[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.

                          ____________________