Congressional Record, Volume 168 Issue 38 (Wednesday, March 2, 2022)

[Congressional Record Volume 168, Number 38 (Wednesday, March 2, 2022)]
[House]
[Pages H1219-H1246]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

HONORING OUR PROMISE TO ADDRESS COMPREHENSIVE TOXICS ACT OF 2021

Mr. TAKANO. Mr. Speaker, pursuant to House Resolution 950, I call up
the bill (H.R. 3967) to improve health care and benefits for veterans
exposed to toxic substances, and for other purposes, and ask for its
immediate consideration in the House.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 950, an
amendment in the nature of a substitute consisting of the text of Rules
Committee Print 117-33, modified by the amendment printed in part A of
House Report 117-253, is adopted and the bill, as amended, is
considered read.
The text of the bill, as amended, is as follows:

H.R. 3967

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

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

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

Sec. 1. Short title; references to title 38, United States Code; table
of contents.

TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY

Subtitle A--Toxic-exposed Veterans

Sec. 101. Short title.
Sec. 102. Definitions relating to toxic-exposed veterans.
Sec. 103. Expansion of health care for specific categories of toxic-
exposed veterans and veterans supporting certain overseas
contingency operations.
Sec. 104. Assessments of implementation and operation.

Subtitle B--Certain Veterans of Combat Service

Sec. 111. Expansion of period of eligibility for health care for
certain veterans of combat service.

TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS

Sec. 201. Short title.
Sec. 202. Improvements to ability of Department of Veterans Affairs to
establish presumptions of service connection based on
toxic exposure.
Sec. 203. Reevaluation of claims for compensation involving
presumptions of service connection.

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

Sec. 301. Short title.
Sec. 302. Presumptions of toxic exposure.
Sec. 303. Medical nexus examinations for toxic exposure risk
activities.

TITLE IV--PRESUMPTIONS OF SERVICE CONNECTION

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

TITLE V--RESEARCH MATTERS

Sec. 501. Coordination by Department of Veterans Affairs of toxic
exposure research.
Sec. 502. Data collection, analysis, and report on treatment of
veterans for illnesses related to toxic exposure.
Sec. 503. Studies related to veterans who served in Southwest Asia and
certain other locations.
Sec. 504. Study on health trends of post 9/11 veterans.
Sec. 505. Study on cancer rates among veterans.
Sec. 506. Study on feasibility and advisability of furnishing hospital
care and medical services to dependents of veterans who
participated in toxic exposure risk activities.

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

Sec. 601. Short title; definitions.
Sec. 602. Publication of list of resources of Department of Veterans
Affairs for toxic-exposed veterans and outreach program
for such veterans and caregivers and survivors of such
veterans.
Sec. 603. Incorporation of toxic exposure questionnaire during primary
care appointments.
Sec. 604. Training for personnel of the Department of Veterans Affairs
with respect to toxic-exposed veterans.

TITLE VII--REGISTRIES, RECORDS, AND OTHER MATTERS

Sec. 701. Registry of individuals exposed to per- and polyfluoroalkyl
substances on military installations.
Sec. 702. Fort McClellan Health Registry.
Sec. 703. Independent study on Individual Longitudinal Exposure Record.
Sec. 704. Biannual report on Individual Longitudinal Exposure Record.
Sec. 705. Correction of exposure records by members of the Armed Forces
and veterans.
Sec. 706. Federal cause of action relating to water at Camp Lejeune,
North Carolina.
Sec. 7__. Veterans toxic exposures fund.

TITLE I--EXPANSION OF HEALTH CARE ELIGIBILITY

Subtitle A--Toxic-exposed Veterans

SEC. 101. SHORT TITLE.

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

[[Page H1220]]

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

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

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

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

SEC. 104. ASSESSMENTS OF IMPLEMENTATION AND OPERATION.

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

[[Page H1221]]

(2) The term ``Veterans Community Care Program'' means the
program established under section 1703 of title 38, United
States Code.

Subtitle B--Certain Veterans of Combat Service

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

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

TITLE II--TOXIC EXPOSURE PRESUMPTION PROCESS

SEC. 201. SHORT TITLE.

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

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

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

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

``Sec. 1171. Procedures to determine presumptions of service
connection based on toxic exposure; definitions

``(a) Procedures.--The Secretary shall determine whether to
establish, or to remove, presumptions of service connection
based on toxic exposure pursuant to this subchapter,
whereby--
``(1) the Formal Advisory Committee on Toxic Exposure under
section 1172 of this title--
``(A) provides advice to the Secretary on toxic-exposed
veterans and cases in which veterans who, during active
military, naval, air, or space service, may have experienced
a toxic exposure or their dependents may have experienced a
toxic exposure while the veterans were serving in the active
military, naval, air, or space service;
``(B) provides to the Secretary recommendations on
corrections needed in the Individual Longitudinal Exposure
Record, or successor system, to better reflect veterans and
dependents described in subparagraph (A); and
``(C) provides to the Secretary recommendations regarding
which cases of possible toxic exposure should be reviewed;
and
``(2) the Secretary provides for formal evaluations of such
recommendations under section 1173 of this title; and
``(3) the Secretary issues regulations under section 1174
of this title.
``(b) Illness Defined.--In this subchapter, the term
`illness' includes a disease or other condition affecting the
health of an individual.

``Sec. 1172. Formal Advisory Committee on Toxic Exposure

``(a) Establishment.--(1) There is in the Veterans Health
Administration of the Department the Formal Advisory
Committee on Toxic Exposure (in this section referred to as
the `Committee').
``(2)(A) The Committee shall be composed of nine members
appointed as follows:
``(i) Five members shall be appointed by the Secretary.
``(ii) One member shall be appointed by the Speaker of the
House of Representatives.
``(iii) One member shall be appointed by the minority
leader of the House of Representatives.
``(iv) One member shall be appointed by the majority leader
of the Senate.
``(v) One member shall be appointed by the minority leader
of the Senate.
``(B) The members appointed under subparagraph (A) shall
meet the following criteria:
``(i) Not more than three members shall be appointed from
among individuals who are officials or employees of the
Veterans Benefits Administration or the Veterans Health
Administration.
``(ii) At least one member shall be appointed from among
individuals who are officials or employees of other
departments or agencies of the Federal Government, including
the Department of Defense and the Agency of Toxic Substances
and Disease Registry of the Centers for Disease Control and
Prevention.
``(iii) At least two members shall represent an
organization recognized by the Secretary for the
representation of veterans under section 5902 of this title.
``(iv) At least one member shall be appointed from among
individuals in the private sector, State or local government,
or academia, who are experts in toxicology and epidemiology.
``(3) The Secretary shall determine the pay and allowances
of the members of the Committee, including with respect to
any additional pay and allowances for members who are
officials or employees of the Federal Government.
``(4)(A) Except as provided by subparagraph (B), each
member of the Committee shall be appointed for a two-year
term, and may serve not more than three successive terms.
``(B) With respect to the five members who are initially
appointed by the Secretary under subparagraph (A)(i), the
Secretary shall determine the length of the term of each such
member in a manner that ensures the expiration of the terms
on a staggered basis.''.
``(5) A vacancy in the Committee shall be filled in the
manner in which the original appointment was made.
``(b) Consultation.--The Secretary may consult with, and
seek the advice of, the Committee with respect to cases in
which veterans who, during active military, naval, air, or
space service, are suspected of having experienced a toxic
exposure or dependents of veterans who may have experienced a
toxic exposure during such service.
``(c) Assessments.--(1) The Committee shall assess cases of
the toxic exposure of veterans and their dependents that
occurred during active military, naval, air, or space
service, including by conducting ongoing surveillance and
reviewing such exposure described in scientific literature,
media reports, information from veterans, and information
from Congress.
``(2) The assessments under paragraph (1) shall cover
suspected and known toxic exposures occurring during active
military, naval, air, or space service, including by
identifying and evaluating new and emerging toxic exposures
that are not recognized under existing presumptions of
service connection.
``(3) The Committee may conduct an assessment under
paragraph (1) in response to comments by a person described
in subsection (e)(2), by a majority vote of the members of
the Committee.
``(4) The Committee shall on a periodic basis assess the
Individual Longitudinal Exposure Record, or successor system,
to ensure the accuracy of data collected.
``(d) Research Recommendations.--(1) Following an
assessment of a case of the toxic exposure of veterans or
their dependents that occurred during active military, naval,
air, or space service under subsection (c), the Committee may
develop a recommendation for formal evaluation under section
1173 of this title to conduct a review of the health effects
related to the case of exposure if the Committee determines
that the research may change the current understanding of the
relationship between an exposure to an environmental hazard
and adverse health outcomes in humans.
``(2) Upon receipt of evidence suggesting that previous
findings regarding the periods and locations of exposure
covered by an existing presumption of service connection are
no longer supported, the Committee may nominate such evidence
for formal evaluation under section 1173 of this title to
modify the periods and locations.
``(e) Input.--(1) Not less than quarterly, the Committee
shall provide an opportunity for persons described in
paragraph (2) to present written or oral comments to the
Committee.
``(2) The persons described in this paragraph are persons
who may be affected by the actions of the Committee,
including--
``(A) veterans, the families of veterans, veterans service
organizations and representatives, researchers, and other
members of the general public; and
``(B) departments and agencies of the Federal Government.
``(f) Reports by the Committee.--Not less frequently than
once each year, the Committee shall submit to the Secretary
and the Committees on Veterans' Affairs of the Senate and the
House of Representatives, and make publicly available, a
report on--
``(1) recommendations for research under subsection (d), if
any; and
``(2) recommendations for such legislative or
administrative action as the Committee considers necessary
for the Committee to be more effective in carrying out the
requirements of this section.
``(g) Responses by Secretary.--In response to each report
submitted under subsection (f), the Secretary shall submit to
the Secretary and the Committees on Veterans' Affairs of the
Senate and the House of Representatives, and make publicly
available, a report on--
``(1) the findings and opinions of the Secretary with
respect to the report most recently submitted under
subsection (f); and

[[Page H1222]]

``(2) whether the Secretary will conduct research
recommended under subsection (f) included in the report, and
if not, an explanation of why, including citations and
sources.
``(h) Nonapplication of Sunset Requirements.--Section 14 of
the Federal Advisory Committee Act (5 U.S.C. App.) shall not
apply to the Committee.

``Sec. 1173. Formal evaluation of recommendations

``(a) Formal Evaluation.--The Secretary shall establish a
process to conduct a formal evaluation with respect to each
recommendation made by the Formal Advisory Committee on Toxic
Exposure under section 1172 of this title--
``(1) to conduct research regarding the health effects
related to a case of toxic exposure; or
``(2) to evaluate evidence regarding the periods and
locations of exposure covered by an existing presumption of
service connection.
``(b) Evidence, Data, and Factors.--The Secretary shall
ensure that each formal evaluation under paragraph (1) covers
the following:
``(1) Scientific evidence, based on the review of available
scientific literature, including human, toxicological,
animal, and methodological studies, and other factors.
``(2) Claims data, based on the review of claim rate, grant
rate, and service connection prevalence, and other factors.
``(3) Other factors the Secretary determines appropriate,
such as--
``(A) the level of disability and mortality caused by the
health effects related to the case of toxic exposure being
evaluated;
``(B) the level of assistance required to remain in the
community because of such health effects;
``(C) the quantity and quality of the information available
and reviewed;
``(D) the feasibility of and period for generating relevant
information and evidence;
``(E) whether such health effects are combat- or
deployment-related; and
``(F) the ubiquity or rarity of the health effects.
``(c) Conduct of Evaluations.--(1) The Secretary shall
ensure that each formal evaluation under subsection (a)--
``(A) reviews scientific evidence in a manner that--
``(i) conforms to principles of scientific and data
integrity;
``(ii) is free from suppression or distortion of scientific
or technological findings, data, information, conclusions, or
technical results; and
``(B)(i) evaluates the likelihood that a positive
association exists between an illness and a toxic exposure
while serving in the active military, naval, air, or space
service; and
``(ii) assesses the toxic exposures and illnesses and
determines whether the evidence supports a finding of a
positive association between the toxic exposure and the
illness.
``(2) In carrying out paragraph (1)(B)(ii), a formal
evaluation under subsection (a) shall include reviewing all
relevant data to determine the strength of evidence for a
positive association based on the following four categories:
``(A) The `sufficient' category, where the evidence is
sufficient to conclude that a positive association exists.
``(B) The `equipoise and above' category, where the
evidence is sufficient to conclude that a positive
association is at least as likely as not, but not sufficient
to conclude that a positive association exists.
``(C) The `below equipoise' category, where the evidence is
not sufficient to conclude that a positive association is at
least as likely as not, or is not sufficient to make a
scientifically informed judgment.
``(D) The `against' category, where the evidence suggests
the lack of a positive association.
``(d) Recommendation for Rulemaking.--Not later than 120
days after the date on which a formal evaluation is
commenced, the element of the Department that conducts the
evaluation shall submit to the Secretary a recommendation
with respect to establishing a presumption of service
connection for the toxic exposure and illness, or modifying
an existing presumption of service connection, covered by the
evaluation.

``Sec. 1174. Regulations regarding presumptions of service
connection based on toxic exposure

``(a) Action Upon Recommendation.--Not later than 160 days
after the date on which the Secretary receives a
recommendation to establish or modify a presumption of
service connection under section 1173 of this title--
``(1) if the Secretary determines that the presumption, or
modification, is warranted, the Secretary shall commence
issuing regulations in accordance with the provisions of
subchapter II of chapter 5 of title 5 (commonly referred to
as the Administrative Procedures Act) setting forth the
presumption or commence revising regulations to carry out
such modification; or
``(2) if the Secretary determines that the presumption, or
modification, is not warranted, the Secretary shall publish
in the Federal Register a notice of the determination,
including the reasons supporting the determination.
``(b) Removal of Presumption.--(1) The Secretary may issue
regulations to remove an illness from a presumption of
service connection previously established pursuant to a
regulation issued under subsection (a).
``(2) Whenever an illness is removed from regulations
pursuant to paragraph (1), or the periods and locations of
exposure covered by a presumption of service connection are
modified under subsection (a)--
``(A) a veteran who was awarded compensation for such
illness on the basis of the presumption provided under such
regulations before the effective date of the removal or
modification shall continue to be entitled to receive
compensation on that basis; and
``(B) a survivor of a veteran who was awarded dependency
and indemnity compensation for the death of a veteran
resulting from such illness on the basis of such presumption
shall continue to be entitled to receive dependency and
indemnity compensation on such basis.

``Sec. 1175. Authority to modify process; congressional
oversight

``(a) Authority.--(1) The Secretary may modify the process
under which the Secretary conducts formal evaluations under
section 1173 of this title and issues regulations under
section 1174 if--
``(A) such evaluations cover the evidence, data, and
factors required by subsection (b) of such section 1173; and
``(B) a period of 180 days has elapsed following the date
on which the Secretary submits the notice under paragraph (2)
regarding the modification.
``(2) If the Secretary proposes to modify the process under
which the Secretary conducts formal evaluations under section
1173 of this title or issues regulations under section 1174,
the Secretary shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
notice of the proposed modifications containing the
following:
``(A) A description of the proposed modifications.
``(B) A description of any exceptions to the requirements
of such sections that are proposed because of limited
available scientific evidence, and a description of how such
evaluations will be conducted.
``(b) Reports and Briefings.--(1)(A) Not later than two
years after the date of the enactment of the Honoring our
Promise to Address Comprehensive Toxics Act of 2021, the
Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report on
the implementation of, and recommendations for, this
subchapter.
``(B) The Secretary shall develop the report under
subparagraph (A) in consultation with organizations
recognized by the Secretary for the representation of
veterans under section 5902 of this title and any other
entity the Secretary determines appropriate.
``(2) On a quarterly basis during the two-year period
beginning on the date of the enactment of the Honoring our
Promise to Address Comprehensive Toxics Act of 2021, the
Secretary shall provide to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
briefing on the implementation of this subchapter.
``(c) Independent Review.--The Secretary shall seek to
enter into an agreement with a nongovernmental entity or a
federally funded research and development center to conduct a
review of the implementation of this subchapter. Not later
than 540 days after the date of the enactment of the Honoring
our Promise to Address Comprehensive Toxics Act of 2021, the
Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report
containing such review.''.
(b) Conforming Amendments.--Chapter 11 is amended--
(1) in section 1116--
(A) by striking subsections (b), (c), (d), and (e);
(B) by inserting after subsection (a) the following new
subsection (b):
``(b) The Secretary shall ensure that any determination
made on or after the date of the enactment of the Honoring
our Promise to Address Comprehensive Toxics Act of 2021
regarding a presumption of service connection based on
exposure to an herbicide agent under this section is made
pursuant to subchapter VII of this chapter, including with
respect to assessing reports received by the Secretary from
the National Academy of Sciences under section 3 of the Agent
Orange Act of 1991 (Public Law 102-4).''; and
(C) by redesignating subsection (f) as subsection (c);
(2) in section 1116B(b)(2)(A), by inserting ``pursuant to
subchapter VII of this chapter,'' before ``the Secretary
determines''; and
(3) in section 1118--
(A) by striking subsections (b) through (e); and
(B) by inserting after subsection (a) the following new
subsection (b):
``(b) The Secretary shall ensure that any determination
made on or after the date of the enactment of the Honoring
our Promise to Address Comprehensive Toxics Act of 2021
regarding a presumption of service connection based on a
toxic exposure under this section is made pursuant to
subchapter VII of this chapter.''.
(c) Rule of Construction.--Nothing in section 1172(a)(2)(A)
of title 38, United States Code, as added by subsection (a),
shall be construed so as to require the advice and consent of
the Senate in the appointment of members of the Formal
Advisory Committee on Toxic Exposure.

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

(a) In General.--Subchapter VI of chapter 11 is amended by
adding at the end the following new section:

``Sec. 1167. Reevaluation of compensation determinations
pursuant to changes in presumptions of service connection

``(a) Reevaluation.--Whenever a law, including through a
regulation or Federal court decision, establishes or modifies
a presumption of service connection, the Secretary shall--
``(1) identify all claims for compensation under this
chapter that--
``(A) were submitted to the Secretary;
``(B) were evaluated and denied by the Secretary before the
date on which such provision of law went into effect; and
``(C) might have been evaluated differently had the
establishment or modification been applicable to the claim;

[[Page H1223]]

``(2) allow for the reevaluation of such claims at the
election of the veteran; and
``(3) notwithstanding section 5110 of this title, with
respect to claims approved pursuant to such reevaluation,
provide compensation under this chapter effective as if the
establishment or modification of the presumption of service
connection had been in effect on the date of the submission
of the original claim described in paragraph (1).
``(b) Outreach.--The Secretary shall conduct outreach to
inform relevant veterans that they may elect to have a claim
be reevaluated in light of the establishment or modification
of a presumption of service connection described in
subsection (a). Such outreach shall include the following:
``(1) The Secretary shall publish on the internet website
of the Department a notice that such veterans may elect to
have a claim so reevaluated.
``(2) The Secretary shall notify, in writing or by
electronic means, veterans service organizations of the
ability of such veterans to elect to have a claim so
reevaluated.''.
(b) Application.--Section 1167 of title 38, United States
Code, as added by subsection (a), shall apply with respect to
presumptions of service connection established or modified on
or after the date of the enactment of this Act, including
pursuant to amendments made by this Act.

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

SEC. 301. SHORT TITLE.

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

SEC. 302. PRESUMPTIONS OF TOXIC EXPOSURE.

Subchapter II of chapter 11 is amended by adding at the end
the following new section:

``Sec. 1119. Presumptions of toxic exposure

``(a) Consideration of Records.--If a veteran submits to
the Secretary a claim for compensation for a service-
connected disability under section 1110 of this title with
evidence of a disability and a toxic exposure that occurred
during active military, naval, air, or space service, the
Secretary may, in adjudicating such claim, consider--
``(1) any record of the veteran in an exposure tracking
record system; and
``(2) if no record of the veteran in an exposure tracking
record system indicates that the veteran was subject to a
toxic exposure during active military, naval, air, or space
service, the totality of the circumstances of the service of
the veteran.
``(b) Presumption of Specific Toxic Exposure for Members
Who Served in Certain Locations.--(1) The Secretary shall,
for purposes of section 1110 and chapter 17 of this title,
presume that any covered veteran was exposed to the
substances, chemicals, and airborne hazards identified in the
list under paragraph (2) during the service of the covered
veteran specified in subsection (c)(1), unless there is
affirmative evidence to establish that the covered veteran
was not exposed to any such substances, chemicals, or hazards
in connection with such service.
``(2) The Secretary shall establish and maintain a list
that contains an identification of one or more such
substances, chemicals, and airborne hazards as the Secretary,
in collaboration with the Secretary of Defense, may determine
appropriate for purposes of this section.
``(3) Beginning not later than two years after the date of
the enactment of the Honoring our Promise to Address
Comprehensive Toxics Act of 2021, and not less frequently
than once every two years thereafter, the Secretary shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report identifying any
additions or removals to the list under paragraph (2) during
the period covered by the report.
``(c) Definitions.--In this section:
``(1) The term `covered veteran' means any veteran who--
``(A) on or after August 2, 1990, performed active
military, naval, air, or space service while assigned to a
duty station in--
``(i) Bahrain;
``(ii) Iraq;
``(iii) Kuwait;
``(iv) Oman;
``(v) Qatar;
``(vi) Saudi Arabia;
``(vii) Somalia; or
``(viii) United Arab Emirates; or
``(B) on or after September 11, 2001, performed active
military, naval, air, or space service while assigned to a
duty station in--
``(i) Afghanistan;
``(ii) Djibouti;
``(iii) Egypt;
``(iv) Jordan;
``(v) Lebanon;
``(vi) Syria;
``(vii) Yemen;
``(viii) Uzbekistan;
``(ix) the Philippines; or
``(x) any other country determined relevant by the
Secretary.
``(2) The term `exposure tracking record system'--
``(A) means any system, program, or pilot program used by
the Secretary of Veterans Affairs or the Secretary of Defense
to track how veterans or members of the Armed Forces have
been exposed to various occupational or environmental
hazards; and
``(B) includes the Individual Longitudinal Exposure Record,
or successor system.
``(3) The term `toxic exposure risk activity' has the
meaning given such term in section 1710(e)(4) of this
title.''.

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

Subchapter VI of chapter 11, as amended by section 203, is
further amended by adding at the end the following new
section:

``Sec. 1168. Medical nexus examinations for toxic exposure
risk activities

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

TITLE IV--PRESUMPTIONS OF SERVICE CONNECTION

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

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

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

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

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

(a) Short Title.--This section may be cited as the
``Veterans Agent Orange Exposure Equity Act''.
(b) In General.--Section 1116, as amended by section 202,
is further amended--
(1) by striking ``, during active military, naval, air, or
space service, served in the Republic of Vietnam during the
period beginning on January 9, 1962, and ending on May 7,
1975'' each place it appears and inserting ``performed
covered service'';
(2) by striking ``performed active military, naval, air, or
space service in the Republic of Vietnam during the period
beginning on January 9, 1962, and ending on May 7, 1975''
each place it appears and inserting ``performed covered
service''; and
(3) by adding at the end the following new subsection:
``(d) In this section, the term `covered service' means
active military, naval, air, or space service--
``(1) performed in the Republic of Vietnam during the
period beginning on January 9, 1962, and ending on May 7,
1975;
``(2) performed in Thailand at any United States or Royal
Thai base during the period beginning on January 9, 1962, and
ending on June 30, 1976, without regard to where on the base
the veteran was located or what military job specialty the
veteran performed;
``(3) performed in Laos during the period beginning on
December 1, 1965, and ending on September 30, 1969;

[[Page H1224]]

``(4) performed in Cambodia at Mimot or Krek, Kampong Cham
Province during the period beginning on April 16, 1969, and
ending on April 30, 1969; or
``(5) performed on Guam or American Samoa, or in the
territorial waters thereof, during the period beginning on
January 9, 1962, and ending on July 31, 1980, or served on
Johnston Atoll or on a ship that called at Johnston Atoll
during the period beginning on January 1, 1972, and ending on
September 30, 1977.''.
(c) Eligibility for Hospital Care and Medical Services.--
Section 1710(e)(4), as amended by section 102(c), is further
amended by striking subparagraph (A) and inserting the
following new subparagraph:
``(A) The term `Vietnam-era herbicide-exposed veteran'
means a veteran who--
``(i) performed covered service, as defined in section
1116(d) of this title; or
``(ii) the Secretary finds may have been exposed during
such service to dioxin or was exposed during such service to
a toxic substance found in a herbicide or defoliant used for
military purposes during such period.''.
(d) Conforming Amendment.--The heading for section 1116 is
amended by striking ``the Republic of Vietnam'' and inserting
``certain locations''.

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

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

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

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

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

(a) Short Title.--This section may be cited as the
``Presumptive Benefits for War Fighters Exposed to Burn Pits
and Other Toxins Act''.
(b) In General.--Subchapter II of chapter 11, as amended by
section 302, is further amended by inserting after section
1119 the following new section:

``Sec. 1120. Presumption of service connection for certain
diseases associated with exposure to burn pits and other
toxins

``(a) Presumption of Service Connection.--For the purposes
of section 1110 of this title, and subject to section 1113 of
this title, a disease specified in subsection (b) becoming
manifest in a covered veteran shall be considered to have
been incurred in or aggravated during active military, naval,
air, or space service, notwithstanding that there is no
record of evidence of such disease during the period of such
service.
``(b) Diseases Specified.--The diseases specified in this
subsection are the following:
``(1) Asthma that was diagnosed after service of the
covered veteran as specified in subsection (c).
``(2) The following types of cancer:
``(A) Head cancer of any type.
``(B) Neck cancer of any type.
``(C) Respiratory cancer of any type.
``(D) Gastrointestinal cancer of any type.
``(E) Reproductive cancer of any type.
``(F) Lymphoma cancer of any type.
``(G) Lymphomatic cancer of any type.
``(H) Kidney cancer.
``(I) Brain cancer.
``(J) Melanoma.
``(K) Pancreatic cancer.
``(3) Chronic bronchitis.
``(4) Chronic obstructive pulmonary disease.
``(5) Constrictive bronchiolitis or obliterative
bronchiolitis.
``(6) Emphysema.
``(7) Granulomatous disease.
``(8) Interstitial lung disease.
``(9) Pleuritis.
``(10) Pulmonary fibrosis.
``(11) Sarcoidosis.
``(12) Chronic sinusitis.
``(13) Chronic rhinitis.
``(14) Glioblastoma.
``(15) Any other disease for which the Secretary
determines, pursuant to regulations prescribed under
subchapter VII that a presumption of service connection is
warranted based on a positive association with a substance,
chemical, or airborne hazard identified in the list under
section 1119(b)(2) of this title.
``(c) Covered Veteran Defined.--In this section, the term
`covered veteran' has the meaning given that term in section
1119(c) of this title.''.
(c) Conforming Amendment.--Section 1113 is amended by
striking ``or 1118'' each place it appears and inserting
``1118, or 1120''.

TITLE V--RESEARCH MATTERS

SEC. 501. COORDINATION BY DEPARTMENT OF VETERANS AFFAIRS OF
TOXIC EXPOSURE RESEARCH.

Subchapter II of chapter 73 is amended by adding at the end
the following new section:

``Sec. 7330D. Coordination of toxic exposure research

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

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

(a) In General.--The Secretary of Veterans Affairs shall
compile and analyze, on a continuous basis, all clinical data
that--
(1) is obtained by the Secretary in connection with
hospital care, medical services, or nursing home care
furnished to a veteran for an illness under section
1710(a)(2)(F) of title 38, United States Code, as amended by
section 102; and
(2) is likely to be scientifically useful, as determined by
the Secretary, in determining whether a positive association
exists between the illness of the veteran and a toxic
exposure.
(b) Consent of Patients.--The Secretary shall ensure that
the compilation and analysis of the clinical data of a
veteran under subsection (a) shall be conducted, and such
data shall be used, in a manner that is consistent with the
informed consent of the veteran and in compliance with all
applicable Federal law.
(c) Annual Report.--Not later than one year after the date
of the enactment of this Act, and annually thereafter, the
Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report
containing--
(1) any data compiled under subsection (a);
(2) an analysis of any such data;
(3) a description of the types and incidences of illnesses
identified by the Secretary pursuant to such subsection;
(4) an explanation by the Secretary for the incidence of
such illnesses and such alternate explanations for the
incidence of such illnesses as the Secretary may consider
reasonable; and
(5) a description of the views of the Secretary regarding
the scientific validity of drawing conclusions from the
incidence of such illnesses, as evidenced by the data
compiled under subsection (a), regarding the existence of a
positive association between such illness and a toxic
exposure.
(d) Definitions.--In this section:
(1) The term ``toxic exposure'' has the meaning given that
term in section 101 of title 38, United States Code.
(2) The term ``illness'' has the meaning given that term in
section 1171 of such title, as added by section 202.

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

(a) Analysis on Mortality in Covered Veterans.--
(1) Analysis.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall conduct an updated analysis of total and respiratory
disease mortality in covered veterans.
(2) Elements.--The analysis under paragraph (1) shall
include, to the extent practicable, the following:
(A) Metrics of airborne exposures.
(B) The location and timing of any deployments of the
veteran.
(C) The military occupational specialty of the veteran.
(D) The Armed Force in which the veteran served.

[[Page H1225]]

(E) The preexisting health status of the veteran, including
with respect to asthma.
(F) Such personal information of the veteran as the
Secretary may consider relevant, including cigarette and e-
cigarette smoking history, diet, sex, gender, age, race, and
ethnicity.
(b) Epidemiological Study.--Not later than 180 days after
the date of the enactment of this Act, the Secretary shall
conduct an epidemiological study of covered veterans that
involves--
(1) the use of improved spatio-temporal estimates of
ambient air pollution exposures that leverage advances in
retrospective exposure assessment; and
(2) the collection of detailed information on the covered
veterans studied through medical records, administrative
data, and other existing sources, including, with respect to
the covered veterans--
(A) personal information, including cigarette and e-
cigarette smoking history, diet, sex, gender, age, race, and
ethnicity;
(B) deployment history, including locations, periods, and
number of deployments;
(C) biospecimen data; and
(D) supplementary health status and outcomes data,
including imaging and physiological parameters.
(c) Toxicology Study.--
(1) Study.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall conduct a
toxicology study, to include variability, to replicate toxic
exposures of healthy, young members of the Armed Forces, as
well as potentially susceptible members, with preexisting
health conditions.
(2) Elements.--The study under paragraph (1) shall
include--
(A) an analysis of results for mechanistic markers and
clinically relevant outcomes; and
(B) a validation of any serum, tissue, or other biomarkers
of toxic exposure, susceptibility, or effect with respect to
the subjects of the study.
(d) Covered Veteran Defined.--In this section, the term
``covered veteran'' has the meaning given that term in
section 1119(c) of title 38, United States Code, as added by
section 302.

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

(a) Study.--The Secretary of Veterans Affairs shall conduct
an epidemiological study on the health trends of veterans who
served in the Armed Forces after September 11, 2001.
(b) Report.--Not later than two years after the date of the
enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the study under
subsection (a).

SEC. 505. STUDY ON CANCER RATES AMONG VETERANS.

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

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

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

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

SEC. 601. SHORT TITLE; DEFINITIONS.

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

SEC. 602. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF
VETERANS AFFAIRS FOR TOXIC-EXPOSED VETERANS AND
OUTREACH PROGRAM FOR SUCH VETERANS AND
CAREGIVERS AND SURVIVORS OF SUCH VETERANS.

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

SEC. 603. INCORPORATION OF TOXIC EXPOSURE QUESTIONNAIRE
DURING PRIMARY CARE APPOINTMENTS.

(a) In General.--The Secretary of Veterans Affairs shall
incorporate a clinical questionnaire to help determine
potential toxic exposures during active military, naval, air,
or space service as part of the initial screening conducted
for an appointment of a veteran with a primary care provider
of the Department of Veterans Affairs to improve
understanding by the Department of toxic exposures of
veterans while serving in the Armed Forces.
(b) Determination of Questions.--The questions included in
the questionnaire required under subsection (a) shall be
determined by the Secretary with input from medical
professionals.

SEC. 604. TRAINING FOR PERSONNEL OF THE DEPARTMENT OF
VETERANS AFFAIRS WITH RESPECT TO TOXIC-EXPOSED
VETERANS.

(a) Health Care Personnel.--The Secretary of Veterans
Affairs shall provide to health care personnel of the
Department of Veterans Affairs education and training to
identify, treat, and assess the impact on toxic-exposed
veterans of illnesses related to toxic exposure and inform
such personnel of how to ask for additional information from
veterans regarding different toxic exposures.
(b) Benefits Personnel.--
(1) Standard claims processor training curriculum.--
(A) Curriculum.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall ensure that a
standard training curriculum exists for processors of claims
under the laws administered by the Secretary who review
claims for disability benefits relating to

[[Page H1226]]

service-connected disabilities based on toxic exposure,
including employees who adjudicate such claims.
(B) Matters included.--The Secretary shall ensure that the
training under subparagraph (A) includes the following
explanations with respect to claims relating to toxic
exposure:
(i) A lack of a presumption of service connection is not by
itself sufficient to determine that service connection does
not exist.
(ii) The claims adjudicator shall always consider whether
direct service connection is applicable and request, as
needed, an advisory medical opinion pursuant to section 1168
of title 38, United States Code, as added by section 303.
(iii) The claims adjudicator may review and consider any
record of the claimant in an exposure tracking record system
pursuant to section 1119 of such title, as added by section
302, but a lack of such information is not by itself
sufficient to determine that such exposure did not occur or
sufficient to deny the claim.
(C) Provision of training.--The Secretary shall--
(i) provide training under subparagraph (A) to each
employee described in such subparagraph not less frequently
than annually; and
(ii) using the Systematic Technical Accuracy Review
program, or such successor program, conduct a nationwide,
quarterly, randomized review of the quality of adjudication
of claims relating to toxic exposure.
(2) Standard medical examiner training curriculum.--
(A) Curriculum.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall ensure that a
standard medical training curriculum exists for medical
providers who conduct examinations and provide opinions
pursuant to section 1168 of title 38, United States Code, as
added by section 303, regardless of whether the provider is
an employee of the Department or a contractor.
(B) Standardized approach.--The Secretary shall ensure that
the curriculum established under subparagraph (A)--
(i) provides a standardized approach to conducting and
providing examinations and opinions in accordance with such
section 1168; and
(ii) instructs medical providers to consider, when
conducting an examination or providing an opinion--

(I) relevant medical and scientific literature;
(II) the proximity, intensity, and frequency of exposure of
the individual to the identified toxic exposure;
(III) medically unexplained chronic multisymptom illnesses;
and
(IV) all competent and credible evidence of record.

TITLE VII--REGISTRIES, RECORDS, AND OTHER MATTERS

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

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

SEC. 702. FORT MCCLELLAN HEALTH REGISTRY.

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

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

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

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

(a) In General.--Not later than one year after the date on
which the Individual Longitudinal Exposure Record, or
successor system,

[[Page H1227]]

achieves full operation capability, as determined by the
Secretary of Defense, and every 180 days thereafter, the
Secretary of Defense, in consultation with the Secretary of
Veterans Affairs, shall submit to the appropriate committees
of Congress a report on--
(1) the data quality of the databases of the Department of
Defense that provide the information presented in such
Individual Longitudinal Exposure Record; and
(2) the usefulness of such Individual Longitudinal Exposure
Record in supporting members of the Armed Forces and veterans
in receiving health care and benefits from the Department of
Defense and the Department of Veterans Affairs.
(b) Elements.--Each report required by subsection (a) shall
include, for the period covered by the report, the following:
(1) An identification of toxic exposure events that may not
be fully captured by the current systems of the Department of
Defense for environmental, occupational, and health
monitoring, and recommendations for how to improve those
systems.
(2) An analysis of the quality of the location data used by
the Department of Defense in determining toxic exposures of
members of the Armed Forces and veterans, and recommendations
for how to improve the quality of that location data if
necessary.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Armed Services and the Committee on
Veterans' Affairs of the Senate; and
(B) the Committee on Armed Services and the Committee on
Veterans' Affairs of the House of Representatives.
(2) Toxic exposure.--The term ``toxic exposure'' has the
meaning given that term in section 101(37) of title 38,
United States Code, as added by section 102(b).

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

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

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

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

SEC. 7__. VETERANS TOXIC EXPOSURES FUND.

Chapter 3 is amended by adding at the end the following new
section:

``Sec. 324. Veterans Toxic Exposures Fund

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

SEC. 7__. AUTHORIZATION OF ELECTRONIC NOTICE IN CLAIMS UNDER
LAWS ADMINISTERED BY THE SECRETARY OF VETERANS
AFFAIRS.

Title 38, United States Code, is amended as follows:
(1) By striking section 5100 and inserting the following:

``Sec. 5100. Definitions

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

[[Page H1228]]

``(3) Any authorized representative of the appellant or
party described in paragraph (2).
``(f) The Secretary may provide notice under subsection (e)
electronically if a claimant (or the claimant's
representative) elects to receive such notice electronically.
A claimant (or the claimant's representative) may revoke such
an election at any time, by means prescribed by the
Secretary.''.
(5) In section 7105(b)(1)(A), by striking ``mailing'' and
inserting ``issuance''.
(6) In section 7105A(a), by striking ``mailed'' and
inserting ``issued''.
(7) In section 7266(a), by striking ``mailed'' and
inserting ``issued''.

SEC. 7__. AUTHORIZATION OF APPROPRIATIONS FOR EXPANSION OF
CLAIMS AUTOMATION.

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

The SPEAKER pro tempore. The bill, as amended, is debatable for 1
hour equally divided and controlled by the chair and ranking minority
member of the Committee on Veterans' Affairs or their respective
designees.
The gentleman from California (Mr. Takano) and the gentlewoman from
Iowa (Mrs. Miller-Meeks) each will control 30 minutes.
The Chair recognizes the gentleman from California.

General Leave

Mr. TAKANO. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
to insert extraneous material on H.R. 3967, as amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 3967, as amended, the
Honoring our PACT Act of 2021.
When we sent our servicemembers into harm's way, we made a pact to
care for them when they came home. But for too long, Congress and the
Department of Veterans Affairs have been slow to accept responsibility
and cost of that care, citing high costs or lack of absolute,
scientific proof of illness connections to service. The result is a
disability claims process that is cumbersome and places the burden of
proof for toxic exposure on veterans themselves.
Every day more and more veterans speak out about exposure to
environmental hazards and other toxic substances during their military
service.
Recently, I put out a call encouraging toxic exposed veterans to
share their experiences with the House Veterans' Affairs Committee. We
heard from thousands of veterans in 49 States. These reflections are
very powerful, Mr. Speaker, and I would like to share some of them with
you now.
Navy veteran Ed described how toxic exposures overwhelmed his senses.
He wrote: ``You could not escape the jet fuel. You could see it, smell
it, and taste it.''
I heard from Marine veteran Mike who said: ``Even when we weren't
actively engaged in dumping items into the burn pit, we were still
exposed.''
Air Force veteran Christopher R. described his dealings with VA
stating: ``I continue to be rejected because they say that it is
impossible to prove that it is service related. I never worked with
chemicals before my service or since. I feel like a nuisance to the VA
health system.''
I heard from a widow of Army veteran Austin Monk who said: ``No wife
should have to bury her 22-year-old husband because of his exposure to
unsafe conditions while in service to his country.''

{time} 1230

These stories are heart-wrenching and frustrating. Our veterans are
fighting their own government to grant them the care and benefits they
have earned.
We should be outraged listening to these stories, and it should be
clear how urgent passing the Honoring our PACT Act is for our veterans.
Veterans and veterans service organizations agree.
Mr. Speaker, I include in the Record letters of support from more
than 42 veterans service organizations.

February 24, 2022.
Hon. Nancy Pelosi,
Speaker,
House of Representatives.
Hon. Kevin McCarthy,
Minority Leader,
House of Representatives.
Dear Speaker Pelosi and Minority Leader McCarthy: On behalf
of the American service members and veterans we represent,
the undersigned representatives of our respective Veterans
and Military Service Organizations call on the House to
expeditiously consider and pass into law the Honoring Our
PACT Act (H.R. 3967).
Throughout our history, and most recently over the course
of more than 20 years of war in the post-9/11 era, service
members and veterans suffered prolonged exposure to dangerous
toxic substances, such as burn pits that destroyed trash,
medical and human waste, chemicals, and fuel, in and around
the battlefields of Iraq, Afghanistan and other places. Of
the hundreds of thousands of our members who have suffered
these exposures, many have returned home sick (or would
become ill), and many have also died of their injuries.
Collectively, we have spent years educating Congress,
national leaders, and the public on the enormous scope of the
injuries faced by our community. There have been small-scale
measures to boost education, training, research, and outreach
to begin to address the problem. Over the last several years,
many of our organizations have worked together to assemble
the components of comprehensive toxic exposure legislation
that provides VA health care, a new process to determine
future presumptive conditions, and provide overdue disability
benefits to thousands of veterans from all wars and eras
suffering from toxic exposures.
There have been a number of bills introduced in the House
that address different aspects of the toxic exposures puzzle,
however the Honoring Our PACT Act is the only bill that
provides a truly comprehensive solution. Although many of us
have supported some of these other burn pits and toxic
exposure bills, none of them provides a complete and lasting
solution for veterans who are or may become ill as a result
of toxic exposures. Consequently, when the Honoring Our PACT
Act is brought to the floor for consideration, if any such
legislation is offered as an amendment or motion to restrict
or substitute, rather than supplement, the underlying bill,
we would urge all members to oppose such amendments or
motions.
Our organizations call on the House to pass the Honoring
Our PACT Act without further delay, to finally provide those
who have laid their lives on the line for all Americans with
the health care and benefits they need and deserve.
Sincerely,
Air Force Sergeants Association (AFSA), Association of
Military Surgeons of the United States (AMSUS), Army Aviation
Association of America, Burn Pits 360, California Communities
Against Toxics, Cease Fire Campaign, Commissioned Officers
Association of the USPHS, Disabled American Veterans (DAV),
Dixon Center for Military and Veterans Services, Enlisted
Association of the National Guard of the United States
(EANGUS), Environmental Working Group (EWG), Fleet Reserve
Association (FRA), Gold Star Wives of America, GO2 Foundation
for Lung Cancer.
Green Beret Foundation, Iraq and Afghanistan Veterans of
America (IAVA), Jewish War Veterans of the USA, Service
Women's Action Network (SWAN), Military Chaplains
Association, Military Officers Association of America (MOAA),
Military Order of the Purple Heart (MOPH), Military-Veterans
Advocacy, Minority Veterans of America, National Association
of County Veterans Service Officers, National Military Family
Association (NMFA), National Veterans Legal Services Program
(NVLSP), Naval Enlisted Reserve Association (NERA), Non
Commissioned Officers Association (NCOA).
Paralyzed Veterans of America (PVA), Reserve Organization
of America (ROA), Student Veterans of America (SVA), Task
Force Dagger Foundation, The American Legion, The Enlisted
Association (TREA), Tragedy Assistance Program for Survivors
(TAPS), United Soldiers and Sailors of America, United States
Army Warrant Officers Association, Veteran Warriors, Veterans
of Foreign Wars (VFW), Veterans Prostate Cancer Awareness,
Vietnam Veterans of America VVA), Wounded Warrior Project
(WWP).

Mr. TAKANO. Mr. Speaker, I wish to thank Nancy Pelosi, our Speaker,
for her commitment to bring this bill to the floor. After years of
diligent input from my colleagues, our staff, VA, VSOs, and toxic-
exposed veterans themselves, I am confident that we are bringing the
best possible version of this bill up for a vote.
The administration agrees and has stated that it ``strongly
supports'' this legislation.
Mr. Speaker, I include in the Record the Statement of Administrative
Policy for H.R. 3967.

[[Page H1229]]

Statement of Administration Policy

H.R. 3967--Honoring Our Promise to Address Comprehensive Toxics (PACT)
Act--Rep. Takano, D-California and 100 cosponsors

The Administration strongly supports H.R. 3967, which would
expand veterans' access to health care and benefits to
address the health effects of harmful environmental exposures
that occurred during military service.
The President believes that our Nation has only one truly
sacred obligation: to properly prepare and equip our service
members when we send them into harm's way and to care for
them and their families when they return home. Far too often,
military service comes with a cost, and we owe it to our
veterans and their families to address these consequences
comprehensively. Unfortunately, it has taken decades to
understand the deleterious effects of environmental
exposures--leaving too many without access to the benefits
and services they need.
H.R. 3967 would make changes to the definitions for who is
eligible for VA health care based on presumed toxic exposure
during military service, including from burn pits, radiation,
or other environmental conditions. H.R. 3967 would also make
changes to the Department of Veteran Affairs (VA's) process
for determining presumptive service connection and mandate
several research studies related to military related
environmental exposures. It would also establish new
registries related to exposures, which would provide new data
on the long-term impacts from environmental exposures. H.R.
3697 also would allow a Federal cause of action related to
contaminated water at Camp Lejeune, North Carolina and
establish training requirements for health providers, and
require an outreach plan to educate veterans about their
eligibility for benefits and services related to toxic
exposure.
The Administration looks forward to working with the
Congress to enact this legislation and ensuring it is
effectively implemented. We must address the toxic legacy of
environmental exposures sustained by veterans during their
military service and fulfill our sacred obligation to our
veterans, their families, caregivers, and survivors. We must
also ensure that VA has the resources it needs to implement
this legislation.

Mr. TAKANO. Mr. Speaker, I include in the Record a letter of support
from The Independence Fund.

The Independence Fund,

February 23, 2022.
Hon. Mark Takano,
Chair, House Committee on Veterans Affairs,
Washington, DC.
Hon. Mike Bost,
Ranking Member, House Committee on Veterans Affairs,
Washington, DC.
Dear Chairman Takano and Ranking Member Bost: The
Independence Fund endorses the Honoring Our PACT Act (H.R.
3976) and urges its quickest adoption by the full House of
Representatives. We further urge the House to engage the
Senate with an appropriate legislative vehicle to get a
House-Senate conference started as soon as possible to work
out a final legislative solution this spring.
The Independence Fund's been proud to join with Wounded
Warrior Project, Iraq and Afghanistan Veterans of America,
and numerous other veteran organizations through the Toxic
Exposure in the American Military (TEAM) Coalition since
August of 2020 and the initial introduction and Senate
passage of the Toxic Exposure in the American Military (TEAM)
Act of 2020 (S. 4393) and has applauded the serious and
intensive work the House Committee on Veterans Affairs
undertook over the last 16 months.
Now, with the potential House passage of H.R. 3967, we
commit to engaging the Senate to pass this bill as soon as
possible, and if necessary, proceed to a Conference Committee
as soon as possible to ensure this bill can be enacted in
this Session of Congress. We will also urge the other veteran
and military serving organizations with which we work to join
us in such an effort collectively.
A veteran The Independence Fund serves, Nick Ooley, joined
the Army in 2007 and deployed to Iraq the following year.
Today, he is unable to run, jog, or even play basketball with
his 11-year-old son. As he details, ``Burn pits were all over
the place. We did convoy security, so we would travel to Al
Taqaddum, Ramadi, Fallujah, Baghdad, all over the place. When
we would drive through or get stationed in those areas, we
would be breathing this smoke all the time. The smoke would
be so thick during the day that the lights would come on like
it was dark.'' But with 78% of all disability claims related
to toxic exposure denied by the VA, disabled veterans are
denied the help they desperately need and deserve.
While The Independence Fund will always support disabled
veterans like Nick through our disabled veteran assistance
programs, the presumptive condition relief and mandated
health care provided in The Honoring Our PACT Act will be a
crucially needed lifeline for these veterans who have given
so much in the defense of our country. We salute your
leadership on this issue and stand ready to assist however we
can in making this the law of the land.
Very Respectfully,

Bob Carey,

Executive Vice President,
Advocacy & Strategy.

Mr. TAKANO. Mr. Speaker, it is now time for the Members of this body
to answer a simple question: Am I willing to support our troops and
honor our Nation's promise to them?
This bill addresses the true cost of war, and opposing it would be a
vote against our servicemembers and veterans. Such a vote would be
inconsistent with the thank-yous and patriotic displays so many of my
colleagues offer on Veterans Day. Veterans want action, and they
deserve our action.
We made a promise to deliver comprehensive toxic exposure
legislation, and I intend to keep that promise.
The Honoring our PACT Act will address the full scope of issues
affecting toxic-exposed veterans' access to VA care and benefits while
reforming VA's presumptive decisionmaking process. It will expand VA
healthcare eligibility for over 3.5 million veterans exposed to burn
pits and establish a presumption of service connection for over 23
respiratory illnesses and cancers. There is no other toxic exposure
legislation in Congress like this one in scope or in soundness.
Before I close, I must emphasize something essential. We cannot
renege on our responsibility to toxic-exposed veterans because of any
perceived sticker shock.
Cries for offsets and pay-fors did not stop Congress from passing a
$1.9 trillion tax cut for corporations and the wealthy in 2017. Over
the past 20 years, Congress and our country made the choice to spend
trillions on other priorities while sending servicemembers into harm's
way at the cost of $6.4 trillion.
We know that this Congress is willing to find money when it wants to,
as it recently demonstrated by adding $25 billion to the last National
Defense Authorization Act. When our country goes to war, we don't
nickel and dime the Department of Defense, and we shouldn't try to
pinch pennies when it comes to covering the care for toxic-exposed
veterans.
We will not stand by and be lectured about fiscal responsibility when
we have a moral obligation to America's veterans. And the time to meet
that obligation is now.
Mr. Speaker, I reserve the balance of my time.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise today in opposition to H.R. 3967, the PACT Act. I
wish that this were not the case. I would love to be here today
standing proud alongside the chairman in support of this bill. I know
Ranking Member Bost would as well.
I am new to Congress, but I understand that, historically, the
Veterans' Affairs Committee would work on a bipartisan basis to advance
legislation of this magnitude. The MISSION Act and the Forever GI Bill
are wonderful examples of the majority and minority in the House and
Senate working together in prior Congresses on a compromise that both
sides could support and send to the President's desk. That is how
Congress should work.
That is why they used to say that those of us on the Veterans'
Affairs Committee would leave our party affiliations at the door, and
that the Veterans' Affairs Committee was the most bipartisan committee
in Congress. That is no longer the case under this Democrat majority.
The PACT Act is a sad example of that.
My fellow Republicans and I want to work with the majority to create
a fair and consistent pathway for healthcare benefits for toxic-exposed
veterans. This is an issue we care deeply about, for which I have a
personal association, and have made our top priority in the 117th
Congress.
But the majority has consistently refused to meaningfully communicate
with us on this bill. In fact, the majority significantly rewrote major
portions and components of the PACT Act less than 2 weeks ago and
refused to even discuss those changes with those of us in the minority.
Because we did not work together to resolve our differences, the bill
has serious flaws that we were unable to resolve. Already, the
manager's amendment would extend benefits to more veterans without
scientific justification, showing just how slippery a slope this bill
would set.
As an alternative, I support creating a fair and consistent process
for the VA to decide whether benefits are warranted for certain
military toxic exposure events.

[[Page H1230]]

VA should base this decision on criteria that weighs the strength of
scientific evidence supporting a link between the development of a
condition and toxic exposure. In fact, for the past 2 years during the
pandemic, we have heard repeatedly from the opposite side about
following the science.
If the VA determines that there is at least a 50 percent chance that
these veterans' disabilities are linked to toxic exposure, then VA
should grant benefits on a presumptive basis.
The PACT Act attempts to create such a framework, but I believe more
discussion is needed to determine if it is the best path forward. That
is especially important since the VA began piloting its own program for
deciding whether there is a scientific link between a disability and
toxic exposure last year.
Under VA's model, certain Gulf war and post-9/11 veterans who were
exposed to airborne hazards and develop asthma, sinusitis, and rhinitis
became eligible for benefits last September. And just this past week,
VA announced it will provide compensation to certain veterans who are
diagnosed with nine rare respiratory cancers.
VA's decisions were based on science. However, it is unclear if all
the conditions under Chairman Takano's bill would meet the scientific
threshold under his framework or under the VA's.
Furthermore, the PACT Act could also flood VA with so many new
mandates that veterans already receiving care and benefits wait longer.
Veterans wait too long for VA services right now. I hear frequently
from veterans in Iowa who can't get the care they need, are waiting
months and, in some States, even years for the benefits they have
earned. I don't know of a Member in this body who can't say the same
thing.
Making those veterans wait even longer is unacceptable, and it could
be unprecedented where the claims process is concerned.
In 2013, the disability claims backlog peaked at 600,000 pending
claims. Veterans were waiting years to receive an initial decision of
their claim, and then, if it was denied, they were waiting even longer
while the VA processed their appeal.
VA has made some improvements to how disability claims are processed
since 2013, but the Department is still years away from developing the
information technology needed to truly expedite claims processing.
If the PACT Act were enacted, VA estimates the disability claims
backlog could reach over 1.5 million claims by the end of fiscal year
2023. That is more than double the height of the backlog in 2013.
If veterans were waiting years for their benefits 9 years ago,
imagine how long they would have to wait today for a backlog that is
more than two times the size it was then. That is completely
unreasonable.
The PACT Act is also unacceptable for taxpayers. CBO estimates the
PACT Act would require over $300 million in new government spending.
Not a penny of those costs are offset.
Additionally, some of the amendments we will be voting on would
increase the costs by millions of dollars in new mandatory spending on
top of that.
You will hear some say that this is just the cost of war. Anyone who
has served, or has a loved one who serves, like I have, and do, know
what war costs. They also know that veterans pay taxes, too. They also
know that veterans have children and grandchildren whose futures they
don't want to be anymore burdened with debt than they already are.
The PACT Act costs more than the combined discretionary budgets of
nine Cabinet-level departments. Think about that. And then think about
inflation and our national debt, which is already skyrocketing and is
causing American taxpayers to pinch pennies.
We are not doing right by our veterans by being fiscally
irresponsible in their name, and I say that as a veteran myself.
Finally, there is no clear or quick path forward in the Senate for
the PACT Act. In comparison, we could send legislation to the
President's desk today that would help sick veterans get the care they
need.
The Health Care for Burn Pit Veterans Act would let toxic-exposed
post-9/11 combat veterans enroll in the VA healthcare system. It is
bipartisan, and it has already passed the Senate last month.
I understand the majority would like to go to conference over the
Health Care for Burn Pit Veterans Act and the PACT Act, but I also
understand that the majority supports the Health Care for Burn Pit
Veterans Act because they included it as a provision in the Rules
Committee print of the PACT Act.
If we all agree that the Health Care for Burn Pit Veterans Act is a
good policy, why would we delay its enactment?
Every day that the House fails to send it to the President is another
day that veterans are deprived of lifesaving care. Nothing could be
more wrongheaded than that.
The Health Care for Burn Pit Veterans Act is the correct first step
toward this process. It will deliver needed healthcare to toxic-exposed
veterans and buy us the time to work on a bipartisan, bicameral basis
to deliver other benefits and services to them down the line. They
would at least have healthcare now.
We should have done this throughout this congressional session, but
we haven't even started yet. Sick veterans should not pay the price for
our inaction.
Rather than pass the PACT Act in the House, with its many flaws and
an extremely high likelihood of dying in the Senate, we must pass the
Health Care for Burn Pit Veterans Act today.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, it is my honor and privilege to yield 1
minute to the gentlewoman from California (Ms. Pelosi), a person who
has done more for veterans in modern times than any other leader of
this body.
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding and for
his kind words, which I accept on behalf of our working in a bipartisan
way for our veterans over the years, Democrats and Republicans. And I
thank the chairman for his extraordinary leadership, both in this case
and earlier for our veterans, completing our Agent Orange
responsibilities to our veterans.
As well, I thank Congressman Ruiz, a doctor and a Member of Congress
who has been a champion on this issue, and Elaine Luria, a veteran and
a Member of Congress who has been so instrumental in bringing this
legislation to the floor.
When the President spoke last night about meeting the needs of our
veterans when it came to the burn pits, he received almost a unanimous
standing ovation for that. It was very encouraging to see the Congress
of the United States, House and Senate, Democrats and Republicans,
recognize their obligation to our men and women in uniform.
It is important to note that over the past generation, over 3 million
of our courageous Americans have answered the call to serve and have
donned the uniform to protect our freedoms as heroic Americans, just as
people have done since our founding.
From the deserts of Iraq to the mountains of Afghanistan--I was
hearing this morning about Kandahar--and on bases and in military
theaters around the world, these heroes have risked their lives to
fight the enemy and yet, tragically, have had to face another deadly
threat due to exposure to burn pits and other toxic substances.
We always say about our military on the battlefield that we leave no
soldier behind, and when they come home, we leave no veteran behind.
Instead of receiving comprehensive, timely care and benefits, sometimes
they are forced to confront a disability claims process that is nearly
impossible to navigate. That is why the Honoring our Promise to Address
Comprehensive Toxics Act, the PACT Act, finally, faithfully fulfills
that pledge now and into the future, that we will leave no veteran
behind.

{time} 1245

The budget costs of it are a cost of war. When we decide that we need
to engage and initiate military action, we should understand that the
cost is not just in our defense budget but also in our veterans' budget
when they come home.
Frankly, the cost of this bill is a fraction, if we are talking
budget, of the cost of the Republican tax bill that they passed in
2017, which added $2 trillion to the national debt. I don't hear

[[Page H1231]]

anybody complaining on the other side of the aisle about what impact
that had on veterans and their concerns about the fiscal soundness of
the United States.
So let's just put it to rest: If it is a cost that we must have for
our veterans--and this has been thoroughly researched, and others will
speak to that--then we cannot say we can't afford it. It isn't about
the price. It is about the value of what we get for this.
In the last 20 years, the VA has seen over a 60 percent increase in
rates of cancer due to toxic exposure. Eighty-six percent of veterans
from Iraq and Afghanistan report being exposed to the toxic fumes of
burn pits, and 88 percent of those exposed said they were experiencing
symptoms that could be related to that.
Potentially up to 3.5 million veterans deployed post-9/11 may have
been exposed to toxic fumes and substances. Despite this reality,
nearly 75 percent of burn-pit-related disability claims were denied,
Mr. Speaker.
Too often, the VA and Congress have said it is just too expensive to
care for, and there just isn't enough proof. The result of this
negligence has been tragic. Thousands of veterans and families have
been forced to suffer, including heroes like one I will quote, Staff
Sergeant Wesley Black.
Staff Sergeant Black was a Purple Heart hero who survived two tours
in Iraq and Afghanistan. In November, he died at the age of 36 from
colon cancer tied to toxic exposure from burn pits, leaving behind his
wife and new baby.
After serving his country with distinction, Sergeant Black should
have been able to retire happily, with pride. Instead, he spent his
final days fighting for the reforms contained in this legislation so
that no current or future veteran would be forced to endure the same
horror that he and his family did.
Staff Sergeant Wesley Black, before his passing, said: It is too late
for me, but it is not too late for the next veteran who walks down the
halls of the VA and goes in and complains about the signs and symptoms.
We must make sure it is not too late for other veterans, I say, and
when we send our servicemen and servicewomen into harm's way, we care
for them when they come home.
This is particularly important to me, because a long time ago, long
before I was in Congress, in 1981, I went and sat with veterans in
California, with Dick Gregory, who was making a big association with
the cause for Agent Orange, in 1981, California, veterans having a
hunger strike. Dick Gregory knew about hunger strikes from the civil
rights movement, and he was associating himself with them and
instructing them on how to survive a hunger strike, and I had the
privilege of being with them.
Little did I know at that time, it would take decades to address
their Agent Orange concerns. And it wasn't even complete until Chairman
Takano did so with the Navy legislation that he passed.
We cannot let that much time go by. That would be shameful to our
country.
Let us also thank Mr. Cartwright, who also included in his package
the Camp Lejeune Justice Act. Anyone who has heard from those families
coming from Camp Lejeune, not just the servicemembers but their family
members, who have been damaged related to injuries incurred while
serving at Camp Lejeune. The list goes on.
Again, thanks to Chairman Takano, Congressman Raul Ruiz,
Congresswoman Elaine Luria, and Congressman Matt Cartwright. I thank
everyone who has worked so hard to bring this to the floor. I want to
also thank Senator Tester, with whom Chairman Takano and our committee
have worked closely.
We share a goal. We have to find the complete package so that it is
comprehensive and fulfills our responsibilities.
Others will go into the particulars of it. I want to also salute the
distinguished Secretary of the VA, Denis McDonough, for the attention
that he has paid to making sure what we do honors the promise of the
PACT Act, so that the bill is written in a way that delivers in a
timely fashion to our veterans.
I could not have been more excited when the President of the United
States included this important initiative in his remarks, not only as
legislation but in the larger issue of what it means to our country,
how we value our veterans and how we want to pass this legislation and
get it to his desk soon so it will be a comfort to our veterans and
their families.
On the battlefield, we leave no soldier behind. When they come home,
we leave no veterans behind.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I could not agree more that we can act today, and we can
forward legislation to the desk of the President for his signature by
passing the Health Care for Burn Pit Veterans Act today, so that there
is not another Sergeant Wesley Black who is denied healthcare while the
VA processes his claims.
We would be more than delighted to help the President in honoring his
initiative, as he stated last night in the State of the Union, by today
passing the Health Care for Burn Pit Veterans Act.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentleman from
California (Mr. Levin), my good friend, who serves as the chair of the
Committee on Veterans' Affairs Subcommittee on Economic Opportunity.
Mr. LEVIN of California. Mr. Speaker, I thank Chairman Takano for his
leadership.
Mr. Speaker, I rise today in strong support of the Honoring our PACT
Act.

All too often, many veterans hear the words ``thank you for your
service'' but don't see enough action behind those words.
Sadly, that has been true for millions of veterans who were exposed
to toxic substances during their service and are now suffering from
related health conditions.
While they defended our country, they were exposed to burn pits, PFAS
chemicals, and more, but we failed to hold up our end of the bargain to
care for them when they returned home.
In the case of Vietnam veterans, many who were exposed to Agent
Orange, were forced to wait more than 40 years before they saw proper
benefits.
For too long, the burden of proof has been on the veteran to show
that their illness is a result of toxic exposure they experienced
during their service. For too long, veterans have been told that it is
too expensive to cover the range of health issues that they have as a
result of their toxic exposure. That is wrong, and we must do better
for our veterans.
With the Honoring our PACT Act, we can do right by our veterans. This
includes finally presuming that if they were exposed to toxic
substances during their service and are now experiencing one of 23
respiratory illnesses and cancers, then that illness is as a result of
their exposure, and they are owed proper access to benefits and care
through the VA.
I also want to highlight what I hope will become a key piece of this
bill, an amendment I offered to authorize Federal grants for county
veterans service officers who help veterans and their families
understand resources at their disposal, file benefit claims, and
represent veterans in VA hearings.
County veterans service officers are often veterans' best allies in
navigating red tape within the VA and securing the benefits that
veterans have earned, which will be particularly important for the 3.5
million veterans who may be eligible for new benefits and care as a
result of this legislation.
The amendment is similar to my Commitment to Veteran Support and
Outreach Act, which I introduced with a bipartisan group last year. I
hope to see it move forward as part of our Honoring our PACT Act today.
As I said, this legislation is our opportunity to put real action
behind our words. Saying ``thank you for your service'' has never been
enough. It is time to fulfill the promises we made to our troops and
invest in the care and benefits they deserve.
Mr. Speaker, I encourage my colleagues to vote ``yes.''
Mrs. MILLER-MEEKS. Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 1 minute to the gentleman from
Maryland (Mr. Hoyer), the esteemed majority leader of this House.
Mr. HOYER. Mr. Speaker, I thank Chairman Takano not only for yielding

[[Page H1232]]

time, but much more importantly, I thank him for the extraordinary work
he does on behalf of the Armed Forces and for its veterans. He is
tireless in his advocacy of veterans' interest.
I meet with him every Wednesday in the chairman's meeting. He is
always speaking up about how we need to continue our focus on the needs
of our veterans who served our country so heroically, whether they went
overseas or not.
Some of the veterans that we are talking about today were not
overseas when they contracted a disease or an illness as a result of
toxic substances. They were here in America. There is a poet who says:
They also serve who stand and wait ready to serve, ready to be deployed
to the point of the spear.
Mr. Speaker, you and I are old enough--I don't want to be too harsh
on the Speaker--but to remember the song: When Johnny comes marching
home again, hurray, hurray, the boys will shout, the girls will cheer,
and the women, they will all turn out.
One of the problems we have seen, though, after that cheering, that
after that parade, after that exultation, is that memories are short.
As time goes by, some of our veterans, sadly, tragically, and
wrongfully, have been forgotten.
This bill says we do not forget. This bill says we will be there for
you, and, yes, we will be there even if there is a substantial cost to
it.
This is a defense cost. In my view, the veterans cost ought to be in
the defense budget, and it ought to be there because that is what we
are all enthusiastic about spending money on. Veterans need to be and
are our first priority.
I thank the chairman for his focus and for his action. He has long
been a champion of our veterans and their well-being.
I also thank Representative Ruiz and Representative Luria, who is
sitting here with us, who have worked very hard on this legislation.
Mrs. Luria, from Virginia, is a retired commander from the United
States Navy. She and her husband commanded a ship. Dr. Ruiz has been on
the front line of illness, the front line as an emergency physician,
and knows full well the psychological and physical effects of toxic
material to the well-being of individuals. I thank Dr. Ruiz and
Commander Luria for their work on this bill.

Our veterans served with honor and routinely went above and beyond
the call of duty in their defense of our Nation. Many of them risked
their lives; not everybody, there were some that were support, and
without their support those at the point of the spear could not have
been successful.
We have a responsibility, Mr. Speaker, a moral responsibility, to
care for our veterans when they return home and ensure that they
receive the treatment they deserve.
When we send our servicemembers to war, when we recruit them, when we
put them in a position by order and they become ill because of where
they are, because of either negligent or unknowing actions, unknowing
to the extent we don't know the adverse effects that they caused,
whatever the situation, a soldier's exposure is our responsibility.
A soldier's exposure to burn pits and other toxic substances during
their service has been shown to be connected to a greatly increased
risk of cancer and respiratory diseases. There is no doubt about that.
The legislation before us would expand veterans' healthcare access
and benefits to address the effects of those toxic exposures that
occurred during their military service.
Mr. Speaker, you and I both know we asked our veterans to go to
battle for America, and they answered the call. When they return home,
veterans should not have to go to battle against red tape to receive
the medical treatment and benefits they have earned through their
service.

{time} 1300

They ought to be able to access care for the physical and mental
wounds they carry without impediment or delay. All of us have gotten
cases where there have been weeks, months, years that veterans have
waited for benefits that they deserve under law, and as a moral
responsibility of our government.
We thank our veterans for their service. As I said, we cheer and
shout and turn out. But this is our responsibility. This is not about
cheering or shouting. This is about doing what we ought to do for those
who were injured in the defense of our Nation and our freedom. This is
our opportunity to keep our promise to put our veterans first and truly
give them our highest respect.
Again, I thank my friend, Chairman Takano. I thank all the members of
the Committee on Veterans' Affairs and all those veterans who don't
forget those who come after them. I thank Mr. Takano for his
leadership, and I urge my colleagues from both sides of the aisle to
join in passing this bill with a strong bipartisan support.
Our President talked about bipartisanship. I talked to Mr. Scalise
about being the loyal opposition. Not loyal to Democrats or Democrat
leaders, but loyal to our country. Being loyal to our country means
being loyal to those who served and preserved the freedoms that we
enjoy, this home of the free and land of the brave. I think it is the
opposite way around, but we get the point. Brave and free go together.
Let us not forget. Let's pass this bill.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, anyone who has served or has a loved one who serves,
like I have and do, knows the cost of war good and well.
Veterans pay taxes, too. Veterans also have children and
grandchildren that they don't want to burden with debt. The Honoring
our PACT Act costs more than the combined discretionary budgets of nine
Cabinet-level departments: Transportation, Commerce, Homeland Security,
State, HUD, Interior, Justice, Energy, and Labor.
We shouldn't dismiss those massive costs so easily. Just as we have a
moral responsibility to care for our veterans, we have a moral
responsibility to understand the real-world consequences that we can
already see in skyrocketing inflation and national debt. Congress
should have to pay our bills just like our constituents do.
I am not downplaying the importance of benefits. Getting the Health
Care for Burn Pit Veterans Act signed into law may be the first step in
this fight, but it would be a lifesaving one. It does no good to have
benefits if you are not alive to have them. Republicans invited Jim
Price, a toxic-exposed veteran and widower of one, to testify, and he
says it better than I could. In Jim's words, ``Benefits mean nothing if
you are no longer alive.''
Chairman Takano acknowledged last week that he has not even started
talking to the Senate about a compromise on this bill. That means we
are months away from a deal, if we can even find one. Meanwhile,
veterans could receive lifesaving healthcare now. Some veterans don't
have that long to wait. They need that healthcare now.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentleman from New
Hampshire (Mr. Pappas), my good friend who serves as chair of the
Subcommittee on Oversight and Investigations for the Veterans' Affairs
Committee.
Mr. PAPPAS. Mr. Speaker, I thank Chairman Takano for yielding and for
his leadership on this issue, which answers the call of our Nation's
veterans, their advocates, and our veterans service organizations.
I rise in support of the Honoring our PACT Act, which makes good on
this Nation's promise to veterans. It is well past the time that we
address the impacts of toxic exposure that have been endured by members
of our military. I am glad that we are taking meaningful, comprehensive
action today.
I am also pleased that this legislation includes a bill that I
introduced, the PFAS Registry Act. PFAS chemicals have contaminated the
environment and drinking water sources of hundreds of military bases
across the country, including Pease Air Force Base in my district.
These forever chemicals persist in the environment and the body and are
linked to serious health conditions, including cancer.
This provision will give military servicemembers and veterans access
to health information, research updates, and other resources to help
protect public health and provide relief to those who have been exposed
to PFAS.

[[Page H1233]]

The Honoring our PACT Act will help veterans already suffering from
the impacts of toxic exposure. We also must do more to reduce the risk
that more servicemembers will be exposed. That is why I have also
submitted an amendment that will require our government to proactively
raise awareness of the dangers of toxic exposure to Active Duty
personnel.
These provisions will require DOD and VA to create a strategy for
awareness and prevention that will protect Active Duty servicemembers
from harm and save lives.
Our men and women in uniform already face numerous threats to life
and limb for their service. We must minimize risks that environmental
and toxic hazards pose and provide the care, benefits, and support that
these veterans have earned. It is our solemn responsibility.
Mr. Speaker, I urge swift passage of my amendment as well as the
underlying legislation.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, section 706 comes from H.R. 6482, which was referred to
the Judiciary Committee, not the Veterans' Affairs Committee. H.R. 6482
has not gone through the regular order of this Congress. This is
another blatant example of the Democrat majority pushing through
legislation without careful consideration of the impact it may have on
the Federal Government. Moreover, this provision is a departure from
past precedent because it would allow veterans to sue the United States
for a disability incurred in military service. This type of change
would not simply be air dropped into a bill without careful
consideration within this committee.

The VA estimates that the PACT Act will cause an unprecedented
backlog of over 1.5 million disability claims. This will lead to longer
wait times for veterans and put a strain on DVA resources and
personnel. An increase in claims decisions is likely to result in an
increase in appeals, which will add to the appeals backlog.
All veterans, not just toxic-exposed veterans, will be forced to wait
months or years for a final decision on their disability claim or
appeal. This is a big risk to take when there is little to no science
backing the benefits expansion under this bill.
And our moral responsibilities? What will I say to the veterans in my
district who could get healthcare now if we refuse to consider a bill
that will pass?
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Virginia (Mrs. Luria), my good friend and cosponsor of H.R. 3967. She
is the chair of the Disability Assistance and Memorial Affairs
Subcommittee and also a veteran herself and former commander of a naval
surface ship.
Mrs. LURIA. Mr. Speaker, as a 20-year veteran myself, it is an honor
to stand before you today. I would say that the urgency of what our
veterans are facing should not be lost on this body: Autoimmune
disorders, cancer, chronic disease, respiratory issues, infertility,
and organ failure are just a few in a lengthy list of conditions
associated with toxins during military service.
Why should our veterans, who risked their lives on the battlefield,
now have to battle for their healthcare when they return home?
There should be no question of our commitment to the veterans who
voluntarily served our Nation without hesitation. This body should not
hesitate to pass this legislation, the Honoring our PACT Act. I am
proud to serve a district that has such a strong military and veteran
presence.
Nearly one out of every six people in Virginia's Second Congressional
District is a veteran and even more of their family members. Many of
those veterans come from the Gulf war era, with 42 percent of them
having served in the post-9/11 era. My presence at this podium today
reconfirms my unwavering commitment to all of our constituents who
depend on the passage of this legislation to get the healthcare that
they deserve from toxic exposure.
Let me be clear. Veterans have earned the right to accessible VA
healthcare. As such, the choice is clear that we need to pass the
Honoring our PACT Act. Our work on this vital legislation has been
bipartisan, and it incorporates two bills that I have introduced: The
COVENANT Act, which recognized the toxic exposure of so many of our
veterans and established their eligibility for healthcare. Furthermore,
we have introduced in this legislation a provision that brings the VA
healthcare notifications into the 21st century, allowing the Secretary
of the VA to notify our veterans of their disability determinations
electronically, something that is long overdue and has been coordinated
with and requested by the Secretary of the VA.
Let me say again that as a 20-year veteran myself, I support this
legislation, and I want to get this healthcare to all those veterans
who served and those who desperately need it.
Mrs. MILLER-MEEKS. Mr. Speaker, how much time do I have remaining?
The SPEAKER pro tempore. The gentlewoman from Iowa has 18 minutes
remaining.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, the benefits provided under this bill have little to no
scientific basis. For example, in 2020, the National Academies reviewed
11 of the 24 burn pit-related conditions in the bill but could not
establish a link between exposure to burn pits and those 11 conditions.
The other 13 conditions were not reviewed, which further proves the
point that more research is needed.
It is not fair to provide benefits to select veterans under this bill
while telling other veterans to wait for the science. Instead, there
needs to be a fair and consistent process to decide if there is enough
evidence supporting the extension of benefits to a condition that may
be linked to toxic exposure.
This bill sets a dangerous precedent that we cannot afford to
maintain for the next group of toxic-exposure veterans wanting benefits
with no scientific support. May I also add that veterans need not be in
a battle for healthcare if we pass today the Health Care for Burn Pit
Veterans Act, which has already passed in the Senate.
We have received zero assurance from the VA that the PACT Act can be
implemented without disrupting services to veterans. I hear every day
from veterans who cannot get care in a timely manner through the VA
right now. The PACT Act would make millions more veterans eligible for
care through the same system, much more than the Health Care for Burn
Pit Veterans Act would, and of course that will have implications for
access. Even VA's own providers have expressed concern about the impact
an influx of new patients without accommodations and resources will
have, clogging up an already overburdened system.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, may I inquire as to how much time I have
remaining?
The SPEAKER pro tempore. The gentleman from California has 15\1/2\
minutes remaining.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentleman from
Indiana (Mr. Mrvan), my good friend who serves as chair of the
Subcommittee on Technology Modernization on the Veterans' Affairs
Committee.
Mr. MRVAN. Mr. Speaker, I am proud to rise today in support of
Honoring our PACT Act.
Respectfully, the impact of this piece of legislation will be
veterans receive world-class healthcare.
As I meet with veterans and veteran groups from northwest Indiana, I
continue to be grateful every day for the selfless service and
sacrifice by our veterans and their families.
Just yesterday, less than 24 hours ago, a veteran representing the
DAV, came to me who had two forms of cancer, who was advocating not
only for himself but other veterans to make sure they received the care
and the necessity of care that they deserve, as we have a
responsibility to ensure that all veterans receive world-class
healthcare when they return home from protecting our freedoms and
defending our democracy.
I commend Chairman Takano for his consistent advocacy and leadership
to bring this measure to the floor today.
I appreciate the announcement yesterday that the VA will process
claims for toxic-exposed veterans with certain rare respiratory
cancers. More must be done. I encourage all my colleagues to vote for
the Honoring our PACT Act so

[[Page H1234]]

that a regular and transparent process is established to ensure that
all issues facing toxic-exposed veterans are comprehensively addressed.
As I stated when I opened, the impact of this legislation is that
veterans receive the world-class healthcare they deserve.

{time} 1315

Mrs. MILLER-MEEKS. Mr. Speaker, I applaud the VA for initiating a
review of these nine rare cancers to determine if they are linked to
airborne hazard exposure while deployed. I am looking forward to
hearing about the VHA's research, which supported the expansion of
benefits to these Gulf war and post-9/11 veterans.
Likewise, I am interested in learning more about the number of
veterans who would be impacted by this decision and the effect it will
have on the VA.
However, these nine cancers are only a subset of the conditions
included in Chairman Takano's bill. I believe more scientific research
is needed to determine if additional disabilities are linked to
airborne hazard exposure.
Both the majority and the minority want world-class healthcare for
our veterans, and thus, it underscores our concern with this bill.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentleman from
California (Mr. Ruiz), my good friend and neighbor in California,
someone who has authored a great big section of this bill on our
presumptives, a member of the House Veterans' Affairs Committee and an
active member on the Disability Assistance and Memorial Affairs
Subcommittee.
Mr. RUIZ. Mr. Speaker, as we stand here right now, our servicemembers
have returned home from the battlefield only to become delayed
casualties of war due to their battlefield exposure to toxic burn pits.
My constituents, Jennifer Kepner and Alejandro Camacho, both
developed cancers from the burn pits' toxic smoke containing
carcinogens they breathed day in and day out while serving our country.
Jen Kepner died from pancreatic cancer, and Alejandro Camacho suffers
from testicular cancer.
Let me repeat that. They got sick because they were exposed to burn
pits' toxic smoke while doing their duty for our country.
To make matters worse, both Jennifer and Alejandro were turned down
when applying for benefits because the VA said that there wasn't enough
evidence to link their illness to their service.
To not give our veterans the proper care and benefits they earned and
rightly deserve is a dereliction of our Nation's duty.
That is why I introduced the Presumptive Benefits for War Fighters
Exposed to Burn Pits and Other Toxins Act.
It would create a presumption of service connection for 23 illnesses,
including cancers related to service near burn pits, and it has been
included in the Honoring our PACT Act.
My bill is the very soul of the Honoring our PACT Act. It would take
the burden off of our veterans to prove that they are sick as a result
of their service by presuming the reason they were diagnosed with this
illness is because of their service near burn pits.
Now is the time to fix this, and anything short of including all 23
of these illnesses is not good enough. The Health Care for Burn Pit
Veterans Act is not good enough. It will shortchange our veterans. It
is like telling a pneumonia patient who needs antibiotics for the cure
that, hey, listen, let's just give you Tylenol, call it a day, and we
have taken care of the patient. That is medical negligence, and that is
not what we are going to do to our veterans.
We cannot have another Agent Orange in our generation and ``delay
until dead'' as our Vietnam veterans have said.
So I urge my colleagues to support passage of this lifesaving
bipartisan bill. I urge them to stop the medical negligence and the
dereliction of duty to come together as a country and do what is right
because the science is there. It is not a secret. Carcinogens cause
cancer. Burn pits' smoke have carcinogens. Our burn pits veterans are
delayed casualties from cancers.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, the veterans who are sick may not be able to get
benefits immediately under this bill since they will be waiting for the
VA to process their claims during a 1.5 million-claim backlog.
There is also no guarantee VA will get it right the first time. The
VA does not have a great track record of accurately processing claims
while working to address a massive backlog.
For example, during the Obama administration, VA took shortcuts to
artificially reduce the backlog, such as the provisional denial
program. We should be focused on getting veterans the care they need
now to recover while continuing to work on the best path forward to
other benefits.
Additionally, without a clear path forward in the Senate on the PACT
Act, veterans will continue to wait while Congress works to get it
right.
The revisions to the presumptive framework in Title 2 were unveiled
less than 2 weeks ago. We have not had a chance to discuss these
changes publicly with stakeholders and VA. As such, it is unclear if
the changes made by the Rules Committee Print version would improve or
hinder VA's efforts to establish a consistent scientific process for
deciding when to extend benefits based on toxic exposure. And by doing
so, as my colleague suggests, we may, in fact, not go down a pathway
determining why a veteran is ill and what other exposures may have
caused their illness.
I believe more time is needed to refine the presumptive framework in
this bill to ensure that veterans will receive a fair look at which
conditions are linked to toxic exposure. We can pass the Health Care
for Burn Pit Veterans Act now as the first step to get these veterans
the healthcare that they need as we continue to develop a bipartisan,
bicameral way forward on the presumptive framework.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 1 minute to the gentleman from
Georgia (Mr. Bishop), my very good friend who serves as a subcommittee
chair on the Appropriations Committee and also a former member of the
House Veterans' Affairs Committee.

Mr. BISHOP of Georgia. Mr. Speaker, I thank the chairman for
yielding.
Mr. Speaker, I rise to support the Honoring our PACT Act, which will
ensure that veterans who have been exposed to toxic substances,
materials, or environments during their military service, particularly
toxic burn pits and Agent Orange, will receive the care and benefits
they deserve.
Exposure to these toxins has led to devastating health conditions
suffered by veterans, including neurological disorders, pulmonary
diseases, rare forms of cancer, and many other conditions.
In the past, the government has been too slow to recognize the link
between exposure to toxic substances and the medical problems that
veterans have dealt with when they returned home.
As a result, veterans and their families have been denied benefits
and much-needed disability compensation to deal with the health effects
of these toxins.
The Honoring our PACT Act would correct these errors and renew our
solemn commitment to our Nation's veterans.
I urge my colleagues to support the Honoring our PACT Act to ensure
that our country fulfills Abraham Lincoln's promise to care for him and
her who shall have borne the battle.
Mrs. MILLER-MEEKS. Mr. Speaker, the concerns the minority had with
this bill were laid out during the markup of the PACT Act, as well as
the roundtable last month. We did not see the revised text until it was
published by the Rules Committee.
At the ranking member's direction, the minority staff were willing to
work through these concerns with your staff line-by-line, but this was
rebuffed.
The minority staff was also told that any proposed changes to the
scope of the bill would not be accepted.
It is clear that the majority was not willing to address our concerns
with this bill.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 1 minute to the gentleman from Texas

[[Page H1235]]

(Mr. Castro), my good friend who serves on the Education and Labor
Committee and is a member of the Permanent Select Committee on
Intelligence and is a subcommittee chair on the Foreign Affairs
Committee.
Mr. CASTRO of Texas. Mr. Speaker, I proudly represent what is known
as ``Military City U.S.A.,'' San Antonio, Texas, the home to hundreds,
if not thousands, of veterans who, like others across the country, were
exposed to open-air burn pits whose lives have been ruined, and for
some, it has cost them their life.
We have to stand up for our veterans the way they stood up for our
country when they were on Active Duty. Yet, what I keep hearing from
Republicans is that there is not enough information. There is not
enough money.
Mr. Speaker, how often do you hear people around here ask whether it
is too expensive to buy a tank, whether it is too expensive to buy a
jet or an aircraft carrier. Yet, when it comes to our men and women in
uniform, who go risk their lives on behalf of our country and our
allies, the question coming from Republicans is whether it is too
expensive.
Why don't you just tell them that it is too goddamned expensive to
save their lives? Why don't you tell them that they are not worth the
money? Because what you are saying is that you want tax cuts for
billionaires and cancer for veterans.
Mrs. MILLER-MEEKS. Mr. Speaker, the question from Republicans is why
not pass a bill that has already passed the Senate that would give
access to lifesaving healthcare to our veterans now?
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 1 minute to the gentlewoman from
Connecticut (Mrs. Hayes), my very good friend who serves on the
Education and Labor Committee with me and as is the subcommittee chair
on the Agriculture Committee.
Mrs. HAYES. Mr. Speaker, today I rise to urge my colleagues to
support the Honoring our PACT Act, which upholds the promise we made to
servicemembers that we would care for them if they became sick or
wounded while fighting to protect this country.
This legislation recognizes the full range of military toxic exposure
that servicemembers have faced.
This monumental package also includes my bill, the Palomares Veterans
Act, which would remove barriers to benefits and compensation for those
veterans who responded to one of the largest nuclear disasters in
history.
Over 55 years ago, a B-52 bomber collided with aircraft over the
Spanish village of Palomares, causing radiation exposure to more than
1,600 U.S. airmen who had no protection when they responded to the
crash.
Decades later, many of these airmen are suffering and dying from
health conditions that likely came from radioactive material. But the
VA still does not count Palomares as a radiation risk event or provide
these veterans with benefits or disability.
My bill, the Honoring our PACT Act, would address this, ensuring
these veterans get the healthcare and benefits they deserve and
ensuring their surviving spouses and children are eligible for
benefits.
The job of Congress is to appropriate funds, yet whenever we want to
help people, my Republican colleagues say no. If we are not willing to
support our veterans, what are we willing to support?
Mrs. MILLER-MEEKS. Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, at this time I yield 2 minutes to the
gentlewoman from Florida (Ms. Lois Frankel), my good friend who is a
valued member of the Veterans' Affairs Committee, serving on the
Subcommittee on Health.
Ms. LOIS FRANKEL of Florida. Mr. Speaker, I thank the gentleman for
yielding and for his leadership.
Mr. Speaker, I am blessed that my son, Ben, a Marine war veteran,
returned safely from tours in Iraq and Afghanistan. Ben is now a small
business owner, and he has even given me two beautiful grandsons. And
listen, not every family is as lucky.
Our servicemen and -women put their lives on the line for our Nation,
and yet for too long, countless veterans have unknowingly been exposed
to environmental hazards and toxic waste, like burn pits, during their
duty. And then they come back home with long-term health impacts like
cancer, infertility, and breathing issues.
Mr. Speaker, they deserve better. We owe them better. And here is the
thing: If we are willing to send our troops to war, we must also be
willing to care for their health upon return, and this includes the
80,000 veterans in my home area of Palm Beach County.
It is time for Congress to honor this commitment and pass the
Honoring our PACT Act to provide access to VA healthcare to millions of
veterans exposed to toxic substances.
The best way to thank our veterans for their service is with action.
I urge my colleagues to pass this important bill.
Mr. TAKANO. Mr. Speaker, I would like to inquire as to how much time
I have remaining.
The SPEAKER pro tempore. The gentleman has 7\1/2\ minutes remaining.
Mrs. MILLER-MEEKS. Mr. Speaker, Republicans agree with Democrats
about how important it is to help veterans suffering from toxic
exposure. However, there is nothing bipartisan about how the majority
has gone about this.
The majority has consistently refused to meaningfully communicate
with us on this bill. We are seeing similar refusal to work together in
good faith on other fronts, as well.
This is the third controversial veterans bill that has gone before
the Rules Committee this year alone.
In 2017, when this committee had a Republican chairman, The New York
Times called the Veterans' Affairs Committee ``the most bipartisan in
Congress.'' That is not the case in the House anymore, not since the
Democrat majority took charge.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 1 minute to the gentlewoman from New
York (Ms. Meng), my very good friend who serves on the House
Appropriations Committee.

{time} 1330

Ms. MENG. Mr. Speaker, I rise today in favor of H.R. 3967, Honoring
our PACT Act, authored by my friend and esteemed colleague, Chairman
Takano.
This important bill includes the text of my bill, the Mark Takai
Atomic Veterans Healthcare Parity Act, named after our dear, late
friend and colleague, Representative Mark Takai.
H.R. 3967 would permit veterans who participated in the nuclear
cleanup of Enewetak Atoll in the Western Pacific to be treated as
radiation-exposed veterans and receive service-connected compensation
benefits.
Current law only covers servicemembers who participated in active
nuclear tests and not those who participated in the cleanup. With the
passage of this bill, Congress will finally right this wrong.
Mr. Speaker, once again, I thank Chairman Mark Takano for his
tremendous leadership on this legislation, and I urge my colleagues to
vote for the passage of H.R. 3967.
Mrs. MILLER-MEEKS. Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 1 minute to the gentleman from Guam
(Mr. San Nicolas), my good friend who serves on the Committee on
Financial Services and the Committee on Natural Resources.
Mr. SAN NICOLAS. Mr. Speaker, imagine a system that frustrates you
being weaponized in order to deny you the care that you are entitled to
and that you should be entitled to in this country. That is what we do
when we say that the inefficiencies of the VA system is reason for us
not to pass this bill.
This bill is going to do so much good for veterans who deserve it,
and it is going to do so much good for particular veterans who served
in Guam and were exposed to Agent Orange. It is the only bill right now
that is going to get that done.
Mr. Speaker, the late Lonnie Kilpatrick died from his exposure to
Agent Orange. My bipartisan colleague, Gus Bilirakis, and I introduced
a bill to address that exposure. This legislation that we are talking
about today, the Honoring our PACT Act, will get that done.
Let's not weaponize the frustrations of the VA to prevent those kinds
of solutions. Let's get this done for our veterans. It is about time.

[[Page H1236]]

Mrs. MILLER-MEEKS. Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman from
the State of California (Mr. Ruiz), my good friend and colleague, the
author of the provisions on the 23 presumptions.
Mr. RUIZ. Mr. Speaker, I have been hearing these arguments or these
pleas that our colleagues on the other side agree with the sentiment,
that they agree that they want to take care of this. Well, those are
just words. Whether they agree will be demonstrated by their votes.
Those are actions.
I am hearing the same excuses that our Vietnam veterans heard when
they were dying from Agent Orange and pleading for help, the excuse
that the science is not there; we need more time; oh, it costs too
much.
Well, listen here, the science is there. As a medical professional, I
reviewed the science. The scientific studies were flawed. They did not
ask the right questions. And there is enough evidence from other
extrapolated data that shows that carcinogens can cause cancer, that
heavy toxic metals in your lungs can cause pulmonary fibrosis. We have
to make sure that if the burn pits are illegal in the United States,
they should be illegal everywhere else because of this science.
Then we hear, ``We need more time.'' Well, look, it has taken us
years to get to this point. I want them to ask the widows of General
Kepner and all the veterans, the thousands of widows and sons and
daughters who lost their parents, if they need more time. To them, it
is too late, and we need to act now.
Mr. Speaker, this is reminiscent of the notion that our Vietnam
veterans say, that what they want to do is delay till dead. Delay,
delay, delay until they are dead. We cannot allow that to happen.
Then the next is, ``It costs too much.'' Well, that is a value
statement. That is a value statement. To us, valuing the lives of our
veterans and their family members is more important than giving
billions of dollars to billionaires in a tax law that shortchanged the
middle class. Their Health Care for Burn Pit Veterans Act will
shortchange our veterans and their widows who need the care right now
because they are dying from burn pits.
That is our value, and that is the value I am pleading to the folks
on the other side to join us in, in a bipartisan way with unity to
support our veterans.
Mr. Speaker, veterans are watching. They are listening. They care.
Some are even listening to this with oxygen in nasal cannula taking
their medications. Some could possibly be in their hospital bed taking
chemotherapy. Some are in tears because a widow's and their father or
mother's experiences are finally being recognized, and finally, we are
able to do something. They are watching, and your sympathies will be
reflected in your vote.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, the blue water Navy and Agent Orange were different. In
2011, the Institute of Medicine concluded that, given the passage of
time and lack of sampling data, there was not enough information to
conclusively determine whether blue water Navy veterans were exposed to
Agent Orange. However, we already knew what conditions were linked to
Agent Orange.
On the other hand, VA already presumes that certain veterans were
exposed to burn pits, but it is unclear what conditions are linked to
that exposure. The use of burn pits was more recent, and much of the
data needed to determine whether benefits are warranted for certain
conditions is still available.
That is why I support and why I urge my colleagues to support H.R.
6659, which has already passed the Senate, which would advance research
into health benefits for toxic exposures and get needed healthcare for
those veterans now.
Mr. Speaker, I was pleased during last night's State of the Union
that President Biden highlighted the need to address the needs of
toxic-exposed veterans.
As I stated earlier in debate just yesterday, VA announced it is
initiating the rulemaking process to extend benefits to certain Gulf
war and post-9/11 veterans who developed nine respiratory cancers.
Clearly, Secretary McDonough has the authority to provide benefits
for veterans on a presumptive basis. I applaud the Secretary for
exercising his authority to provide toxic-exposed veterans with the
earned benefits based on science, and I urge him to continue to do so.
We should pass the Health Care for Burn Pit Veterans Act now so we
can send it straight to the President's desk immediately while we
continue to work with our Senate colleagues and VA on the right
solution for additional benefits. However, toxic-exposed veterans will
not receive healthcare or benefits simply by virtue of passing the PACT
Act in the House today.
Mr. Speaker, I yield back the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, to give the final words on the underlying bill, the PACT
Act, on my mind is a constituent, a Vietnam veteran named Zack Earp, a
distant relative of the great Wyatt Earp.
Zack sacrificed mightily on behalf of our country, and his body
trembles today from Parkinsonism, one of the presumptives that got
added during the blue water Navy debate. And I was happy to lead the
final charge on getting the Blue Water Navy Vietnam Veterans Act across
the finish line.
But do you know what? Passage of that bill and its signage into law
finally brought justice to our Vietnam veterans who served on naval
surface ships on the territorial waters of Vietnam. It was 40 years
late, justice 40 years late.
Mr. Speaker, I vowed that this would not happen again. To pass half
measures, one-tenth measures, or one-half of 1 percent measures, which
is what the minority proposes to do today, as a substitute for a
comprehensive bill is simply repeating the history of what we did to
our Vietnam veterans. Burn pits are this generation of veterans' Agent
Orange.
Mr. Speaker, I say to my friends that we cannot repeat that history.
We owe our Vietnam veterans that implicit promise that we would not
repeat the history that was done to them.
As for the cost, I hear the other side competing with the President.
Let us send more billions of dollars to Ukraine. And I, myself, would
support a robust response to Ukraine in terms of money, but where is
that same sense of one-upmanship when it comes to taking care of the
veterans here in America?
People are falling over each other in this Chamber to get more money
to Ukraine. That is the right thing to do, but it is also the right
thing to do to take care of our veterans and to finish the unfinished
business.
Finally, the science, I am glad to see science is being taken so
seriously by the minority after we have seen skepticism about vaccines,
skepticism about climate change. Suddenly, we are looking for
scientific absolutism about our veterans.
Mr. Speaker, I say to my friends, the science is there. Let's get
this done. Let's pass the PACT Act today with a big bipartisan vote.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. All time for debate has expired.
Each further amendment printed in part B of House Report 117-253 not
earlier considered as part of amendments en bloc pursuant to section 3
of House Resolution 950, shall be considered only in the order printed
in the report, may be offered only by a Member designated in the
report, shall be considered as read, shall be debatable for the time
specified in the report equally divided and controlled by the proponent
and an opponent, may be withdrawn by the proponent at any time before
the question is put thereon, shall not be subject to amendment, and
shall not be subject to a demand for division of the question.
It shall be in order at any time after debate for the chair of the
Committee on Veterans' Affairs or his designee to offer amendments en
bloc consisting of further amendments printed in part B of House Report
117-253, not earlier disposed of. Amendments en bloc shall be
considered as read, shall be debatable

[[Page H1237]]

for 20 minutes equally divided and controlled by the chair and ranking
minority member of the Committee on Veterans' Affairs or their
respective designees, shall not be subject to amendment, and shall not
be subject to a demand for division of the question.

Amendments En Bloc Offered by Mr. Takano of California

Mr. TAKANO. Mr. Speaker, pursuant to section 3 of House Resolution
950, I rise to offer 23 amendments en bloc to H.R. 3967.
The SPEAKER pro tempore. The Clerk will designate the amendments en
bloc.
Amendments en bloc consisting of amendment Nos. 1, 2, 3, 4, 7, 8, 9,
10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 21, 24, 25, 26, 27, and 28,
printed in part B of House Report 117-253, offered by Mr. Takano of
California:

Amendment No. 1 Offered by Ms. Bush of Missouri

Page 55, line 20, strike ``age'' and insert ``race and
ethnicity''.
Page 55, after line 20, insert the following new paragraph
(and redesignate the subsequent paragraphs accordingly):
(2) The age of the veteran.

Amendment No. 2 Offered by Ms. Bush of Missouri

Page 55, after line 6, insert the following new subsection
(and redesignate the subsequent subsection accordingly):
(b) Elements.--The study under subsection (a) shall assess,
with respect to each veteran included in the study, the
following:
(1) The race and ethnicity of the veteran.
(2) The age of the veteran.
(3) The period of service and length of service of the
veteran in the Armed Forces.
(4) Any military occupational speciality of the veteran.
(5) The gender of the veteran.
(6) The disability status of the veteran.

Amendment No. 3 Offered by Ms. Bush of Missouri

Page 58, line 5, strike ``located in the United States''.

Amendment No. 4 Offered by Ms. Bush of Missouri

At the end of title V, add the following:

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

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

Amendment No. 7 Offered by Mr. Cartwright of Pennsylvania

Page 61, after line 20, insert the following:
(c) Veterans Organizations.--To the extent practicable, the
Secretary shall share with national veterans service
organizations and other veterans groups, including such
organizations and groups that improve access by veterans to
health care and benefits, the list of resources under
subsection (a) and the outreach program under subsection (b).

Amendment No. 8 Offered by Mr. Gibbs of Ohio

Page 15, line 2, insert ``and Other Matters'' after
``Service''.
Page 17, after line 6, insert the following new section:

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

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

Amendment No. 9 Offered by Mr. Golden of Maine

Page 6, line 5, insert ``(including mental health services
and counseling)'' after ``hospital care''.
Page 6, line 11, insert ``(including mental health services
and counseling)'' after ``hospital care''.
Page 6, line 17, insert ``(including mental health services
and counseling)'' after ``hospital care''.
Page 50, line 14, insert ``(including mental health
services and counseling)'' after ``hospital care''.

Amendment No. 10 Offered by Mr. Gottheimer of New Jersey

At the end of title V, insert the following:

SEC. 507. STUDY ON TOXIC EXPOSURE AND MENTAL HEALTH OUTCOMES.

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

Amendment No. 11 Offered by Mr. Gottheimer of New Jersey

Page 61, line 20, insert after the period the following:
``Information distributed under the outreach program shall be
treated as a fact sheet of the Department of Veterans Affairs
for purposes of making the information available in multiple
languages pursuant to section 2 of the Veterans and Family
Information Act (Public Law 117-62; 38 U.S.C. 6303 note).''.

Amendment No. 12 Offered by Mrs. Hartzler of Missouri

Add at the end of title VII the following new sections:

SEC. 7__. NON-APPLICABILITY OF NON-DEPARTMENT OF VETERANS
AFFAIRS COVENANTS NOT TO COMPETE TO APPOINTMENT
OF VETERANS HEALTH ADMINISTRATION PERSONNEL.

(a) In General.--Subchapter I of chapter 74 of title 38,
United States Code, is amended by adding at the end the
following new section:

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

``(a) Non-Applicability.--Except as provided in subsection
(b), in the case of an individual who is an applicant for
appointment to a position in the Veterans Health
Administration described in section 7401 of this title, any
covenant not to compete into which the individual has entered
with a non-Department facility or party shall have no force
or effect with respect to the appointment of the individual
to such a position.
``(b) Service Obligation.--(1) Any individual who is
appointed to such a position in the Veterans Health
Administration shall, as a condition of such appointment,
agree to provide clinical services at a Department medical
facility for the duration of the period described in
paragraph (2).
``(2) The period described in this paragraph is the period
that begins on the date on which an individual is appointed
to such a position and ends on the latter of the following
dates:
``(A) The date that is one year after such date of
appointment.

[[Page H1238]]

``(B) The date of the termination of any covenant not to
compete entered into between the individual and a non-
Department facility or party.
``(3) The Secretary may waive the requirement under
paragraph (1) with respect to an individual at the discretion
of the Secretary.
``(c) Termination of Department Employment.--In the case of
an individual who is appointed to such a position in the
Veterans Health Administration who has entered into a
covenant not to compete that is rendered non-applicable
pursuant to subsection (a), if the individual's employment at
the Veterans Health Administration is terminated for any
reason before the specified termination date of such
covenant, subsection (a) shall not apply with respect to such
covenant after the date of the termination of the
individual's employment at the Veterans Health
Administration.
``(d) Covenant Not To Compete.--In this section, the term
`covenant not to compete' means an agreement--
``(1) between an employee and employer or a contractor and
principal that restricts such employee or contractor from
performing--
``(A) any work for another employer for a specified period
of time;
``(B) any work in a specified geographical area; or
``(C) work for another employer performing work that is
similar to the work such employee or contractor performed for
the employer or principal, included as a party to the
agreement; and
``(2) that is entered into after the date of enactment of
this Act.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 7413 the following new item:

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

SEC. 7__. RECRUITMENT OF PHYSICIANS ON A CONTINGENT BASIS
PRIOR TO COMPLETION OF TRAINING REQUIREMENTS.

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

Amendment No. 13 Offered by Ms. Jackson Lee of Texas

Page 74, after line 19, insert the following new
subsection:
(c) Report on National Guard Use of ILER.--Not later than
one year after the date of the enactment of this Act, the
Secretary of Defense shall submit to the appropriate
committees of Congress a report on the feasibility of
modifying the Individual Longitudinal Exposure Record to
ensure that a member of the National Guard who is deployed in
the United States in connection with a natural disaster,
without regard to duty status (including any duty under title
10 or title 32, United States Code, or State active duty),
may record information regarding a suspected exposure by the
member to toxic substances during such deployment.

Amendment No. 14 Offered by Mr. Levin of Michigan

Page 19, line 11, insert ``, including mental and physical
health'' after ``individual''.

amendment no. 15 offered by mr. levin of california

Add at the end of title VII the following new section:

SEC. 7__. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO
AWARD GRANTS TO STATES TO IMPROVE OUTREACH TO
VETERANS.

(a) In General.--Chapter 63 of title 38, United States
Code, is amended--
(1) by redesignating sections 6307 and 6308 and sections
6308 and 6309, respectively; and
(2) by inserting after section 6306 the following new
section 6307:

``Sec. 6307. Grants to States to improve outreach to veterans

``(a) Purpose.--It is the purpose of this section to
provide for assistance by the Secretary to States to carry
out programs that--
``(1) improve outreach and assistance to veterans and the
spouses, children, and parents of veterans, to ensure that
such individuals are fully informed about any veterans and
veterans-related benefits and programs (including State
veterans programs) for which they may be eligible; and
``(2) facilitate opportunities for such individuals to
receive competent, qualified services in the preparation,
presentation, and prosecution of veterans benefits claims.
``(b) Authority.--The Secretary may award grants to
States--
``(1) to carry out, coordinate, improve, or otherwise
enhance outreach activities;
``(2) to increase the number of county or tribal veterans
service officers serving in the State by hiring new,
additional such officers; or
``(3) to expand, carry out, coordinate, improve, or
otherwise enhance existing programs, activities, and services
of the State's existing organization that has been recognized
by the Department of Veterans Affairs pursuant to section
5902, in the preparation, presentation, and prosecution of
claims for veterans benefits through representatives who hold
positions as county or Tribal veterans service officers.
``(c) Application.--(1) To be eligible for a grant under
this section, a State shall submit to the Secretary an
application therefor at such time, in such manner, and
containing such information as the Secretary may require.
``(2) Each application submitted under paragraph (1) shall
include the following:
``(A) A detailed plan for the use of the grant.
``(B) A description of the programs through which the State
will meet the outcome measures developed by the Secretary
under subsection (i).
``(C) A description of how the State will distribute grant
amounts equitably among counties (or Tribal lands, as the
case may be) with varying levels of urbanization.
``(D) A plan for how the grant will be used to meet the
unique needs of American Indian or Alaska Native veterans,
elderly veterans, women veterans, and veterans from other
underserved communities.
``(d) Distribution.--The Secretary shall seek to ensure
that grants awarded under this section are equitably
distributed among States with varying levels of urbanization.
``(e) Priority.--The Secretary shall prioritize awarding
grants under this section that will serve the following
areas:
``(1) Areas with a critical shortage of county or tribal
veterans service officers.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(f) Use of County or Tribal Veterans Service Officers.--A
State that receives a grant under this section to carry out
an activity described in subsection (b)(1) shall carry out
the activity through--
``(1) a county or Tribal veterans service officer of the
State; or
``(2) if the State does not have a county or tribal
veterans service officer, or if the county or Tribal veterans
service officers of the State cover only a portion of that
State, an appropriate entity of a State, local, or Tribal
government, or another publicly funded entity, as determined
by the Secretary.
``(g) Required Activities.--Any grant awarded under this
section shall be used--
``(1) to expand existing programs, activities, and
services;
``(2) to hire and maintain new, additional county or Tribal
veterans service officers; or
``(3) for travel and transportation to facilitate carrying
out paragraph (1) or (2).
``(h) Other Permissible Activities.--A grant under this
section may be used to provide education and training,
including on-the-job training, for State, county, local, and
tribal government employees who provide (or when trained will
provide) veterans outreach services in order for those
employees to obtain and maintain accreditation in accordance
with procedures approved by the Secretary.
``(i) Outcome Measures.--(1) The Secretary shall develop
and provide to each State that receives a grant under this
section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1),
the Secretary shall consider the following goals:
``(A) Increasing the use of veterans and veterans-related
benefits, particularly among vulnerable populations.
``(B) Increasing the number of county and tribal veterans
service officers recognized by the Secretary for the
representation of veterans under chapter 59 of this title.
``(j) Tracking Requirements.--(1) With respect to each
grant awarded under this section, the Secretary shall track
the use of veterans benefits among the population served by
the grant, including the average period of time between the
date on which a veteran or other eligible claimant applies
for such a benefit and the date on which the veteran or other
eligible claimant receives the benefit, disaggregated by type
of benefit.
``(2) Not less frequently than annually during the life of
the grant program established under this section, the
Secretary shall submit to Congress a report on--
``(A) the information tracked under paragraph (1);

[[Page H1239]]

``(B) how the grants awarded under this section serve the
unique needs of American Indian or Alaska Native veterans,
elderly veterans, women veterans, and veterans from other
underserved communities; and
``(C) other information provided by States pursuant to the
grant reporting requirements.
``(k) Performance Review.--(1) The Secretary shall--
``(A) review the performance of each State that receives a
grant under this section; and
``(B) make information regarding such performance publicly
available.
``(l) Remediation Plan.--(1) In the case of a State that
receives a grant under this section and does not meet the
outcome measures developed by the Secretary under subsection
(i), the Secretary shall require the State to submit a
remediation plan under which the State shall describe how and
when it plans to meet such outcome measures.
``(2) The Secretary may not award a subsequent grant under
this section to a State described in paragraph (1) unless the
Secretary approves the remediation plan submitted by the
State.
``(m) Maximum Amount.--The amount of a grant awarded under
this section may not exceed 10 percent of amounts made
available for grants under this section for the fiscal year
in which the grant is awarded.
``(n) Supplement, Not Supplant.--Any grant awarded under
this section shall be used to supplement and not supplant
State and local funding that is otherwise available.
``(o) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary for each of fiscal years
2023 through 2027, $50,000,000 to carry out this section.
``(p) Definitions.--In this section:
``(1) The term `county or tribal veterans service officer'
includes a local equivalent veterans service officer.
``(2) The term `State' includes each Indian Tribe, the
District of Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands, and any
territory or possession of the United States.
``(3) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of
this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 63 of such title is amended by striking
the items relating to sections 6307 and 6308 and inserting
the following new items:

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

amendment no. 16 offered by ms. newman of illinois

Add at the end of title VII the following new section:

SEC. 7__. STUDY AND REPORT ON HERBICIDE AGENT EXPOSURE IN
PANAMA CANAL ZONE.

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

amendment no. 17 offered by mr. pappas of new hampshire

Page 65, after line 22, insert the following:

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

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

amendment no. 18 offered by ms. plaskett of virgin islands

At the end of title V, add the following:

SEC. 506. STUDY ON VETERANS IN TERRITORIES OF THE UNITED
STATES.

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

amendment no. 19 offered by ms. porter of california

Add at the end of title V the following new section:

SEC. 507. DEPARTMENT OF VETERANS AFFAIRS PUBLIC WEBSITE FOR
TOXIC EXPOSURE RESEARCH.

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

amendment no. 21 offered by mr. ruiz of california

At the end of title VII, insert the following:

SEC. 707. BUDGET INFORMATION FOR ALTERNATIVES TO BURN PITS.

The Secretary of Defense shall include in the budget
submission of the President under section 1105(a) of title
31, United States Code, for each of fiscal years 2023 through

[[Page H1240]]

2027, a dedicated budget line item for incinerators and
waste-to-energy waste disposal alternatives to burn pits.

amendment no. 24 offered by ms. scanlon of pennsylvania

Add at the end of title VII the following new section:

SEC. 7__. AUTHORIZATION OF APPROPRIATIONS FOR EXPANSION OF
CLAIMS AUTOMATION.

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

amendment no. 25 offered by ms. slotkin of michigan

Strike section 501 and insert the following:

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

(a) In General.--Subchapter II of chapter 73 of title 38,
United States Code, is amended by adding at the end the
following new section:

``Sec. 7330D. Interagency working group on toxic exposure
research

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

``7330D. Interagency working group on toxic exposure research.''.

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

amendment no. 26 offered by ms. spanberger of virginia

Add at the end of title V the following new section:

SEC. 5__. BIENNIAL REPORT ON HEALTH EFFECTS OF JET FUELS USED
BY ARMED FORCES.

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

amendment no. 27 offered by mrs. torres of california

Page 61, after line 15, insert the following:
``(3) Languages.--The Secretary shall publish the list
under paragraph (1) in languages including the following:
``(A) English.
``(B) Spanish.
``(C) Chinese.
``(D) The seven other most commonly spoken languages in the
United States.''.

amendment no. 28 offered by mrs. torres of california

Page 55, line 14, strike ``veterans to'' and insert
``veterans, to''.
Page 55, line 16, strike ``veterans.'' and insert
``veterans, and on available early detection diagnostics, to
determine the feasibility and advisability of including such
diagnostics as part of the health care furnished to veterans
by the Secretary.''.

The SPEAKER pro tempore. Pursuant to House Resolution 950, the
gentleman from California (Mr. Takano) and the gentlewoman from Iowa
(Mrs. Miller-Meeks) each will control 20 minutes.
The Chair recognizes the gentleman from California.
Mr. TAKANO. Mr. Speaker, I urge my colleagues to support this
bipartisan en bloc of amendments, and I reserve the balance of my time.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise in support of the en bloc package. Many of these
amendments strengthen the underlying bill. However, I wish we could
have more time in committee to fully examine the impact these
amendments would have on this legislation.
While I will not oppose the en bloc package, some of the included
amendments are well outside the Committee on Veterans' Affairs'
jurisdiction or may require additional work, and I must highlight these
concerns.
Three of the amendments clearly impact the operations of the
Department of Defense and are well outside the Department of Veterans
Affairs' expertise or mission.
Representative Bush's amendment No. 3 would necessitate that the VA
review known cases of toxic exposure on military installations both in
the United States and abroad. Bush amendment No. 4 requires a study of
health outcomes related to waste from the Manhattan Project.
If anyone is going to conduct such reviews, it should be the
Department of Defense, not the Department of Veterans Affairs. VA's
time and resources need to be focused on meeting the needs of veterans,
not on investigating activities on military bases or as part of
military programs.
Yet another amendment, Representative Pappas' amendment No. 17, would
require VA to conduct a study outside of VA's expertise and purview.

{time} 1345

This amendment would require Virginia to coordinate with the
Department of Defense to provide training to Active Duty servicemembers
on toxic exposure. It is inappropriate for the VA to be involved in
training Active Duty servicemembers, that is entirely the DOD's
purview.
Finally, Representative Scanlon's amendment 24 would authorize an
additional $150 million in discretionary funding for VA's Veterans
Benefits Management System, ahead of an expected drastic increase in
disability claims should the Honoring our PACT Act be enacted. I agree
with the intent. We need to make additional investments in benefits IT,
but this is not the right way to do it.
According to the CBO, the bill already includes funding for IT
improvements. We have no plan from the VA about how various systems
should be modernized and how much it will ultimately cost. The worst
thing we could do is throw money at individual systems with no
coordination.
Moreover, this amendment improperly earmarks $150 million for VBMS,
which is a dysfunctional and flawed system. VBMS has cost over $1
billion and has been struggling since its inception 10 years ago. I am
not comfortable with spending another $150 million on it unless the VA
gives us a plan explaining how it can be modernized.
Moving forward, we need to work on allocating funding where it can
have

[[Page H1241]]

the most impact. Again, I support the intent and look forward to
ensuring that any IT funding supports veterans in the manner intended.
As I stated earlier, while I do have concerns about these four
amendments, I will support the en bloc package and urge my colleagues
to do the same.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, at this time I yield 2 minutes to the
gentlewoman from Missouri (Ms. Bush), my good friend who serves on the
Judiciary Committee and the House Oversight and Reform Committee.
Ms. BUSH. Mr. Speaker, I thank Mr. Takano for his leadership on this
historic legislation.
Mr. Speaker, St. Louis and I rise today in support of H.R. 3967, the
Honoring our PACT Act, to expand healthcare, research, and resources
for our veterans who are far too often exposed to toxic substances,
both around the world and at home in St. Louis. This means so much to
me as a nurse, I see it all the time.
I am proud to put forward four critical amendments to this
legislation to help expand racial equity and study the military's
environmental impact through rigorous Department of Veterans Affairs
initiatives. My first two amendments ensure that VA research studies
include a broader array of demographic information, including race,
ethnicity, and disability status in gathering information on the
impacts of toxic exposure.
Our third vital amendment ensures the VA will extend reviews of known
cases of toxic exposure to military sites abroad. The Department of
Defense needs to provide concrete data about the waste and pollution we
are leaving in the nearly 750 military bases in over 80 countries
around the world.
Finally, our last amendment adds a new study to this bill to measure
the harmful health consequences of Manhattan Project waste on our
veterans and their families in St. Louis.
If you are from North St. Louis there is a good chance that at some
point in your life you have been exposed to toxic military waste like I
have. From West Lake Landfill to Coldwater Creek, toxic military
nuclear waste has been dumped in our communities, leading to rare
cancers and birth defects.
Our veterans worked with this waste and are still living with it. The
study is just one step we are taking to care for their health and
safety. I look forward to voting in support of the Honoring our PACT
Act and advancing these critical amendments that will help us to save
lives.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield 2 minutes to the gentleman
from Ohio (Mr. Gibbs).
Mr. GIBBS. Mr. Speaker, I rise today in support of amendment No. 8 in
the en bloc. This amendment helps veterans and their families navigate
a bureaucratic maze at VA. It is very frustrating a lot of times when
they receive medical treatment at a non-VA facility.
When a veteran is admitted to a hospital or emergency department they
currently only have 3 days to notify the VA. If they fail to notify the
VA in that 3-day window, any claim associated with that visit will be
automatically denied.
There are circumstances when getting immediate medical care outside
of the VA system is the veteran's only option, especially during a
medical emergency. They and their family should not have to worry about
paperwork and the bureaucracy if the veteran is facing a life-
threatening condition or is unable to make his or her own healthcare
decisions.
My amendment simply just lengthens that window and adds another day
onto that window to report the claim. When you think about this, if you
are going in on an emergency basis and after you get stabilized--it
might take a couple days in the hospital to get stabilized--that extra
day doesn't seem like much, but it is really important because they get
stabilized and they get time to sort through where they are at. That is
so important. We have helped hundreds and maybe thousands of veterans
back in Ohio, and this comes up all the time, and they have to fight to
get their claim.
Mr. Speaker, I think it is really important, just a little bit of
extra time. It is a no-brainer issue. I appreciate the chair putting it
in the en bloc because it is really important because veterans,
especially when they are in a non-veteran facility and have emergency
care, they shouldn't have to worry about that deadline, and it just
gives them a little extra time.
Mr. Speaker, I support amendment No. 8.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Virginia (Ms. Spanberger), my good friend who serves as a subcommittee
chair on the Agriculture Committee and as a member of the
Foreign Affairs Committee.

Ms. SPANBERGER. Mr. Speaker, my commitment to supporting veterans
suffering from toxic exposures has been ironclad since I first met the
late Michael Lecik, a father, a husband, a firefighter, and a veteran
who died of cancer related to his exposures.
It continued when I met Gillie Jenkins, an atomic war veteran from
Chesterfield, Virginia, who in his 90s is still fighting for the
recognition of his brothers in arms and the sacrifices that they made.
Today, when I rise in support of my amendment to H.R. 3967, I am
doing so inspired by William G. Collins, a veteran from Louisa County,
Virginia. My amendment would require the VA to investigate the long-
term health impacts of jet fuel exposures on our country's
servicemembers.
Mr. Collins, a veteran from Louisa County, Virginia, is living with
Parkinson's. As a former Air Force crew fire chief, his years of
constant exposure to jet fuel put him at risk, but now the VA does not
recognize Mr. Collins' condition as having a service connection. Mr.
Collins served honorably, and he should know that his country has his
back.
Mr. Speaker, this amendment would bring us one step closer to ensure
that veterans like William have the healthcare benefits they deserve
and the acknowledgment of their sacrifice.
Mr. Collins says, ``This disease has impacted my health, my economic
security, and potentially my wife and I's dream of spending our last
years on our beloved farm where we raised our family.''
Mr. Speaker, today I urge my colleagues to support this long overdue
amendment as we support all of our Nation's veterans.
Mrs. MILLER-MEEKS. Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentleman from
Pennsylvania (Mr. Cartwright), the distinguished subcommittee chair of
the Appropriations Committee.
Mr. CARTWRIGHT. Mr. Speaker, here is the deal. When we send our
servicemembers into harm's way the deal is that we are going to take
care of them when they get back home. It is more than a deal; it is a
pact. It is something sacred. But for far too long Congress and the
Department of Veterans Affairs have been slow in acting on that pact
citing the high cost or the lack of science. The result is a disability
claims benefit process that is cumbersome and places the burden on the
veteran himself or herself to prove toxic exposure.
Mr. Speaker, I rise in support of my amendment which streamlines this
process. It helps ease the burden of the disability benefit claims
process on servicemembers and their families by, number one, requiring
the Secretary of the VA to share a list of resources for toxic-exposed
veterans, caregivers of toxic-exposed veterans, and survivors of toxic-
exposed vets, national veterans service organizations, and other
veterans' groups.
Number two, it requires the VA Secretary to share an outreach program
with those VSOs. I believe we have to take every step possible to
ensure that we offer the best care to those who have served our Nation.
My amendment is a step forward in reaching the goal that servicemembers
and their families should be made aware of every resource, and that
includes the resources included in the Honoring our PACT Act.
Mrs. MILLER-MEEKS. Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I have no further speakers and I reserve the
balance of my time.
Mrs. MILLER-MEEKS. Mr. Speaker, I yield back the balance of my time.
Mr. TAKANO. Mr. Speaker, I ask all my colleagues to join me in
supporting these 23 amendments en bloc, and I yield back the balance of
my time.

[[Page H1242]]

The SPEAKER pro tempore. Pursuant to House Resolution 950, the
previous question is ordered on the amendments en bloc offered by the
gentleman from California (Mr. Takano).
The question is on the amendments en bloc.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. BIGGS. Mr. Speaker, on that I demand the yeas and nays.
The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution
8, the yeas and nays are ordered.
Pursuant to clause 8 of rule XX, further proceedings on this question
are postponed.

Amendment No. 5 Offered by Mrs. Miller-Meeks.

The SPEAKER pro tempore. It is now in order to consider amendment No.
5 printed in part B of House Report 117-253.
Mrs. MILLER-MEEKS. Mr. Speaker, I rise as the designee of the
gentleman from Illinois, and I have an amendment at the desk.
The SPEAKER pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:

Strike page 1, line 1, and all that follows through page
80, line 7, and insert the following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Health Care for Burn Pit
Veterans Act''.

SEC. 2. EXPANSION OF ELIGIBILITY FOR HEALTH CARE FROM
DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN
VETERANS EXPOSED TO TOXIC SUBSTANCES.

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

SEC. 3. INCORPORATION OF TOXIC EXPOSURE SCREENING FOR
VETERANS.

(a) In General.--Beginning not later than 90 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall incorporate a screening to help determine
potential exposures to toxic substances during active
military, naval, air, or space service as part of a health
care screening furnished by the Secretary to veterans
enrolled in the system of annual patient enrollment of the
Department of Veterans Affairs established and operated under
section 1705 of title 38, United States Code, to improve
understanding by the Department of exposures of veterans to
toxic substances while serving in the Armed Forces.
(b) Timing.--The Secretary shall ensure that a veteran
described in subsection (a) completes the screening required
under such subsection not less frequently than once every
five years.
(c) Determination of Questions.--
(1) In general.--The questions included in the screening
required under subsection (a) shall be determined by the
Secretary with input from medical professionals.
(2) Specific questions.--At a minimum, the screening
required under subsection (a) shall, with respect to a
veteran, include--
(A) a question about the potential exposure of the veteran
to an open burn pit; and
(B) a question regarding exposures that are commonly
associated with service in the Armed Forces.
(3) Open burn pit defined.--In this subsection, the term
``open burn pit'' means an area of land that--
(A) is designated by the Secretary of Defense to be used
for disposing solid waste by burning in the outdoor air; and
(B) does not contain a commercially manufactured
incinerator or other equipment specifically designed and
manufactured for the burning of solid waste.
(d) Print Material.--In developing the screening
established under subsection (a), the Secretary shall ensure
that print materials complementary to such screening that
outline related resources for veterans are available at each
medical center of the Department to veterans who may not have
access to the internet.
(e) Screening Updates.--The Secretary shall consider
updates to the content of the screening required under
subsection (a) not less frequently than biennially to ensure
the screening contains the most current information.
(f) Active Military, Naval, Air, or Space Service
Defined.--In this section, the term ``active military, naval,
air, or space service'' has the meaning given that term in
section 101(24) of title 38, United States Code.

SEC. 4. TRAINING FOR PERSONNEL OF THE DEPARTMENT OF VETERANS
AFFAIRS WITH RESPECT TO VETERANS EXPOSED TO
TOXIC SUBSTANCES.

(a) Health Care Personnel.--The Secretary of Veterans
Affairs shall provide to health care personnel of the
Department of Veterans Affairs education and training to
identify, treat, and assess the impact on veterans of
illnesses related to exposure to toxic substances and inform
such personnel of how to ask for additional information from
veterans regarding different exposures.
(b) Benefits Personnel.--
(1) In general.--The Secretary shall incorporate a training
program for processors of claims under the laws administered
by the Secretary who review claims for disability benefits
relating to service-connected disabilities based on exposure
to toxic substances.
(2) Annual training.--Training provided to processors under
paragraph (1) shall be provided not less frequently than
annually.

SEC. 5. ANALYSIS AND REPORT ON TREATMENT OF VETERANS FOR
MEDICAL CONDITIONS RELATED TO TOXIC EXPOSURE.

(a) In General.--The Secretary of Veterans Affairs shall
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 the exposure of the veteran to a toxic substance.
(b) Annual Report.--Not later than one year after the date
of the enactment of this Act, and annually thereafter, the
Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report
containing--
(1) the aggregate 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.

SEC. 6. ANALYSIS RELATING TO MORTALITY OF VETERANS WHO SERVED
IN SOUTHWEST ASIA.

(a) Analysis.--
(1) In general.--Not later than 270 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in coordination with the Secretary of Defense, shall conduct
an updated analysis of total and respiratory disease
mortality in covered veterans.
(2) Elements.--The analysis required by paragraph (1) shall
include, to the extent practicable, the following with
respect to each covered veteran:
(A) Metrics of airborne exposures.
(B) The location and timing of deployments of the veteran.
(C) The military occupational specialty of the veteran.
(D) The Armed Force in which the veteran served.
(E) Pre-existing health status of the veteran, including
with respect to asthma.

[[Page H1243]]

(F) Relevant personal information of the veteran, including
cigarette and e-cigarette smoking history, diet, sex, gender,
age, race, and ethnicity.
(b) Covered Veteran Defined.--In this section, the term
``covered veteran'' means any veteran who--
(1) on or after August 2, 1990, served on active duty in--
(A) Bahrain;
(B) Iraq;
(C) Kuwait;
(D) Oman;
(E) Qatar;
(F) Saudi Arabia;
(G) Somalia; or
(H) the United Arab Emirates; or
(2) on or after September 11, 2001, served on active duty
in--
(A) Afghanistan;
(B) Djibouti;
(C) Egypt;
(D) Jordan;
(E) Lebanon;
(F) Syria; or
(G) Yemen.

SEC. 7. STUDY ON HEALTH TRENDS OF POST 9/11 VETERANS.

The Secretary of Veterans Affairs shall conduct an
epidemiological study on the health trends of veterans who
served in the Armed Forces after September 11, 2001.

SEC. 8. STUDY ON CANCER RATES AMONG VETERANS.

(a) In General.--The Secretary of Veterans Affairs shall
conduct a study on the incidence of cancer in veterans to
determine trends in the rates of the incidence of cancer in
veterans.
(b) Elements.--The study required by subsection (a) shall
assess, with respect to each veteran included in the study,
the following:
(1) The age of the veteran.
(2) The period of service and length of service of the
veteran in the Armed Forces.
(3) The military occupational specialty or specialties of
the veteran.
(4) The gender of the veteran.
(5) The type or types of cancer that the veteran has.

SEC. 9. 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 who were exposed to toxic substances;
(B) families and caregivers of such veterans; and
(C) survivors of such veterans who are receiving death
benefits under the laws administered by the Secretary.
(2) Update.--The Secretary shall periodically update the
list published under paragraph (1).
(b) Outreach.--The Secretary shall develop, with input from
the community, an informative outreach program for veterans
on illnesses that may be related to exposure to toxic
substances, including outreach with respect to benefits and
support programs.

SEC. 10. REPORT ON INDIVIDUAL LONGITUDINAL EXPOSURE RECORD.

(a) In General.--Not later than one year after the date on
which the Individual Longitudinal Exposure Record achieves
full operational capability, the Secretary of Veterans
Affairs shall submit to the appropriate congressional
committees a report on the data quality of the Individual
Longitudinal Exposure Record and the usefulness of the
Individual Longitudinal Exposure Record in supporting
veterans in receiving health care and benefits from the
Department of Veterans Affairs.
(b) Elements.--The report required by subsection (a) shall
include the following:
(1) An identification of exposures to toxic substances that
may not be fully captured by the current systems for
environmental and occupational health monitoring and
recommendations for how to improve those systems.
(2) An analysis of the quality of the location data in
determining exposures of veterans to toxic substances and
recommendations for how to improve the quality of that
location data.
(3) Recommendations on how to improve the usefulness of the
Individual Longitudinal Exposure Record.
(c) Definitions.--In this section:
(1) The term ``appropriate congressional committees''
means--
(A) the Committee on Armed Services and the Committee on
Veterans' Affairs of the House of Representatives; and
(B) the Committee on Armed Services and the Committee on
Veterans' Affairs of the Senate.
(2) The term ``Individual Longitudinal Exposure Record''
includes any pilot program or other program used by the
Department of Veterans Affairs or the Department of Defense
to track how members of the Armed Forces or veterans have
been exposed to various occupational or environmental
hazards.

The SPEAKER pro tempore. Pursuant to House Resolution 950, the
gentlewoman from Iowa (Mrs. Miller-Meeks) and a Member opposed each
will control 5 minutes.
The Chair recognizes the gentlewoman from Iowa.
Mrs. MILLER-MEEKS. Mr. Speaker, I rise today to discuss Ranking
Member Bost's amendment to replace the Honoring our PACT Act with the
Health Care for Burn Pit Veterans Act.
The Health Care for Burn Pit Veterans Act is a bipartisan legislation
that has already passed in the Senate. It would expand healthcare for
toxic-exposed veterans by extending VA's enhanced combat eligibility
period from 5 to 10 years. That would give post-9/11 combat veterans a
decade after leaving the military to enroll in VA care without having a
service-connected disability rating or a low income.
Those who have been out of the military for more than a decade would
be able to enroll during a 1-year open enrollment period. The bill
would also improve training for VA staff on how to recognize and treat
toxic exposure; research on the impact of toxic exposure; and outreach
about the resources available to veterans regarding toxic exposure. CBO
has estimated that the bill would cost $1 billion in discretionary
funding over 10 years.

{time} 1400

This is in stark contrast to the over $300 billion discretionary and
mandatory costs of the PACT Act.
The Healthcare for Burn Pit Veterans Act would not expand
compensation benefits for toxic-exposed veterans.
I appreciate the importance of benefits. That is why Ranking Member
Bost and I remain committed to working across the aisle and Capitol to
improve benefits for toxic-exposed veterans.
The framework that the PACT Act establishes to do that, however, is
unworkable, and I am afraid the PACT Act will stall without a clear
path forward in the Senate.
I don't want to let the perfect be the enemy of the good on an issue
as important as this one. I also don't want to let this Congress go by
without helping veterans who are sick and dying from toxic exposure. As
a veteran and as a doctor who has cared for sick and dying patients,
that would be an unacceptable outcome for me.
Passage of the Healthcare for Burn Pit Veterans Act is a critical
first step in saving the lives of veterans suffering from toxic
exposure. The House should not let another day go by without sending it
to the President. The stakes are too high.
Behind me is a picture of Lauren Price. She passed away from
conditions she and her husband Jim believe were related to toxic
exposure. Ranking Member Bost invited Jim to testify last year about
Lauren's legacy. During his testimony, Jim stressed the need to provide
veterans like her with VA healthcare. As he said, benefits don't mean
much if a veteran isn't alive to get them because they didn't get the
healthcare they need and earned.
Jim's message is an important one. Some veterans cannot afford to
keep waiting for Congress to agree on a comprehensive way forward. That
would be a monumental task, and we have not even started it yet. That
is why the House must pass the Healthcare for Burn Pit Veterans Act
today. I hope we will.
Mr. Speaker, I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I rise in opposition to the amendment.
The SPEAKER pro tempore (Mr. Johnson of Georgia). The gentleman from
California is recognized for 5 minutes.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise in strong opposition to Ranking Member Bost's
substitute offered in his absence by Representative Miller-Meeks.
I want to be clear about what this substitute is and what it is not.
The ranking member has offered this amendment as the solution to
addressing toxic exposure. But it is not that. The substitute amendment
is the exact text of a Senator Tester bill which is meant to be the
first part of a three-part effort in the Senate.
What Senator Tester has proposed, is doing in three phases what we
have done in the PACT Act together. Yet my colleague from Illinois and
my colleague from Iowa have taken the work of the Senate without
intending to do

[[Page H1244]]

any more. This is it. They are representing this as the complete
solution which amounts to really a bait and switch.
This substitute amendment would strike the entire PACT Act and
replace it with an expansion of existing healthcare eligibility for
combat veterans from 5 to 10 years. The Congressional Budget Office
estimates that this provision will impact roughly 16,000 veterans over
the next 10 years. This is laudable, but let's talk about the math.
Over the past 20 years, 3.5 million servicemembers deployed to areas
where they may have been exposed to toxic substances. So the ranking
member's amendment would leave behind over 3.4 million veterans.
This is not even a half measure, this substitute, this replacement,
that they offer. It is not even one-tenth. It is one-half of 1 percent,
a one-half of 1 percent solution compared to the comprehensive bill
that we need.
The policy of this amendment is something we agree on. We should
enhance eligibility for combat veterans which is why we included the
language in the bill before you today, Mr. Speaker. However, it only
covers less than half a percentage point of the number of veterans who
would be covered under PACT.
My colleague is asserting that less than one-half of a percentage
point is enough to be done and then walk away?
The math does not add up, and veterans know it. That is why over 42
veterans service organizations are supporting the PACT Act. Again, I
reference the letters previously inserted into the Record.
During the President's State of the Union Address last night, he
highlighted the importance of this topic citing his own family tragedy
and the loss of his son, Beau, to brain cancer after his military
service. He called on Congress to ``pass a law to make sure veterans
devastated by toxic exposures in Iraq and Afghanistan finally get the
benefits and comprehensive healthcare they deserve.''
Let me repeat that: pass a law to make sure veterans devastated by
toxic exposures in Iraq and Afghanistan finally get the benefits and
comprehensive healthcare they deserve.
The Bost substitute is far from comprehensive. In fact, it is a
fraction of what our veterans have earned and deserve.
It is time we honored our pact to our veterans. That is why I implore
my colleagues to reject this incremental measure and join me in
supporting the only comprehensive toxic-exposure legislation that
delivers on our sacred promise, the PACT Act.
Mr. Speaker, how much time do I have remaining?
The SPEAKER pro tempore. The gentleman has 1\1/4\ minutes remaining.
Mr. TAKANO. Mr. Speaker, I reserve the balance of my time.
Mrs. MILLER-MEEKS. Mr. Speaker, with all due deference to my
colleague, Ranking Member Bost has made it abundantly clear that this
is a first step--not a last step--but an initial first step in
getting veterans the healthcare that they need and deserve.

Mr. Speaker, I urge and implore my colleagues to pass Mr. Bost's
amendment No. 5.
Mr. Speaker, I yield back the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield the balance of my time to the
gentlewoman from Texas (Ms. Jackson Lee), who is my good friend and who
serves on the Budget Committee, the Homeland Security Committee, and as
the chair of the Subcommittee on Crime, Terrorism, and Homeland
Security on the Judiciary Committee.
Ms. JACKSON LEE. Mr. Speaker, I thank my distinguished friend for
yielding.
I rise enthusiastically joining the President and joining our
chairman in pushing the Honoring our PACT Act and just remind the
underlying amendment by Mr. Bost, one-half of 1 percent, do we in this
time, do our veterans, do our soldiers deserve half treatment?
I don't think so.
The Jackson Lee amendment adds to this legislation. It would add a
report on the feasibility of modifying the individual longitudinal
exposure record system used to register toxic exposure of military
personnel to include members of the National Guard who are deployed in
the United States in connection with a natural disaster without regard
to duty status and may record information regarding a suspected
exposure by the National Guard to toxic substances while they are in
the midst of their rescues.
We know and we thank the House Veterans' Affairs Committee for
recognizing and working with my staff that the National Guard is
involved in toxic matters on home side. They collaborate with and
support civilian authorities and traditional first responders, they are
called in as a helpmate. They serve to strengthen and expand local
disaster response while the emergency services of a State or locale may
have robust plans to deal with unexpected, sometimes disasters strike
that overwhelm their resources.
Let me just show you, Mr. Speaker, they are involved in the work.
This is an important amendment, and I ask my colleagues to support it.
Mr. Speaker, Chairman McGovern, thank you for this opportunity to
discuss briefly three Jackson Lee Amendment #13, to H.R. 3967, the
Honoring our PACT Act.
The PACT Act provides much needed attention to the issue of toxic
exposure of military service personnel when it occurs during
deployment.
Jackson Lee Amendment #13 would add a report on the feasibility of
modifying the Individual Longitudinal Exposure Record System used to
register toxic exposure of military personnel, to include members of
the National Guard who are deployed in the United States in connection
with a natural disaster, without regard to duty status may record
information regarding a suspected exposure by the National Guard to
toxic substances during such deployment.
I thank the House Committee on Veterans Affairs for working with my
staff on this Jackson Lee Amendment to H.R. 3967.
The National Guard collaborates with and supports civilian
authorities and traditional first responders in their efforts to
respond to emergencies and disasters.
They serve to strengthen and expand the local disaster response
capacity.
While the emergency services of a state or locale may have robust
plans to deal with the unexpected, sometimes disasters strike that
overwhelm their resources and manpower.
During these times the National Guard can play a vital role in saving
lives, stemming suffering and protecting property.
This amendment is important because of the conditions that can exist
during manmade or natural disasters that may expose National Guard
members to toxic substances.
National Guard service personnel provide vital services before,
during and following disasters that require that they come into contact
with flood waters, wildfires and other disasters that by their nature
would breach containment, manufacturing, and storage facilities for
toxic substances that would pose a risk to people.
I recall the flood waters of Hurricane Harvey and the hundreds of
refineries, small and large chemical processing facilities, and storage
facilities that were impacted by flood waters.
Some of these impacts included the risk of explosions due to the loss
of containment caused by a loss of electricity or the encroachment of
flood waters.
As was the case when two explosions shook the Arkema chemical
facility that resulted in a fire because the temperature required to
safely store chemicals was lost due to a power outage caused by
Hurricane Harvey flooding.
Many chemical facilities are located in low-lying coastal areas and
vulnerable to damage from hurricanes, flooding, and erosion, which are
increasing with climate change.
Extreme weather can trigger industrial disasters, including
explosions, fires, and major chemical releases, as well as chronic
chemical leakage into air, water, and soil.
Researchers identified 872 highly hazardous chemical facilities
within 50 miles of the hurricane-prone U.S. Gulf Coast.
Coastal areas are also densely populated and would be where National
Guard would be deployed to evacuate and assist residents in advance of,
during and following the landfall of a Hurricane.
There are approximately 4,374,000 people, 1,717 schools, and 98
medical facilities within 1.5 miles of the facilities according to the
Milken Institute School of Public Health, George Washington University,
which collected survey data.
The Jackson Lee amendment would provide a report to inform the
Committee on Veterans Affairs of the importance of including toxic
exposure data on National Guard personnel who are exposed to toxic
substances when deployed in response to disasters.
In 2021, following Hurricane Ida's landfall in an analysis by the
Union of Concerned Scientists (UCS) of the New Orleans area revealed
that 138 industrial facilities in and around the city--some of which
use electricity

[[Page H1245]]

to contain hazardous chemicals--were potentially without power, putting
facility workers and nearby civilians at enormous risk.
Flood waters, smoke from wildfires, and earthquakes have impacts on
facilities, businesses, and research facilities that are safe until
they are compromised by the impact of a natural or manmade disaster.
I urge the Committee to make in order the Jackson Lee Amendment to
H.R. 3967.
Thank you.
Mr. TAKANO. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. Pursuant to House Resolution 950, the
previous question is ordered on the amendment offered by the
gentlewoman from Iowa (Mrs. Miller-Meeks).
The question is on the amendment offered by the gentlewoman from Iowa
(Mrs. Miller-Meeks).
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mrs. MILLER-MEEKS. Mr. Speaker, on that I demand the yeas and nays.
The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution
8, the yeas and nays are ordered.
Pursuant to clause 8 of rule XX, further proceedings on this question
are postponed.

Amendment No. 6 Offered by Ms. Brownley

The SPEAKER pro tempore. It is now in order to consider amendment No.
6 printed in part B of House Report 117-253.
Ms. BROWNLEY. Mr. Speaker, I have an amendment at the desk.
The SPEAKER pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:

Page 14, after line 19, insert the following:

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

(a) In General.--Section 7322 of title 38, United States
Code, is amended--
(1) in subsection (a), by striking ``The'' and inserting
``In General.--The'';
(2) in subsection (b)--
(A) by striking ``The'' and inserting ``Standards for
Screening.--The''; and
(B) in paragraph (2)(B), by inserting ``a record of service
in a location and during a period specified in subsection
(d),'' after ``risk factors,''; and
(3) by adding at the end the following new subsections:
``(c) Eligibility for Screening for Veterans Exposed to
Toxic Substances.--The Under Secretary for Health shall
ensure that, under the policy developed under subsection (a),
any veteran who, during active military, naval, or air
service, was deployed in support of a contingency operation
in a location and during a period specified in subsection
(d), is eligible for a mammography screening by a health care
provider of the Department.
``(d) Locations and Periods Specified.--(1) The locations
and periods specified in this subsection are the following:
``(A) Iraq during following periods:
``(i) The period beginning on August 2, 1990, and ending on
February 28, 1991.
``(ii) The period beginning on March 19, 2003, and ending
on such date as the Secretary determines burn pits are no
longer used in Iraq.
``(B) The Southwest Asia theater of operations, other than
Iraq, during the period beginning on August 2, 1990, and
ending on such date as the Secretary determines burn pits are
no longer used in such location, including the following
locations:
``(i) Kuwait.
``(ii) Saudi Arabia.
``(iii) Oman.
``(iv) Qatar.
``(C) Afghanistan during the period beginning on September
11, 2001, and ending on such date as the Secretary determines
burn pits are no longer used in Afghanistan.
``(D) Djibouti during the period beginning on September 11,
2001, and ending on such date as the Secretary determines
burn pits are no longer used in Djibouti.
``(E) Syria during the period beginning on September 11,
2001, and ending on such date as the Secretary determines
burn pits are no longer used in Syria.
``(F) Jordan during the period beginning on September 11,
2001, and ending on such date as the Secretary determines
burn pits are no longer used in Jordan.
``(G) Egypt during the period beginning on September 11,
2001, and ending on such date as the Secretary determines
burn pits are no longer used in Egypt.
``(H) Lebanon during the period beginning on September 11,
2001, and ending on such date as the Secretary determines
burn pits are no longer used in Lebanon.
``(I) Yemen during the period beginning on September 11,
2001, and ending on such date as the Secretary determines
burn pits are no longer used in Yemen.
``(J) Such other locations and corresponding periods as set
forth by the Airborne Hazards and Open Burn Pit Registry
established under section 201 of the Dignified Burial and
Other Veterans' Benefits Improvement Act of 2012 (Public Law
112-260; 38 U.S.C. 527 note).
``(K) Such other locations and corresponding periods as the
Secretary, in collaboration with the Secretary of Defense,
may determine appropriate in a report submitted under
paragraph (2).
``(2) Not later than two years after the date of the
enactment of the Supporting Expanded Review for Veterans In
Combat Environments Act of 2021, and not less frequently than
once every two years thereafter, the Secretary of Veterans
Affairs, in collaboration with the Secretary of Defense,
shall submit to Congress a report specifying other locations
and corresponding periods for purposes of paragraph (1)(K).
``(3) A location under this subsection shall not include
any body of water around or any airspace above such location.
``(4) In this subsection, the term `burn pit' means an area
of land that is used for disposal of solid waste by burning
in the outdoor air.''.
(b) Report on Breast Cancer Rates for Veterans Deployed to
Certain Areas.--Not later than two years after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report that compares the rates of breast
cancer among members of the Armed Forces deployed to the
locations and during the periods specified in section 7322(d)
of title 38, United States Code, as added by subsection (a),
as compared to members of the Armed Forces who were not
deployed to those locations during those periods and to the
civilian population.

The SPEAKER pro tempore. Pursuant to House Resolution 950, the
gentlewoman from California (Ms. Brownley) and a Member opposed each
will control 5 minutes.
The Chair recognizes the gentlewoman from California.
Ms. BROWNLEY. Mr. Speaker, I rise to offer a straightforward
amendment to H.R. 3967, the Honoring our PACT Act, which would simply
ensure toxic-exposed veterans have access to mammography screenings.
I would like to begin by thanking my colleague from Iowa,
Congresswoman Miller-Meeks, for coauthoring this amendment which is
based on her outstanding bill.
As chair of the House Veterans' Affairs Subcommittee on Health, I
very much want to see the gentlewoman's good bill advance, which is why
I am offering this amendment today.
As you know, Mr. Speaker, the conditions related to toxic exposure
manifest themselves in many ways and on many different timelines. The
incidence rate of breast cancer in women veterans is 20 to 40 percent
higher than the incidence rate of breast cancer among nonveteran women.
From 2000 to 2015, the VA saw the number of women diagnosed with breast
cancer increase by five times for women ages 45 to 65. This is partly
due to better screening, but still more can be done, particularly
related to those who have been exposed to toxic substances.
Ensuring that veterans have access to lifesaving screening for breast
cancer cannot depend on the time after separation from the military and
must simply depend on whether a veteran served in a place where they
were exposed to toxins.
This amendment, based on the SERVICE Act, directs the director of the
Department of Veterans Affairs to provide mammogram screening for
female veterans who served in areas associated with burn pits and other
toxic exposure. It also directs the VA to submit a report to both the
Senate and House Veterans' Affairs Committees 2 years after enactment
that compares the instances of breast cancer among members of the Armed
Forces.
Women veterans who served in areas with high toxic exposures should
not have to wait until they start showing symptoms or reach a certain
age to access preventative mammography screenings.
This is why I am proud to join Congresswoman Miller-Meeks in offering
this lifesaving amendment.
Mr. Speaker, I reserve the balance of my time.
Mrs. MILLER-MEEKS. Mr. Speaker, I claim the time in opposition,
although I am not opposed.
The SPEAKER pro tempore. Without objection, the gentlewoman from Iowa
is recognized for 5 minutes.
There was no objection.
Mrs. MILLER-MEEKS. Mr. Speaker, I was pleased to introduce this
amendment alongside my colleague, Congresswoman Julia Brownley, from
California.

[[Page H1246]]

This amendment is based on our bill, H.R. 4794, the Making Advances
in Mammography and Medical Options for Veterans Act. It would ensure
that toxic-exposed veterans can access mammography screens through the
VA healthcare system. As a doctor I know how very important preventive
care is. Early detection of cancer or other serious conditions can be
lifesaving for patients.
Veterans deserve the very highest quality care that we can offer
them, and that certainly includes timely access to mammograms,
particularly for the growing number of women who are volunteering to
serve in our Armed Forces.
I thank Congresswoman Brownley for working with me on this amendment,
and I am glad that it was made in order.
Mr. Speaker, I urge all of my colleagues to support that, and I
reserve the balance of my time.
Ms. BROWNLEY. Mr. Speaker, how much time is remaining on each side?
The SPEAKER pro tempore. The gentlewoman from California has 2\1/2\
minutes remaining.
Ms. BROWNLEY. Mr. Speaker, I yield 2 minutes to the gentleman from
California (Mr. Takano), who is the great chair of the Veterans'
Affairs Committee and who has worked diligently on this very, very
important bill.
Mr. TAKANO. Mr. Speaker, I thank my colleague, the chair of the
Subcommittee on Health.
Mr. Speaker, I rise today in support of the Brownley-Miller-Meeks
amendment. Women who have served in the military are 20 to 40 percent
more likely to develop breast cancer than women who have never served.
It is believed that it is due to exposure to radiation and other
carcinogens while serving. It is therefore critical that VA ensure all
veterans who have served in locations associated with toxic exposure
have access to prompt, high-quality breast imaging services to detect
breast cancer early.
This amendment would ensure just that. Any eligible veteran who was
deployed and exposed to burn pits and airborne hazards would be
eligible for mammography screens by the VA. These screenings will save
lives.
Furthermore, it requires VA to submit a report to Congress on the
rates of breast cancer among those veterans deployed to such toxic
environments and compare those rates against their veteran peers who
were not exposed, as well as the civilian population.
Mr. Speaker, I urge all my colleagues to support this commonsense
amendment.

{time} 1415

Mrs. MILLER-MEEKS. Mr. Speaker, I yield back the balance of my time.
Ms. BROWNLEY. Mr. Speaker, I urge all Members to support mammography
screenings for toxic-exposed veterans and vote ``yes'' on this
amendment.
I would also like to say that we must pass this bill today, a bill
that will finally, finally, bring justice to our veterans and provide
our commitment and promise that we made to our veterans who served our
country, both men and women. So this bill is long, long overdue.
Men and women sign up for the Armed Forces. They know they may have
to put their lives on the line. They did not know that they may die of
toxic exposures.
This bill is long overdue. We need a ``yes'' vote on the amendment
and a ``yes'' vote on the underlying bill.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. Pursuant to House Resolution 950, the
previous question is ordered on the amendment offered by the
gentlewoman from California (Ms. Brownley).
The question is on the amendment offered by the gentlewoman from
California (Ms. Brownley).
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. WEBER of Texas. Mr. Speaker, on that I demand the yeas and nays.
The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution
8, the yeas and nays are ordered.
Pursuant to clause 8 of rule XX, further proceedings on this question
are postponed.
Pursuant to clause 1(c) of rule XIX, further consideration of H.R.
3697 is postponed.

____________________