exposure to toxic substances</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 exposure to a toxic substance.</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, 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—</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"><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 exposure to a toxic substance.</text></paragraph></subsection></section><enum>III</enum><header>Improvement of resources of Department of Veterans Affairs regarding exposures to toxic substances</header><section id="id8901a1a6b35a4fb795ad6d8cc1af4fb5"><enum>301.</enum><header>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</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>veterans provided 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, relating to exposure to toxic substances;</text></subparagraph><subparagraph id="idFDE3E7BAE8804276B34C63B39E29ED5A"><enum>(B)</enum><text>veterans eligible for hospital care, medical services, and nursing home care under section 1710(a)(2)(F) of such title; </text></subparagraph><subparagraph id="idb6896442b46c4ccd8aa59c1c593103f9"><enum>(C)</enum><text>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</text></subparagraph><subparagraph id="idab8dd98f654f499c89933ebad316bdf7"><enum>(D)</enum><text>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.</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"><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 exposure to toxic substances, including outreach with respect to benefits and support programs.</text></subsection></section><section id="id316e7810d2374574a447268687b9dc0d"><enum>302.</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 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.</text></subsection><subsection id="idb5e886dfcc224b77825d27bfb27e9fc3"><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="id823042cca16d4024adf8f1ecf66a14bf"><enum>303.</enum><header>Training of health care personnel of Department of Veterans Affairs on illnesses related to exposure to toxic substances</header><subsection id="id103a94ab99ff4b4aba3cc70a3e6e339e"><enum>(a)</enum><header>In general</header><text>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.</text></subsection><subsection id="id42c9b83ed2d445e3ae1413aa5ab65d8a"><enum>(b)</enum><header>Elements of training</header><text>The training required under subsection (a) shall—</text><paragraph id="id55ce8888104a4160836aaf9067dd9f5c"><enum>(1)</enum><text>provide health care personnel of the Department with specific education with respect to illnesses related to exposure to toxic substances; and </text></paragraph><paragraph id="idcd52bca0ef614336868892f2eccb379d"><enum>(2)</enum><text>inform such personnel of how to probe for additional information from veterans regarding exposures to different toxicants.</text></paragraph></subsection><subsection id="id66d27d62e59e4abcb00100a24a14fd41" commented="no" display-inline="no-display-inline"><enum>(c)</enum><header>Toxicant defined</header><text>In this section, the term <term>toxicant</term> 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).</text></subsection></section>