[Congressional Record Volume 168, Number 97 (Tuesday, June 7, 2022)]
[Senate]
[Pages S2818-S2834]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 5051. Mr. TESTER (for himself and Mr. Moran) submitted an
amendment intended to be proposed by him to the bill H.R. 3967, to
improve health care and benefits for veterans exposed to toxic
substances, and for other purposes; which was ordered to lie on the
table; as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES
CODE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Sergeant
First Class Heath Robinson Honoring our Promise to Address
Comprehensive Toxics Act of 2022'' or the ``Honoring our PACT
Act of 2022''.
(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 and Other Matters
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. Outreach to claimants for disability compensation pursuant to
changes in presumptions of service connection.
Sec. 204. Reevaluation of claims for dependency and indemnity
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.
Sec. 407. Rule of construction.
[[Page S2819]]
TITLE V--RESEARCH MATTERS
Sec. 501. Interagency working group on toxic exposure research.
Sec. 502. Analysis and report on treatment of veterans for medical
conditions related to toxic exposure.
Sec. 503. Analysis relating to mortality of veterans who served in
Southwest Asia.
Sec. 504. Study on health trends of post-9/11 veterans.
Sec. 505. Study on cancer rates among veterans.
Sec. 506. Study on health effects of waste related to Manhattan Project
on certain veterans.
Sec. 507. Study on toxic exposure and mental health outcomes.
Sec. 508. Study on veterans in Territories of the United States.
Sec. 509. Department of Veterans Affairs public website for toxic
exposure research.
Sec. 510. Report on health effects of jet fuels used by Armed Forces.
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 veterans who
report toxic exposures and outreach program for such
veterans and caregivers and survivors of such veterans.
Sec. 603. Incorporation of toxic exposure screening for veterans.
Sec. 604. Training for personnel of the Department of Veterans Affairs
with respect to veterans who report toxic exposures.
TITLE VII--RESOURCING
Sec. 701. Authority to use appropriations to enhance claims processing
capacity and automation.
Sec. 702. Authorization of major medical facility leases of Department
of Veterans Affairs for fiscal year 2023.
Sec. 703. Treatment of major medical facility leases of the Department
of Veterans Affairs.
Sec. 704. Authority to enter into agreements with academic affiliates
and other entities to acquire space for the purpose of
providing health-care resources to veterans.
Sec. 705. Modifications to enhanced-use lease authority of Department
of Veterans Affairs.
Sec. 706. Authority for joint leasing actions of Department of Defense
and Department of Veterans Affairs.
Sec. 707. Appropriation of amounts for major medical facility leases.
TITLE VIII--RECORDS AND OTHER MATTERS
Sec. 801. Epidemiological study on Fort McClellan veterans.
Sec. 802. Biennial briefing on Individual Longitudinal Exposure Record.
Sec. 803. Correction of exposure records by members of the Armed Forces
and veterans.
Sec. 804. Federal cause of action relating to water at Camp Lejeune,
North Carolina.
Sec. 805. Cost of War Toxic Exposures Fund.
Sec. 806. Appropriation for fiscal year 2022.
Sec. 807. Authorization of electronic notice in claims under laws
administered by the Secretary of Veterans Affairs.
Sec. 808. Burn pit transparency.
TITLE IX--IMPROVEMENT OF WORKFORCE OF DEPARTMENT OF VETERANS AFFAIRS
Sec. 901. National rural recruitment and hiring plan for Veterans
Health Administration.
Sec. 902. Authority to buy out service contracts for certain health
care professionals in exchange for employment at rural or
highly rural facilities of Department of Veterans
Affairs.
Sec. 903. Qualifications for human resources positions within
Department of Veterans Affairs and plan to recruit and
retain human resources employees.
Sec. 904. Modification of pay cap for certain employees of Veterans
Health Administration.
Sec. 905. Expansion of opportunities for housekeeping aides.
Sec. 906. Modification of authority of the Secretary of Veterans
Affairs relating to hours, conditions of employment, and
pay for certain employees of Veterans Health
Administration.
Sec. 907. Waiver of pay limitation for certain employees of Department
of Veterans Affairs.
Sec. 908. Elimination of limitation on awards and bonus for employees
of Department of Veterans Affairs.
Sec. 909. Additional authority of the Secretary of Veterans Affairs
relating to recruitment and retention of personnel.
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'
Exposure Now and Necessitating Training Act of 2022'' or the
``COVENANT Act of 2022''.
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 ``who is a toxic-exposed veteran, in accordance
with subsection (e)''.
(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 any 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
(including mental health services and counseling), 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 (including mental health
services and counseling), 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
(including mental health services and counseling), 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)(i) 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.
``(ii) If the Secretary determines to modify a date under
clause (i), the Secretary shall--
``(I) notify the Committee on Veterans' Affairs of the
Senate and the Committee on
[[Page S2820]]
Veterans' Affairs of the House of Representatives 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 before the date specified in the clause (including a
date modified pursuant to such section), the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a plan to conduct outreach to the veterans
described 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 Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives 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 Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives 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) Patient enrollment system.--The term ``patient
enrollment system'' means the patient enrollment system of
the Department of Veterans Affairs established and operated
under section 1705(a) of title 38, United States Code.
(2) Veterans community care program.--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 and Other Matters
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 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 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 Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives 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(a) 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 title may be cited as the ``Toxic Exposure in the
American Military Act of 2022'' or the ``TEAM Act of 2022''.
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) under section 1172 of this title--
``(A) the Secretary provides--
``(i) public notice regarding what formal evaluations the
Secretary plans to conduct; and
``(ii) the public an opportunity to comment on the proposed
formal evaluations;
``(B) the working group established under subsection (b) of
such section provides--
``(i) advice to the Secretary on toxic-exposed veterans and
cases in which veterans who, during active military, naval,
air, or
[[Page S2821]]
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;
``(ii) recommendations to the Secretary on corrections
needed in the Individual Longitudinal Exposure Record to
better reflect veterans and dependents described in clause
(i); and
``(iii) recommendations to the Secretary regarding which
cases of possible toxic exposure should be reviewed;
``(2) the Secretary provides for formal evaluations of such
recommendations under section 1173 of this title and takes
into account reports received by the Secretary from the
National Academies of Sciences, Engineering, and Medicine
under section 1176 of this title; and
``(3) the Secretary issues regulations under section 1174
of this title.
``(b) Definitions.--In this subchapter:
``(1) The term `illness' includes a disease or other
condition affecting the health of an individual, including
mental and physical health.
``(2) The term `Individual Longitudinal Exposure Record'
includes--
``(A) service records;
``(B) any database maintained by the Department of Defense
and shared with the Department of Veterans Affairs to serve
as a central portal for exposure-related data that compiles,
collates, presents, and provides available occupational and
environmental exposure information to support the needs of
the Department of Defense and the Department of Veterans
Affairs; or
``(C) any successor system to a database described in
subparagraph (B).
``Sec. 1172. Annual notice and opportunity for public comment
``(a) Notice Required.--(1)(A) Not less frequently than
once each year, the Secretary shall publish in the Federal
Register notice of the formal evaluations that the Secretary
plans to conduct pursuant to section 1173 of this title.
``(B) Each notice published under subparagraph (A) shall
include, for each formal evaluation referred to in the
notice, an explanation as to why the military environmental
exposures and adverse health outcomes that are the subject of
the formal evaluation were chosen by the Secretary for formal
evaluation under section 1173 of this title.
``(2)(A) With each notice published under paragraph (1),
the Secretary shall seek public comment on the military
environmental exposures and adverse health outcomes that are
the subject of the formal evaluations referred to in the
notice.
``(B) The Secretary shall--
``(i) consider all public comment received under
subparagraph (A); and
``(ii) publish in the Federal Register a response to the
comments received under subparagraph (A).
``(3)(A) For each notice published under paragraph (1), the
Secretary shall hold an open meeting for members of the
public to voice their comments in response to the notice.
``(B) To help evaluate presumptions of service connection,
the Secretary shall, not less frequently than quarterly,
collaborate with, partner with, and give weight to the advice
of veterans service organizations and such other stakeholders
as the Secretary considers appropriate.
``(4) Failure to include a military environmental exposure
or adverse health effect in a Federal Register notice
published pursuant to subsection (a) shall not preclude the
Secretary from initiating a formal evaluation of such
exposure or health effect.
``(b) Working Group.--(1) The Secretary shall establish a
working group within the Department (in this section referred
to as the `Working Group').
``(2) The Working Group shall include personnel of the
Veterans Health Administration and the Veterans Benefits
Administration.
``(3) The Secretary shall consult with, and seek the advice
of, the Working Group with respect to cases in which--
``(A) a veteran may have, during active military, naval,
air, or space service, experienced a toxic exposure; or
``(B) a dependent of a veteran may have experienced a toxic
exposure during the active military, naval, air, or space
service of the veteran.
``(c) Assessments.--(1) The Working Group 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 Working Group may conduct an assessment under
paragraph (1) in response to a comment received under
paragraph (2) or (3) of subsection (a).
``(4) The Working Group shall, in consultation with the
Secretary of Defense, on a periodic basis, assess the
Individual Longitudinal Exposure Record to ensure the
accuracy of data collected.
``(d) Development of Recommendations.--(1) Following an
assessment of a case of the toxic exposure of veterans that
occurred during active military, naval, air, or space service
under subsection (c), or their dependents, the Working Group
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 Working Group
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 Working Group may nominate such
evidence for formal evaluation under section 1173 of this
title to modify the periods and locations.
``(e) Reports by the Working Group.--Not less frequently
than once each year, the Working Group shall submit to the
Secretary, the Committee on Veterans' Affairs of the Senate,
and the Committee on Veterans' Affairs of the House of
Representatives, and make publicly available, a report on--
``(1) recommendations developed under subsection (d), if
any; and
``(2) recommendations for such legislative or
administrative action as the Working Group considers
necessary for the Working Group to be more effective in
carrying out the requirements of this section.
``(f) Responses by Secretary.--In response to each report
submitted under subsection (e), the Secretary shall, not
later than 30 days after receiving the report, initiate a
formal evaluation pursuant to section 1173 of this title.
``Sec. 1173. Formal evaluation of recommendations
``(a) Formal Evaluations.--The Secretary shall establish a
process to conduct a formal evaluation with respect to each
recommendation made by the Working Group under section 1172
of this title.
``(b) Evidence, Data, and Factors.--The Secretary shall
ensure that each formal evaluation under subsection (a)
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 quantity and quality of the information available
and reviewed;
``(C) the feasibility of and period for generating relevant
information and evidence;
``(D) whether such health effects are combat- or
deployment-related;
``(E) the ubiquity or rarity of the health effects; and
``(F) any time frame during which a health effect must
become manifest.
``(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 Establishing a Presumption of
Service Connection.--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.
[[Page S2822]]
``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, in the discretion of the
Secretary, that the presumption, or modification, is
warranted, the Secretary shall--
``(A) 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; and
``(B) include in such regulations any time frame during
which a health effect must become manifest; or
``(2) if the Secretary determines, in the discretion of the
Secretary, 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)(A) The Secretary may--
``(i) issue a regulation to remove an illness from a
presumption of service connection previously established
pursuant to a regulation issued under subsection (a); and
``(ii) issue a regulation to remove a presumption of
service connection established pursuant to title IV of the
Sergeant First Class Heath Robinson Honoring our Promise to
Address Comprehensive Toxics Act of 2022 if the Secretary
concludes that evidence suggests the lack of a positive
association between the disease and the toxic exposure.
``(B) Under subparagraph (A)(ii), the Secretary shall not
consider the lack of evidence as sufficient to support a
decision for removal of a presumption.
``(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 under chapter
11 of this title 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;
``(B) a survivor of a veteran who was awarded dependency
and indemnity compensation under chapter 13 of this title 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;
and
``(C) no veteran or survivor covered under subparagraph (A)
or (B) shall have their compensation reduced solely because
of the removal of an illness pursuant to paragraph (1).
``Sec. 1175. Authority to modify process; congressional
oversight
``(a) In General.--The Secretary may modify the process
under which the working group established under subsection
(b) of section 1172 of this title conducts assessments under
such section, the Secretary conducts formal evaluations under
section 1173 of this title, and issues regulations under
section 1174 of this title if--
``(1) such evaluations cover the evidence, data, and
factors required by subsection (b) of such section 1173; and
``(2) a period of 180 days has elapsed following the date
on which the Secretary submits the notice under subsection
(b) regarding the modification.
``(b) Notice.--If the Secretary proposes to modify the
process under which the working group established under
subsection (b) of section 1172 of this title conducts
assessments under such section, the process under which the
Secretary conducts formal evaluations under section 1173 of
this title, or issues regulations under section 1174 of this
title, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a notice of
the proposed modifications containing the following:
``(1) A description of the proposed modifications.
``(2) 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.
``Sec. 1176. Agreement with National Academies of Sciences,
Engineering, and Medicine concerning toxic exposures
``(a) Purpose.--The purpose of this section is to provide
for the National Academies of Sciences, Engineering, and
Medicine (in this section referred to as the `Academies'), an
independent nonprofit scientific organization with
appropriate expertise that is not part of the Federal
Government, to review and evaluate the available scientific
evidence regarding associations between diseases and toxic
exposures.
``(b) Agreement.--(1) The Secretary shall seek to enter
into a five-year agreement with the Academies to perform the
services covered by this section.
``(2) The Secretary shall seek to enter into an agreement
described in paragraph (1) not later than 60 days after the
date of the enactment of the Sergeant First Class Heath
Robinson Honoring our Promise to Address Comprehensive Toxics
Act of 2022.
``(3) An agreement under this section may be extended in
five-year increments.
``(c) Review of Scientific Evidence.--Under an agreement
between the Secretary and the Academies under this section,
the Academies shall review and summarize the scientific
evidence, and assess the strength thereof, concerning the
association between toxic exposures during active military,
naval, air, or space service and each disease suspected to be
associated with such exposure in the human population.
``(d) Scientific Determinations Concerning Diseases.--For
each disease reviewed under subsection (c), the Academies
shall determine, to the extent that available scientific data
permit meaningful determinations--
``(1) whether an association exists between toxic exposures
and the occurrence of the disease, taking into account the
strength of the scientific evidence and the appropriateness
of the statistical and epidemiological methods used to detect
the association;
``(2) the increased risk of the disease among those
reporting toxic exposures during active military, naval, air,
or space service;
``(3) whether there exists a plausible biological mechanism
or other evidence of a positive association between the toxic
exposure and the occurrence of the disease; and
``(4) determine the strength of evidence for a positive
association based on categories furnished under section 1173
of this title.
``(e) Cooperation of Federal Agencies.--The head of each
relevant Federal agency, including the Secretary of Defense,
shall cooperate fully with the Academies in performing the
services covered by this section.
``(f) Recommendations for Additional Scientific Studies.--
(1) Under an agreement between the Secretary and the
Academies under this section, the Academies shall make any
recommendations for additional scientific studies to resolve
areas of continuing scientific uncertainty relating to toxic
exposures.
``(2) In making recommendations under paragraph (1), the
Academies shall consider--
``(A) the scientific information that is available at the
time of the recommendation;
``(B) the value and relevance of the information that could
result from additional studies; and
``(C) the cost and feasibility of carrying out such
additional studies.
``(g) Reports.--(1)(A) Under an agreement between the
Secretary and the Academies under this section, not later
than one year after the date of the enactment of the Sergeant
First Class Heath Robinson Honoring our Promise to Address
Comprehensive Toxics Act of 2022, the Academies shall submit
to the Secretary, the Committee on Veterans' Affairs of the
Senate, and the Committee on Veterans' Affairs of the House
of Representatives an initial report on the activities of the
Academies under the agreement.
``(B) The report submitted under subparagraph (A) shall
include the following:
``(i) The determinations described in subsection (d).
``(ii) A full explanation of the scientific evidence and
reasoning that led to such determinations.
``(iii) Any recommendations of the Academies under
subsection (f).
``(2) Under an agreement between the Secretary and the
Academies under this section, not less frequently than once
every two years after the date on which the initial report is
submitted under paragraph (1)(A), the Academies shall submit
to the Secretary, the Committee on Veterans' Affairs of the
Senate, and the Committee on Veterans' Affairs of the House
of Representatives an updated report on the activities of the
Academies under the agreement.
``(h) Alternative Contract Scientific Organization.--(1) If
the Secretary is unable within the time period prescribed in
subsection (b)(2) to enter into an agreement with the
Academies for the purposes of this section on terms
acceptable to the Secretary, the Secretary shall seek to
enter into an agreement for the purposes of this section with
another appropriate scientific organization that--
``(A) is not part of the Federal Government;
``(B) operates as a not-for-profit entity; and
``(C) has expertise and objectivity comparable to that of
the Academies.
``(2) If the Secretary enters into an agreement with
another organization as described in paragraph (1), any
reference in this subchapter to the Academies shall be
treated as a reference to the other organization.''.
(b) Reports and Briefings.--
(1) Report.--
(A) In general.--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 on the implementation of, and
recommendations for, subchapter VII of chapter 11 of title
38, United States Code, as added by subsection (a).
(B) Consultation.--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 such title and any other
entity the Secretary determines appropriate.
[[Page S2823]]
(2) Briefing.--On a quarterly basis during the two-year
period beginning on the date of the enactment of this Act,
the Secretary shall provide to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a briefing on the
implementation of subchapter VII of chapter 11 of such title,
as added by subsection (a).
(c) Independent Assessment.--
(1) Agreement.--The Secretary shall seek to enter into an
agreement with the National Academies of Science,
Engineering, and Medicine (in this subsection referred to as
the ``Academies'') before the date that is 90 days after the
date of the enactment of this Act to perform the services set
forth under paragraph (2).
(2) Assessment.--
(A) In general.--Under an agreement between the Secretary
and the Academies under paragraph (1), the Academies shall
conduct an assessment of the implementation by the Department
of Veterans Affairs of the process established under
subchapter VII of chapter 11 of title 38, United States Code,
as added by subsection (a).
(B) Elements.--The assessment conducted under subparagraph
(A) shall include the following:
(i) An assessment of the Department's implementation of the
process established under subsection (a) to determine whether
the process is in accordance with current scientific
standards for assessing the link between exposure to
environmental hazards and the development of health outcomes,
(ii) assess whether the criteria is fair and consistent,
and
(iii) provide recommendations for improvements to the
process.
(3) Report.--Not later than one year after the date on
which the Secretary enters into an agreement under paragraph
(1), the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the findings of
the Academies pursuant to such agreement.
(4) Alternative contract scientific organization.--
(A) In general.--If the Secretary is unable within the time
period prescribed in paragraph (1) to enter into an agreement
with the Academies for the purposes of this subsection on
terms acceptable to the Secretary, the Secretary shall seek
to enter into an agreement for the purposes of this
subsection with another appropriate scientific organization
that--
(i) is not part of the Federal Government;
(ii) operates as a not-for-profit entity; and
(iii) has expertise and objectivity comparable to that of
the Academies.
(B) Treatment.--If the Secretary enters into an agreement
with another organization as described in subparagraph (A),
any reference in this subsection to the Academies of
Sciences, Engineering, and Medicine shall be treated as a
reference to the other organization.
(d) 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 Sergeant
First Class Heath Robinson Honoring our Promise to Address
Comprehensive Toxics Act of 2022 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 Sergeant
First Class Heath Robinson Honoring our Promise to Address
Comprehensive Toxics Act of 2022 regarding a presumption of
service connection based on a toxic exposure under this
section is made pursuant to subchapter VII of this
chapter.''.
SEC. 203. OUTREACH TO CLAIMANTS FOR DISABILITY COMPENSATION
PURSUANT TO CHANGES IN 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. Outreach pursuant to changes in presumptions of
service connection
``(a) In General.--Whenever a law, including through a
regulation or Federal court decision or settlement,
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;
and
``(2) pursuant to subsection (b), conduct outreach to the
claimants.
``(b) Outreach.--(1) The Secretary shall conduct outreach
to inform claimants identified under subsection (a) that they
may submit a supplemental claim in light of the establishment
or modification of a presumption of service connection
described in subsection (a).
``(2) Outreach under paragraph (1) shall include the
following:
``(A) The Secretary shall publish on the internet website
of the Department a notice that such veterans may elect to
file a supplemental claim.
``(B) The Secretary shall notify, in writing or by
electronic means, veterans service organizations of the
ability of such veterans to file a supplemental claim.
``(C) The Secretary shall contact each claimant identified
under subsection (a) in the same manner that the Department
last provided notice of a decision.''.
(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.
(c) Rule of Construction.--Nothing in this section shall be
construed as--
(1) modifying the obligations of the Department of Veterans
Affairs under Federal court decisions or settlements in
effect as of the date of the enactment of this Act; or
(2) requiring a retroactively applied effective date of a
supplemental claim earlier than the date a presumption of
service connection is established or modified.
SEC. 204. REEVALUATION OF CLAIMS FOR DEPENDENCY AND INDEMNITY
COMPENSATION INVOLVING PRESUMPTIONS OF SERVICE
CONNECTION.
(a) In General.--Subchapter I of chapter 13 is amended by
adding at the end the following new section:
``Sec. 1305. Reevaluation of dependency and indemnity
compensation determinations pursuant to changes in
presumptions of service connection
``(a) Reevaluation.--Whenever a law, including through a
regulation or Federal court decision or settlement,
establishes or modifies a presumption of service connection,
the Secretary shall--
``(1) identify all claims for dependency and indemnity
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;
``(2) allow for the reevaluation of such claims at the
election of the claimant; 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.--(1) The Secretary shall conduct outreach
to inform relevant claimants 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).
``(2) Outreach under paragraph (1) shall include the
following:
``(A) The Secretary shall publish on the internet website
of the Department a notice that such claimants may elect to
have a claim so reevaluated.
``(B) The Secretary shall notify, in writing or by
electronic means, veterans service organizations of the
ability of such claimants to elect to have a claim so
reevaluated.
``(C) The Secretary shall contact each claimant identified
under subsection (a) in the same manner that the Department
last provided notice of a decision.''.
(b) Application.--Section 1305 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.
(c) Rule of Construction.--Nothing in this section shall be
construed as modifying the obligations of the Department of
Veterans Affairs under Federal court decisions or settlements
in effect as of the date of the enactment of 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 of 2022''.
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--
[[Page S2824]]
``(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--
``(A) 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; and
``(B) determine, using procedures consistent with section
1172 of this title and through the conduct of a formal
evaluation under section 1173 of this title, whether to
establish an end date for a covered veteran to qualify for
presumptions of exposure under this section, if appropriate,
but in no case establish an end date earlier than the last
day of the period specified in section 101(33) for the
Persian Gulf War.
``(3) Beginning not later than two years after the date of
the enactment of the Sergeant First Class Heath Robinson
Honoring our Promise to Address Comprehensive Toxics Act of
2022, and not less frequently than once every two years
thereafter, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report
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, including airspace above--
``(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, including airspace above--
``(i) Afghanistan;
``(ii) Djibouti;
``(iii) Egypt;
``(iv) Jordan;
``(v) Lebanon;
``(vi) Syria;
``(vii) Yemen;
``(viii) Uzbekistan; or
``(ix) 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 of 2022''.
(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 of 2022''.
(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 of 2022''.
(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;
``(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
active military, naval, air, or space service to dioxin
during the Vietnam era, regardless of the geographic area of
such service, or was exposed during such service to a toxic
substance found in a herbicide or defoliant used for military
purposes during
[[Page S2825]]
such era, regardless of the geographic area of such
service.''.
(d) Conforming Amendment.--The heading for section 1116 is
amended by striking ``the Republic of Vietnam'' and inserting
``certain locations''.
(e) Effective Date and Applicability.--The amendments made
by this section shall take effect on the date of the
enactment of this Act and shall apply as follows:
(1) On the date of the enactment of this Act for claimants
for dependency and indemnity compensation under chapter 13 of
title 38, United States Code, and for veterans whom the
Secretary of Veterans Affairs determines are--
(A) terminally ill;
(B) homeless;
(C) under extreme financial hardship;
(D) more than 85 years old; or
(E) capable of demonstrating other sufficient cause.
(2) On October 1, 2022, for everyone not described in
paragraph (1).
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 of 2022''.
(b) Monoclonal Gammopathy of Undetermined Significance.--
Section 1116(a)(2) of title 38, United States Code, is
amended by adding at the end the following new subparagraph:
``(L) Monoclonal gammopathy of undetermined
significance.''.
(c) Hypertension.--Such section, as amended by subsection
(b), is further amended by adding at the end the following
new subparagraph:
``(M) Hypertension.''.
(d) Effective Dates and Applicability.--
(1) Monoclonal gammopathy of undetermined significance.--
(A) In general.--The amendment made by subsection (b) shall
take effect on the date of the enactment of this Act and
shall apply as follows:
(i) On the date of the enactment of this Act for claimants
for dependency and indemnity compensation under chapter 13 of
title 38, United States Code, and for veterans whom the
Secretary of Veterans Affairs determines are--
(I) terminally ill;
(II) homeless;
(III) under extreme financial hardship;
(IV) more than 85 years old; or
(V) capable of demonstrating other sufficient cause.
(ii) On October 1, 2022, for everyone not described in
clause (i).
(B) Retroactive application.--Notwithstanding any Federal
court decisions or settlements in effect on the day before
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall award retroactive claims for a
condition under section 1116(a)(2)(L) of title 38, United
States Code, as added by subsection (b) of this section, only
to claimants for dependency and indemnity compensation under
chapter 13 of such title described in subparagraph (A)(i) of
this paragraph.
(2) Hypertension.--
(A) In general.--The amendment made by subsection (c) shall
take effect on the date of the enactment of this Act and
shall apply as follows:
(i) On the date of the enactment of this Act for claimants
for dependency and indemnity compensation under chapter 13 of
title 38, United States Code, and for veterans whom the
Secretary of Veterans Affairs determines are--
(I) terminally ill;
(II) homeless;
(III) under extreme financial hardship;
(IV) more than 85 years old; or
(V) capable of demonstrating other sufficient cause.
(ii) On October 1, 2026, for everyone not described in
subparagraph (A).
(B) Retroactive application.--Notwithstanding any Federal
court decisions or settlements in effect on the day before
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall award retroactive claims for a
condition under section 1116(a)(2)(M) of title 38, United
States Code, as added by subsection (c) of this section, only
to claimants for dependency and indemnity compensation under
chapter 13 of such title described in subparagraph (A)(i) of
this paragraph.
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 of 2022''.
(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''.
(d) Effective Date and Applicability.--The amendments made
by this section shall take effect on the date of the
enactment of this Act and shall apply as follows:
(1) On the date of the enactment of this Act for claimants
for dependency and indemnity compensation under chapter 13 of
title 38, United States Code, and veterans whom the Secretary
of Veterans Affairs determines are--
(A) terminally ill;
(B) homeless;
(C) under extreme financial hardship;
(D) more than 85 years old; or
(E) capable of demonstrating other sufficient cause.
(2) On the date of the enactment of this Act for everyone
not described in paragraph (1), with respect to paragraphs
(1), (2)(C), (2)(I), (5), (6), (7), (8), (9), (10), (11),
(12), (13), and (14), of section 1120(b) of title 38, United
States Code, as added by subsection (b).
(3) On October 1, 2023, for everyone not described in
paragraph (1), with respect to paragraphs (3) and (4) of
section 1120(b) of such title, as so added.
(4) On October 1, 2024, for everyone not described in
paragraph (1), with respect to subparagraphs (A), (B), (D),
(E), (F), (G), and (K) of section 1120(b)(2) of such title,
as so added.
(5) On October 1, 2025, for everyone not described in
paragraph (1), with respect to subparagraphs (H) and (J) of
section 1120(b)(2) of such title, as so added.
[[Page S2826]]
SEC. 407. RULE OF CONSTRUCTION.
(a) Generally.--Nothing in this Act shall be construed to
prevent the Secretary of Veterans Affairs from processing
claims for benefits under title 38, United States Code, for a
condition or disease for which this Act establishes a
presumption of service connection, as a claim for benefits
for a condition or disease with direct service connection.
(b) Effective Dates and Applicability.--The Secretary shall
not deny a claim for benefits under title 38, United States
Code, for a condition or disease for which this Act
establishes a presumption of service connection because the
claimant filed the claim prior to the effective date or date
of applicability for that particular condition or disease.
TITLE V--RESEARCH MATTERS
SEC. 501. INTERAGENCY WORKING GROUP ON TOXIC EXPOSURE
RESEARCH.
(a) Establishment.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall, in collaboration with the heads of the entities
described in paragraph (2), establish the Toxic Exposure
Research Working Group (in this section referred to as the
``Working Group'').
(2) Composition.--The Working Group shall consist of
employees, selected by the Secretary, of the following:
(A) The Department of Veterans Affairs.
(B) The Department of Defense.
(C) The Department of Health and Human Services.
(D) The Environmental Protection Agency.
(E) Other entities of the Federal Government 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 five-year strategic plan for such entities to
carry out collaborative research activities.
(c) Reporting.--The Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives the
following:
(1) Not later than one year after the date of the enactment
of this Act, a report on the establishment of the Working
Group under subsection (a).
(2) Not later than two years after the date of the
enactment of this Act, a report containing the collaborative
research activities identified, and the strategic plan
developed, by the Working Group under subsection (b).
(3) Not less frequently than annually during the five-year
period covered by the strategic plan under subsection (b), a
progress report on implementation of the strategic plan.
(d) Termination.--The Working Group shall terminate after
submitting the final report under subsection (c).
(e) Definitions.--In this section:
(1) Active military, naval, air, or space service.--The
term ``active military, naval, air, or space service'' has
the meaning given that term in section 101 of title 38,
United States Code.
(2) Collaborative research activity.--The term
``collaborative research activity'' means a research
activity--
(A) agreed upon by the Working Group;
(B) conducted by an entity represented by a member of the
Working Group;
(C) funded by the Federal Government; and
(D) regarding the health consequences of toxic exposures
experienced during active military, naval, air, or space
service.
(3) Toxic exposure.--The term ``toxic exposure'' has the
meaning given such term in section 101 of title 38, United
States Code, as amended by section 102(b).
SEC. 502. 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 a toxic exposure.
(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 Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report containing the following:
(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.
(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 toxic exposures.
(c) Toxic Exposure Defined.--In this section, the term
``toxic exposure'' has the meaning given such term in section
101 of title 38, United States Code, as amended by section
102(b).
SEC. 503. 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.
(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. 504. 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. 505. 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 sex of the veteran.
(5) The type or types of cancer that the veteran has.
SEC. 506. STUDY ON HEALTH EFFECTS OF WASTE RELATED TO
MANHATTAN PROJECT ON CERTAIN VETERANS.
(a) Study.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall enter into an agreement with the National Academies of
Sciences, Engineering, and Medicine for the conduct of 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:
(1) In the county of St. Louis, Missouri, the following:
(A) Coldwater Creek, Missouri.
(B) The St. Louis Airport Site, Missouri.
(C) The West Lake Landfill.
(2) Oak Ridge, Tennessee.
(3) Hanford, Washington.
(4) Any other location 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, sex, 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, as determined by the Secretary.
(d) Report.--Not later than three years after the date of
the enactment of this Act,
[[Page S2827]]
the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the study under
subsection (a) and include in such report an analysis of the
data available and data reliability.
(e) Definitions.--In this section:
(1) Active military, naval, air, or space service; toxic
exposure.--The terms ``active military, naval, air, or space
service'' and ``toxic exposure'' have the meanings given
those terms in section 101 of title 38, United States Code,
as added by section 102(b).
(2) Covered waste.--The term ``covered waste'' means any
waste arising from activities carried out in connection with
the Manhattan Project.
(3) Illness.--The term ``illness'' has the meaning given
that term in section 1171 of title 38, United States Code, as
added by section 202.
(4) Toxic exposure.--The term ``toxic exposure'' has the
meaning given such term in section 101 of title 38, United
States Code, as amended by section 102(b).
SEC. 507. STUDY ON TOXIC EXPOSURE AND MENTAL HEALTH OUTCOMES.
(a) Study Required.--Not later than 180 days after the date
of the enactment of this Act, the Secretary 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 conditions,
including chronic multisymptom illness, traumatic brain
injury, post-traumatic stress disorder, depression, episodes
of psychosis, schizophrenia, bipolar disorder, 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) Sex.
(3) Race and ethnicity.
(4) Period and length of service in the Armed Forces.
(5) The military occupational specialty or specialties of
the veteran.
(6) History of toxic exposure during service in the Armed
Forces.
(7) Any diagnosis of chronic multisymptom illness.
(8) Any diagnosis of a mental health or cognitive disorder.
(9) Any history of suicide attempt or suicidality.
(10) If the veteran died by suicide.
(11) Any confounding traumatic experiences that could
affect a veteran's mental health.
(c) Report.--Not later than three years after the date of
the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report containing the findings of the
National Academies of Sciences, Engineering, and Medicine
with respect to the study conducted under subsection (a).
SEC. 508. 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 by the Veterans
Benefits Administration and the Veterans Health
Administration under laws administered by the Secretary of
Veterans Affairs to veterans in Territories and Freely
Associated States 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 and Freely
Associated State of the United States;
(B) the number of veterans in each Territory and Freely
Associated State 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) a description of how the Department estimates the
number of veterans in each Territory and Freely Associated
State 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 and Freely Associated State in accessing
health care services, including those involving the
availability of such services to veterans in the Territory or
Freely Associated State in which the veterans reside, and any
distance impediments to receiving services at a regional
medical center of the Veterans Health Administration, a
community-based outpatient clinic, another full-service
medical facility of the Department, or a Vet Center,
respectively;
(E) a detailed description of obstacles facing veterans in
each Territory and Freely Associated State in accessing
readjustment counseling services, including those involving
the availability of such services to veterans in the
Territory in which the veterans reside, and any distance
impediments to receiving services at a readjustment
counseling services center of the Department;
(F) a detailed description of obstacles facing veterans in
each Territory and Freely Associated State in accessing non-
health care veterans benefits, including those involving the
availability of benefits and services to veterans in the
Territory or Freely Associated State in which the veterans
reside, and any distance impediments to accessing the nearest
office of the Veterans Benefits Administration;
(G) an analysis of the staffing and quality of the offices
of the Veterans Benefits Administration and Veterans Health
Administration charged with serving veterans in the
Territories and Freely Associated States, including the
availability of the full- and part-time staff of each office
to the veterans they are charged with serving;
(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
and Freely Associated State;
(I) an analysis of the economic and health outcomes for
veterans in each Territory or Freely Associated State
resulting from obstacles to accessing adequate assistance and
health care at facilities of the Department;
(J) an analysis of the access to benefit assistance and
health care provided to veterans in the aftermath of major
disasters declared in each of the Territories and Freely
Associated States since September 4, 2017; and
(K) such recommendations as the Comptroller General
considers appropriate for improving access of veterans in the
Territories and Freely Associated States to benefits and
health care 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) Briefing.--Not later than one year after the date of
the enactment of this Act, the Comptroller General shall
provide to the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives a briefing setting forth the results of the
study conducted under subsection (a), including any
recommendations developed under paragraph (2)(K) of such
subsection.
(c) Definitions.--In this section:
(1) Freely associated state.--The term ``Freely Associated
State'' includes the Federated States of Micronesia, the
Republic of the Marshall Islands, and the Republic of Palau.
(2) Territory.--The term ``Territory'' includes American
Samoa, the Commonwealth of the Northern Marianas Islands,
Guam, Puerto Rico, and the Virgin Islands.
(3) Vet center.--The term ``Vet Center'' has the meaning
given that term in section 1712A(h) of title 38, United
States Code.
SEC. 509. 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 publicly
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) Coordination.--In carrying out subsection (a), the
Secretary shall coordinate with--
(1) the heads of each Federal 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.
(c) Definitions.--In this section:
(1) Toxic exposure.--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) Toxic exposure research.--The term ``toxic exposure
research'' means research on the health consequences of toxic
exposures experienced during service in the Armed Forces.
SEC. 510. REPORT ON HEALTH EFFECTS OF JET FUELS USED BY ARMED
FORCES.
(a) Initial Report.--Not later than one year 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, and make publicly available, a
report on health effects of jet fuels used by the Armed
Forces.
(b) Contents.--The report submitted under subsection (a)
shall include the following:
(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 Forces to jet fuel.
(4) An identification of any areas relating to jet fuel
exposure about which new research needs to be conducted.
(c) Follow-up Report.--Not later than five years after the
date of the submittal of the report under subsection (a), the
Secretary shall submit to the committees referred to in such
subsection an update to such report.
[[Page S2828]]
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 ``Fairly
Assessing Service-related Toxic Exposure Residuals
Presumptions Act of 2022'' or the ``FASTER Presumption Act of
2022''.
(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, as
amended by section 102.
SEC. 602. PUBLICATION OF LIST OF RESOURCES OF DEPARTMENT OF
VETERANS AFFAIRS FOR TOXIC-EXPOSED VETERANS AND
VETERANS WHO REPORT TOXIC EXPOSURES 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 and veterans who report toxic
exposure;
(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 toxic exposures,
including outreach with respect to benefits and support
programs.
SEC. 603. 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 toxic exposures during active military, naval, air,
or space service as part of a health care screening furnished
by the Department of Veterans Affairs to veterans enrolled in
the system of annual patient enrollment of the Department
established and operated under section 1705 of title 38,
United States Code, to improve understanding by the
Department of toxic exposures 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 toxic 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.
SEC. 604. TRAINING FOR PERSONNEL OF THE DEPARTMENT OF
VETERANS AFFAIRS WITH RESPECT TO VETERANS WHO
REPORT TOXIC EXPOSURES.
(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 toxic exposures and inform such
personnel of how to ask for additional information from
veterans regarding different toxic 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 toxic
exposures.
(2) Annual training.--Training provided to processors under
paragraph (1) shall be provided not less frequently than
annually.
TITLE VII--RESOURCING
SEC. 701. AUTHORITY TO USE APPROPRIATIONS TO ENHANCE CLAIMS
PROCESSING CAPACITY AND AUTOMATION.
(a) Authority.--The Secretary of Veterans Affairs may use,
from amounts appropriated to the Cost of War Toxic Exposures
Fund established by section 324 of title 38, United States
Code, as added by section 805 of this Act, such amounts as
may be necessary to continue the modernization, development,
and expansion of capabilities and capacity of information
technology systems and infrastructure of the Veterans
Benefits Administration, including for claims automation, to
support expected increased claims processing for newly
eligible veterans pursuant to this Act.
(b) Plan for Modernization of Veterans Benefits
Administration Information Technology Systems.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the appropriate congressional committees a
plan for the modernization of the information technology
systems of the Veterans Benefits Administration. The plan
shall cover the first fiscal year that begins after the date
of the enactment of this Act and the subsequent four fiscal
years and shall include each of the following:
(A) An identification of any information system to be
modernized or retired, if applicable, during the period
covered by the plan.
(B) A description of how the Secretary intends to
incorporate the following principles into the modernization
of such information systems:
(i) The purpose of automation should be to increase the
speed and accuracy of claims processing decisions.
(ii) Automation should be conducted in a manner that
enhances the productivity of employees of the Department of
Veterans Affairs.
(iii) Automation should be carried out in a manner that
achieves greater consistency in the processing and rating of
claims by relying on patterns of similar evidence in claim
files.
(iv) To the greatest extent possible, automation should be
carried out by drawing from information in the possession of
the Department, other Government agencies, and applicants for
benefits.
(v) Automation of any claims analysis or determination
process should not be end-to-end or lack intermediation.
(vi) Employees of the Department should continue to make
decisions with respect to the approval of claims and the
granting of benefits.
(vii) Automation should not be carried out in a manner that
reduces or infringes upon the due process rights of
applicants for benefits under the laws administered by the
Secretary; or the duties of the Secretary to assist and
notify claimants.
(viii) Automation should be carried out while taking all
necessary measures to protect the privacy of claimants and
their personally identifiable information.
(ix) Automation of claims processing should not eliminate
or reduce the workforce of the Veterans Benefits
Administration.
(C) An identification of targets, for each fiscal year, by
which the Secretary intends to complete the modernization of
each information system or major component or functionality
of such system identified under subparagraph (A).
(D) Cost estimates for the modernization of each
information system identified under paragraph (A) for each
fiscal year covered by the plan and in total.
(2) Appropriate congressional committees.--In this section,
the term ``appropriate congressional committees'' means--
(A) the Committee on Veterans' Affairs and the Subcommittee
on Military Construction, Veterans Affairs, and Related
Agencies of the Committee on Appropriations of the Senate;
and
(B) the Committee on Veterans' Affairs and the Subcommittee
on Military Construction, Veterans Affairs, and Related
Agencies of the Committee on Appropriations of the House of
Representatives.
SEC. 702. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES OF
DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR
2023.
(a) In General.--The Secretary of Veterans Affairs may
carry out the following major medical facility leases in
fiscal year 2023:
(1) Lease for an outpatient clinic in the vicinity of
Allentown, Pennsylvania, in an estimated amount of
$31,832,000.
(2) Lease for a facility for member services for the
Veterans Health Administration in the vicinity of Atlanta,
Georgia, in an estimated amount of $27,134,000.
(3) Lease for an outpatient clinic in the vicinity of
Baltimore, Maryland, in an estimated amount of $43,041,000.
(4) Lease for an outpatient clinic in the vicinity of Baton
Rouge, Louisiana, in an estimated amount of $29,550,000.
(5) Lease for an outpatient clinic in the vicinity of
Beaufort, South Carolina, in an estimated amount of
$24,254,000.
(6) Lease for an outpatient clinic in the vicinity of
Beaumont, Texas, in an estimated amount of $15,632,000.
(7) Lease for an outpatient clinic in the vicinity of
Brainerd, Minnesota, in an estimated amount of $14,669,000.
(8) Lease for a facility for research in the vicinity of
Buffalo, New York, in an estimated amount of $11,106,000.
(9) Lease for an outpatient clinic in the vicinity of
Clarksville, Tennessee, in an estimated amount of
$75,135,000.
[[Page S2829]]
(10) Lease of a facility for research in the vicinity of
Columbia, Missouri, in an estimated amount of $20,726,000.
(11) Lease for an outpatient clinic in the vicinity of
Cookeville, Tennessee, in an estimated amount of $10,958,000.
(12) Lease for a residential treatment facility in the
vicinity of Denver, Colorado, in an estimated amount of
$9,133,000.
(13) Lease for an outpatient clinic in the vicinity of
Elizabethtown, Kentucky, in an estimated amount of
$16,671,000.
(14) Lease for an outpatient clinic in the vicinity of
Farmington, Missouri, in an estimated amount of $17,940,000.
(15) Lease for an outpatient clinic in the vicinity of
Hampton, Virginia, in an estimated amount of $63,085,000.
(16) Lease for an outpatient clinic in the vicinity of
Jacksonville, North Carolina, in an estimated amount of
$61,450,000.
(17) Lease for an outpatient clinic in the vicinity of
Killeen, Texas, in an estimated amount of $61,030,000.
(18) Lease for an outpatient clinic in the vicinity of
Lawrence, Indiana, in an estimated amount of $15,811,000.
(19) Lease for an outpatient clinic in the vicinity of
Lecanto, Florida, in an estimated amount of $15,373,000.
(20) Lease for an outpatient clinic in the vicinity of
Nashville, Tennessee, in an estimated amount of $58,038,000.
(21) Lease for an outpatient clinic in the vicinity of
North Kansas City, Missouri, in an estimated amount of
$40,027,000.
(22) Lease for an outpatient clinic in the vicinity of
Pflugerville, Texas, in an estimated amount of $16,654,000.
(23) Lease for an outpatient clinic in the vicinity of
Plano, Texas, in an estimated amount of $32,796,000.
(24) Lease for an outpatient clinic in the vicinity of
Prince George's County, Maryland, in an estimated amount of
$31,754,000.
(25) Lease for an outpatient clinic in the vicinity of
Rolla, Missouri, in an estimated amount of $21,352,000.
(26) Lease for an outpatient clinic in the vicinity of Salt
Lake City, Utah, in an estimated amount of $29,466,000.
(27) Lease for an outpatient clinic in the vicinity of
Sarasota, Florida, in an estimated amount of $36,517,000.
(28) Lease for an outpatient clinic in the vicinity of
Springfield, Massachusetts, in an estimated amount of
$30,918,000.
(29) Lease for a community living center in the vicinity of
Tampa, Florida, in an estimated amount of $51,682,000.
(30) Lease for an outpatient clinic in the vicinity of The
Villages, Florida, in an estimated amount of $48,267,000.
(31) Lease for an outpatient clinic in the vicinity of Tri-
Cities, Washington, in an estimated amount of $36,136,000.
(b) Treatment of Authorizations.--The authorization of
leases under subsection (a) shall be considered to be a
specific authorization by law of the funds for such leases
for purposes of section 8104(a)(2) of title 38, United States
Code, as in effect on the day before the date of the
enactment of this Act.
(c) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs for
fiscal year 2023, or the year in which funds are appropriated
for the Medical Facilities account, $998,137,000 for the
leases authorized in subsection (a).
SEC. 703. TREATMENT OF MAJOR MEDICAL FACILITY LEASES OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Congressional Approval of Major Medical Facility
Leases.--Paragraph (2) of subsection (a) of section 8104 of
title 38, United States Code, is amended--
(1) by striking ``No funds'' and inserting ``(A) No
funds'';
(2) by striking ``or any major medical facility lease'';
(3) by striking ``or lease''; and
(4) by adding at the end the following new subparagraph:
``(B) No funds may be appropriated for any fiscal year, and
the Secretary may not obligate or expend funds (other than
for advance planning and design), for any major medical
facility lease unless the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives each adopt a resolution approving
the lease.''.
(b) Modification of Definition of Major Medical Facility
Lease.--Subparagraph (B) of paragraph (3) of such subsection
is amended to read as follows:
``(B) The term `major medical facility lease'--
``(i) means a lease for space for use as a new medical
facility approved through the General Services Administration
under section 3307(a) of title 40 at an average annual rent
equal to or greater than the appropriate dollar threshold
described in such section, which shall be subject to annual
adjustment in accordance with section 3307(h) of such title;
and
``(ii) does not include a lease for space for use as a
shared Federal medical facility for which the Department's
estimated share of the lease costs does not exceed such
dollar threshold.''.
(c) Separate Prospectus Requirement for Major Medical
Facility Leases.--Subsection (b) of such section is amended--
(1) by striking paragraph (7);
(2) in paragraph (1), by redesignating subparagraphs (A)
through (E) as clauses (i) through (v), respectively;
(3) in paragraph (6), by redesignating subparagraphs (A)
through (C) as clauses (i) through (iii), respectively;
(4) by redesignating paragraphs (1) through (6) as
subparagraphs (A) through (F), respectively;
(5) in the matter preceding subparagraph (A), as
redesignated by paragraph (4)--
(A) by striking ``Whenever the President'' and inserting
``(1) Whenever the President'';
(B) by striking ``the Congress'' and inserting
``Congress''; and
(C) by striking ``or a major medical facility lease (as
defined in subsection (a)(3)(b))'';
(6) in subparagraph (A), as redesignated by paragraph (4),
by striking ``leased,'';
(7) in subparagraph (E), as redesignated by paragraph (4)--
(A) by striking ``or lease'' each place it appears; and
(B) by striking ``or leases''; and
(8) by adding at the end the following new paragraph:
``(2) Whenever the President or the Secretary submit to
Congress a request for the funding of a major medical
facility lease (as defined in subsection (a)(3)(B)), the
Secretary shall submit to each committee, on the same day, a
prospectus of the proposed medical facility. Any such
prospectus shall include the following:
``(A) A description of the facility to be leased.
``(B) An estimate of the cost to the Federal Government of
the facility to be leased.
``(C) An estimate of the energy performance of the proposed
lease space, to include a description of anticipated
utilization of renewable energy, energy efficient and climate
resilient elements, and related matters.
``(D) Current and projected workload and utilization data
regarding the facility to be leased, including information on
projected changes in workload and utilization over a five-
year period, a ten-year period, and a twenty-year period.
``(E) A detailed analysis of how the lease is expected to
comply with Office of Management and Budget Circular A-11 and
section 1341 of title 31 (commonly referred to as the `Anti-
Deficiency Act'). Any such analysis shall include--
``(i) an analysis of the classification of the lease as a
`lease purchase', a `capital lease', or an `operating lease'
as those terms are defined in Office of Management and Budget
Circular A-11;
``(ii) an analysis of the obligation of budgetary resources
associated with the lease; and
``(iii) an analysis of the methodology used in determining
the asset cost, fair market value, and cancellation costs of
the lease.''.
(d) Interim Leasing Actions.--Such section is further
amended by adding at the end the following new subsection:
``(i)(1) Notwithstanding subsection (a)(2)(B), the
Secretary may carry out interim leasing actions as the
Secretary considers necessary for the following leases:
``(A) Major medical facility leases (as defined in
subsection (a)(3)(B)) approved pursuant to this section and
for which a prospectus for a replacement lease has been
submitted to Congress pursuant to subsection (b)(2).
``(B) Replacement leases that do not require approval under
this section and for which a prospectus has been submitted to
Congress pursuant to subsection (b)(2).
``(2) In this subsection, the term `interim leasing
actions' has the meaning given that term by the Administrator
of the General Services Administration.''.
(e) Purchase Options.--Such section is further amended by
adding at the end the following new subsection:
``(j) The Secretary may obligate and expend funds to
exercise a purchase option included in any major medical
facility lease (as defined in subsection (a)(3)(B)).''.
(f) Applicability.--The amendments made by this section
shall apply with respect to any lease that has not been
specifically authorized by law on or before the date of the
enactment of this Act.
SEC. 704. AUTHORITY TO ENTER INTO AGREEMENTS WITH ACADEMIC
AFFILIATES AND OTHER ENTITIES TO ACQUIRE SPACE
FOR THE PURPOSE OF PROVIDING HEALTH-CARE
RESOURCES TO VETERANS.
Section 8103 of title 38, United States Code, is amended by
adding at the end the following new subsection:
``(h)(1) Notwithstanding any other provision of law
requiring the use of competitive procedures, including
section 2304 of title 10, when the Secretary determines it to
be in the best interest of the Department, the Secretary may
enter into a lease with an academic affiliate or covered
entity to acquire space for the purpose of providing health-
care resources to veterans.
``(2) In this subsection:
``(A) The term `academic affiliate' means an institution or
organization described in section 7302(d) of this title.
``(B) The term `covered entity' means a unit or subdivision
of a State, local, or municipal government, public or
nonprofit agency, institution, or organization, or other
institution or organization as the Secretary considers
appropriate that owns property controlled by an academic
affiliate to be leased under this subsection.
``(C) The term `health -care resource' has the meaning
given that term in section 8152(1) of this title.
``(D) The term `space' means any room, unit, floor, wing,
building, parking facility, or other subdivision of a
building or facility
[[Page S2830]]
owned or controlled by an academic affiliate.''.
SEC. 705. MODIFICATIONS TO ENHANCED-USE LEASE AUTHORITY OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) Modifications to Authority.--Paragraph (2) of section
8162(a) of title 38, United States Code, is amended to read
as follows:
``(2)(A) The Secretary may enter into an enhanced-use lease
on or after the date of the enactment of this paragraph only
if the Secretary determines--
``(i) that the lease will not be inconsistent with, and
will not adversely affect--
``(I) the mission of the Department; or
``(II) the operation of facilities, programs, and services
of the Department in the area of the leased property; and
``(ii) that--
``(I) the lease will enhance the use of the leased property
by directly or indirectly benefitting veterans; or
``(II) the leased property will provide supportive housing.
``(B) The Secretary shall give priority to enhanced-use
leases that, on the leased property--
``(i) provide supportive housing for veterans;
``(ii) provide direct services or benefits targeted to
veterans; or
``(iii) provide services or benefits that indirectly
support veterans.''.
(b) Extension of Maximum Term of Enhanced-use Lease.--
Section 8162(b)(2) of such title is amended by striking ``75
years'' and inserting ``99 years''.
(c) Modification of Use of Proceeds.--Section 8165(a)(1) of
such title is amended by striking ``shall be deposited in the
Department of Veterans Affairs Medical Care Collections Fund
established under section 1729A of this title.'' and
inserting ``shall, at the discretion of the Secretary, be
deposited in--
``(A) the Department of Veterans Affairs Medical Care
Collections Fund established under section 1729A of this
title; or
``(B) the Medical Facilities or Construction, Minor
Projects account of the Department to be used to defray the
costs of administration, maintenance, repair, and related
expenses incurred by the Department with respect to property
that is owned by or under the jurisdiction or control of the
Department.''.
(d) Repeal of Sunset.--Section 8169 of such title is
repealed.
(e) Appropriation.--In addition to amounts otherwise
available, there is appropriated for fiscal year 2022, out of
any funds in the Treasury not otherwise appropriated,
$922,000,000 for an additional amount for the Department of
Veterans Affairs, to remain available until expended, to
enter into enhanced-use leases pursuant to section 8162 of
title 38, United States Code, as amended by this section.
SEC. 706. AUTHORITY FOR JOINT LEASING ACTIONS OF DEPARTMENT
OF DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS.
(a) Department of Defense.--Section 1104A of title 10,
United States Code, is amended--
(1) by inserting ``, or the leasing,'' after ``design, and
construction'' each place it appears; and
(2) in subsection (c)(2), by inserting ``, or the
leasing,'' after ``design''.
(b) Department of Veterans Affairs.--Section 8111B of title
38, United States Code, is amended--
(1) in subsection (a), by inserting ``, or the leasing,''
after ``design, and construction'';
(2) in subsection (b), by adding at the end the following
new paragraph:
``(3) The Secretary of Veterans Affairs may transfer to the
Department of Defense amounts appropriated to the `Medical
Facilities' account of the Department of Veterans Affairs for
the purpose of leasing space for a shared medical facility if
the estimated share of the Department of Veterans Affairs for
the lease costs does not exceed the amount specified in
section 8104(a)(3)(B) of this title.''; and
(3) in subsection (c), by adding at the end the following
new paragraph:
``(3) Any amount transferred to the Secretary of Veterans
Affairs by the Secretary of Defense for the purpose of
leasing space for a shared medical facility may be credited
to the `Medical Facilities' account of the Department of
Veterans Affairs and may be used for such purpose.''.
SEC. 707. APPROPRIATION OF AMOUNTS FOR MAJOR MEDICAL FACILITY
LEASES.
(a) Fiscal Year 2023.--In addition to amounts otherwise
available, there is appropriated for fiscal year 2023, out of
any funds in the Treasury not otherwise appropriated,
$1,880,000,000 for an additional amount for the Medical
Facilities account of the Department of Veterans Affairs, to
remain available until expended, for major medical facility
leases authorized by section 702.
(b) Additional Years.--In addition to amounts otherwise
available, there is appropriated, out of any funds in the
Treasury not otherwise appropriated, for an additional amount
for the Medical Facilities account of the Department of
Veterans Affairs, to remain available until expended, for
major medical facility leases authorized by section 702 or
approved pursuant to subchapter I of chapter 81 of title 38,
United States Code, as amended by section 703--
(1) $100,000,000 for fiscal year 2024;
(2) $200,000,000 for fiscal year 2025;
(3) $400,000,000 for fiscal year 2026;
(4) $450,000,000 for fiscal year 2027;
(5) $600,000,000 for fiscal year 2028;
(6) $610,000,000 for fiscal year 2029;
(7) $620,000,000 for fiscal year 2030; and
(8) $650,000,000 for fiscal year 2031.
TITLE VIII--RECORDS AND OTHER MATTERS
SEC. 801. EPIDEMIOLOGICAL STUDY ON FORT MCCLELLAN VETERANS.
The Secretary of Veterans Affairs shall conduct an
epidemiological study on the health trends of veterans who
served in the Armed Forces at Fort McClellan at any time
during the period beginning January 1, 1935, and ending on
May 20, 1999.
SEC. 802. BIENNIAL BRIEFING 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, as determined by the Secretary
of Defense, and every two years thereafter, the Secretary of
Defense, in consultation with the Secretary of Veterans
Affairs, shall provide the appropriate committees of Congress
a briefing on--
(1) the 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 or system 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 briefing required by subsection (a)
shall include, for the period covered by the report, the
following:
(1) An identification of potential exposures to
occupational or environmental hazards 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 and accuracy of the location
data used by the Department of Defense in determining
potential exposures to occupational or environmental hazards
by members of the Armed Forces and veterans, and
recommendations for how to improve the quality of such 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) Individual longitudinal exposure record.--The term
``Individual Longitudinal Exposure Record'' has the meaning
given such term in section 1171 of title 38, United States
Code, as added by section 202.
SEC. 803. CORRECTION OF EXPOSURE RECORDS BY MEMBERS OF THE
ARMED FORCES AND VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall
coordinate with the Secretary of Defense to provide a means
for veterans to update their records as necessary to reflect
exposures to occupational or environmental hazards by such
member or veteran in the Individual Longitudinal Exposure
Record.
(b) Evidence.--
(1) Provision of evidence.--To update a record under
subsection (a), a veteran shall provide such evidence as the
Secretary of Veterans Affairs considers necessary.
(2) Regulations.--The Secretary of Veterans Affairs shall
prescribe by regulation the evidence considered necessary
under paragraph (1).
(c) Definitions.--In this section:
(1) Individual longitudinal exposure record.--The term
``Individual Longitudinal Exposure Record'' has the meaning
given such term in section 1171 of title 38, United States
Code, as added by section 202.
(2) Toxic exposure.--The term ``toxic exposure'' has the
meaning given such term in section 101 of title 38, United
States Code, as amended by section 102(b).
SEC. 804. FEDERAL CAUSE OF ACTION RELATING TO WATER AT CAMP
LEJEUNE, NORTH CAROLINA.
(a) Short Title.--This section may be cited as the ``Camp
Lejeune Justice Act of 2022''.
(b) 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.
(c) 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.
[[Page S2831]]
(d) 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 (b), 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.
(e) 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 (b), 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.
(f) 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.
(g) No Punitive Damages.--Punitive damages may not be
awarded in any action under this section.
(h) 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.
(i) Exception for Combatant Activities.--This section does
not apply to any claim or action arising out of the combatant
activities of the Armed Forces.
(j) 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. 805. COST OF WAR TOXIC EXPOSURES FUND.
(a) In General.--Chapter 3 is amended by adding at the end
the following new section:
``Sec. 324. Cost of War Toxic Exposures Fund
``(a) Establishment.--There is hereby established in the
Treasury of the United States an account to be known as the
`Cost of War Toxic Exposures Fund' (the `Fund'), to be
administered by the Secretary.
``(b) Deposits.--There shall be deposited in the Fund such
amounts as may be appropriated to the Fund pursuant to
subsection (c).
``(c) 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 investment in--
``(1) the delivery of veterans' health care associated with
exposure to environmental hazards in the active military,
naval, air, or space service in programs administered by the
Under Secretary for Health;
``(2) any expenses incident to the delivery of veterans'
health care and benefits associated with exposure to
environmental hazards in the active military, naval, air, or
space service, including administrative expenses, such as
information technology and claims processing and appeals, and
excluding leases as authorized or approved under section 8104
of this title; and
``(3) medical and other research relating to exposure to
environmental hazards.
``(d) Budget Scorekeeping.--(1) Immediately upon enactment
of the Sergeant First Class Heath Robinson Honoring our
Promise to Address Comprehensive Toxics Act of 2022, expenses
authorized to be appropriated to the Fund in subsection (c)
shall be estimated for fiscal year 2023 and each subsequent
fiscal year and treated as budget authority that is
considered to be direct spending--
``(A) in the baseline for purposes of section 257 of the
Balanced Budget and Emergency Deficit Control Act of 1985 (2
U.S.C. 907);
``(B) by the Chairman of the Committee on the Budget of the
Senate and the Chair of the Committee on the Budget of the
House of Representatives, as appropriate, for purposes of
budget enforcement in the Senate and the House of
Representatives;
``(C) under the Congressional Budget Act of 1974 (2 U.S.C.
621 et seq.), including in the reports required by section
308(b) of such Act (2 U.S.C. 639); and
``(D) for purposes of the Statutory Pay-As-You-Go Act of
2010 (2 U.S.C. 931 et seq.).
``(2) No amount appropriated to the Fund in fiscal year
2023 or any subsequent fiscal year pursuant to this section
shall be counted as discretionary budget authority and
outlays or as direct spending for any estimate of an
appropriation Act under the Congressional Budget and
Impoundment Control Act of 1974 (2 U.S.C. 621 et seq.) and
any other Act.
``(3) Notwithstanding the Budget Scorekeeping Guidelines
and the accompanying list of programs and accounts set forth
in the joint explanatory statement of the committee of
conference accompanying Conference Report 105-217, and for
purposes of the Balanced Budget and Emergency Deficit Control
Act of 1985 (2 U.S.C. 900 et seq.) and the Congressional
Budget Act of 1974 (2 U.S.C. 621 et seq.), the Fund shall be
treated as if it were an account designated as `Appropriated
Entitlements and Mandatories for Fiscal Year 1997' in the
joint explanatory statement of the committee of conference
accompanying Conference Report 105-217.
``(e) 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 detailed estimates of the sums
described in subsection (c) for the applicable fiscal year.
``(f) Procedures for Estimates.--The Secretary may, after
consultation with the Committee on Appropriations of the
Senate and the Committee on Appropriations of the House of
Representatives, establish policies and procedures for
developing the annual detailed estimates required by
subsection (e).''.
(b) Sequestration.--Section 256(h)(4) of the Balanced
Budget and Emergency Deficit Control Act of 1985 (2 U.S.C.
906(h)(4)) is amended by adding at the end the following new
subparagraph:
``(G) Cost of War Toxic Exposures Fund.''.
SEC. 806. APPROPRIATION FOR FISCAL YEAR 2022.
(a) Appropriation.--In addition to amounts otherwise
available, there is appropriated for fiscal year 2022, out of
any funds in the Treasury not otherwise appropriated,
$500,000,000 for the Cost of War Toxic Exposures Fund,
established by section 324 of title 38, United States Code,
as added by section 805 of this Act, to remain available
until September 30, 2024.
(b) Spend Plan.--Not later than 30 days after enactment of
this Act, the Secretary of Veterans Affairs shall submit a
plan for expending amounts made available by subsection (a)
by program, project or activity to the Committee on
Appropriations of the Senate and the Committee on
Appropriations of the House of Representatives. Funds may not
be obligated until such Committees issue an approval, or
absent a response, a period of 30 days has elapsed.
SEC. 807. AUTHORIZATION OF ELECTRONIC NOTICE IN CLAIMS UNDER
LAWS ADMINISTERED BY THE SECRETARY OF VETERANS
AFFAIRS.
(a) In General.--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 5112(b)(6), by striking ``(at the payee's
last address of record)''.
(5) 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.
``(3) Any authorized representative of the appellant or
party described in paragraph (2).
``(f)(1) The Secretary may provide notice under subsection
(e) electronically if a claimant (or the claimant's
representative) elects to receive such notice electronically.
``(2) A claimant (or the claimant's representative) may
revoke such an election at any time, by means prescribed by
the Secretary.''.
(6) In section 7105(b)(1)(A), by striking ``mailing'' and
inserting ``issuance''.
(7) In section 7105A(a), by striking ``mailed'' and
inserting ``issued''.
(8) In section 7266(a), by striking ``mailed'' and
inserting ``issued''.
(b) Rule of Construction.--None of the amendments made by
this section shall be
[[Page S2832]]
construed to apply section 5104(a) of such title to decisions
of the Board of Veterans' Appeals under chapter 71 of such
title.
SEC. 808. BURN PIT TRANSPARENCY.
(a) Annual Report on Disability Claims.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and annually thereafter, the
Secretary of Veterans Affairs shall submit to the appropriate
congressional committees a report detailing the following:
(A) The total number of covered veterans.
(B) The total number of claimed issues for disability
compensation under chapter 11 of title 38, United States
Code, approved and the total number denied by the Secretary
of Veterans Affairs with respect to a covered veteran, and a
breakdown of the reasons for the denials.
(C) A comprehensive list of the top 10 conditions from each
body system for which the Secretary awarded service
connection for covered veterans.
(D) Any updates or trends with respect to the information
described in subparagraphs (A), (B), and (C), that the
Secretary determines appropriate.
(2) Covered veteran defined.--In this subsection, the term
``covered veteran'' means a veteran who deployed to the
Southwest Asia theater of operations any time after August
1990, or Afghanistan, Syria, Djibouti, or Uzbekistan after
September 19, 2001, and who submits a claim for disability
compensation under chapter 11 of title 38, United States
Code.
(b) Information Regarding the Airborne Hazards and Open
Burn Pit Registry.--
(1) Notice.--The Secretary of Veterans Affairs shall ensure
that a medical professional of the Department of Veterans
Affairs informs a veteran of the Airborne Hazards and Open
Burn Pit Registry if the veteran presents at a medical
facility of the Department for treatment that the veteran
describes as being related to, or ancillary to, the exposure
of the veteran to toxic airborne chemicals and fumes caused
by open burn pits.
(2) Display.--In making information public regarding the
number of participants in the Airborne Hazards and Open Burn
Pit Registry, the Secretary shall display such numbers by
both State and by congressional district.
(c) Definitions.--In this section:
(1) Airborne hazards and open burn pit registry.--The term
``Airborne Hazards and Open Burn Pit Registry'' means the
registry established by the Secretary of Veterans Affairs
under section 201 of the Dignified Burial and Other Veterans'
Benefits Improvement Act of 2012 (Public Law 112-260; 38
U.S.C. 527 note).
(2) Appropriate congressional committees.--The term
``appropriate congressional committees'' means--
(A) the Committee on Veterans' Affairs and the Committee on
Armed Services of the Senate; and
(B) The Committee on Veterans' Affairs and the Committee on
Armed Services of the House of Representatives.
(3) Open burn pit.--The term ``open burn pit'' has the
meaning given that term in section 201(c) of the Dignified
Burial and Other Veterans' Benefits Improvement Act of 2012
(Public Law 112-260; 38 U.S.C. 527 note).
TITLE IX--IMPROVEMENT OF WORKFORCE OF DEPARTMENT OF VETERANS AFFAIRS
SEC. 901. NATIONAL RURAL RECRUITMENT AND HIRING PLAN FOR
VETERANS HEALTH ADMINISTRATION.
(a) In General.--Not later than 18 months after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in collaboration with the directors of each community-based
outpatient clinic and medical center of the Department of
Veterans Affairs, shall develop and implement a national
rural recruitment and hiring plan for the Veterans Health
Administration to--
(1) recruit health care professionals for rural and highly
rural community-based outpatient clinics and rural and highly
rural medical centers of the Department;
(2) determine which such clinics or centers have a staffing
shortage of health care professionals;
(3) develop best practices and techniques for recruiting
health care professionals for such clinics and centers;
(4) not less frequently than annually, provide virtually
based, on-demand training to human resources professionals of
the Veterans Health Administration on the best practices and
techniques developed under paragraph (3); and
(5) provide recruitment resources, such as pamphlets and
marketing material to--
(A) Veterans Integrated Service Networks of the Department;
(B) rural and highly rural community-based outpatient
clinics of the Department; and
(C) rural and highly rural medical centers of the
Department.
(b) Annual Report.--Not later than 18 months after the date
of the enactment of this Act, and annually thereafter, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report that includes--
(1) the plan developed and implemented under subsection
(a); and
(2) an assessment of the outcomes related to recruitment
and retention of employees of the Veterans Health
Administration at rural and highly rural facilities of the
Department.
(c) Definitions.--In this section, the terms ``rural'' and
``highly rural'' have the meanings given those terms under
the rural-urban commuting areas coding system of the
Department of Agriculture.
SEC. 902. AUTHORITY TO BUY OUT SERVICE CONTRACTS FOR CERTAIN
HEALTH CARE PROFESSIONALS IN EXCHANGE FOR
EMPLOYMENT AT RURAL OR HIGHLY RURAL FACILITIES
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--For any covered health care professional
to whom the Secretary of Veterans Affairs has offered
employment with the Department of Veterans Affairs, the
Secretary may buy out the non-Department service contract of
such individual in exchange for such individual agreeing to
be employed at a rural or highly rural facility of the
Department for a period of obligated service specified in
subsection (c).
(b) Payment of Amounts.--
(1) In general.--Payment of any amounts for a buy out of a
service contract for a covered health care professional under
subsection (a) shall be made directly to the individual or
entity with respect to which the covered health care
professional has a service obligation under such contract.
(2) Limitation on total amount.--The total amount paid by
the Department under this section shall not exceed
$40,000,000 per fiscal year.
(c) Obligated Service.--In exchange for a contract buy out
under subsection (a), a covered health care professional
shall agree to be employed for not less than four years at a
rural or highly rural facility of the Department.
(d) Liability.--
(1) In general.--Except as provided in paragraph (2), if a
covered health care professional fails for any reason to
complete the period of obligated service of the individual
under subsection (c), the United States shall be entitled to
recover from the individual an amount equal to--
(A) the total amount paid under subsection (a) to buy out
the non-Department service contract of the individual;
multiplied by
(B) a fraction--
(i) the numerator of which is--
(I) the total number of months in the period of obligated
service of the individual; minus
(II) the number of months served by the individual; and
(ii) the denominator of which is the total number of months
in the period of obligated service of the individual.
(2) Exception.--Liability shall not arise under paragraph
(1) in the case of an individual covered by that paragraph if
the individual does not obtain, or fails to maintain,
employment as an employee of the Department due to staffing
changes approved by the Under Secretary for Health.
(e) Not a Taxable Benefit.--A contract buy out for a
covered health care professional under subsection (a) shall
not be considered a taxable benefit or event for the covered
health care professional.
(f) Annual Report.--
(1) In general.--Not later than 18 months after the date of
the enactment of this Act, and not less frequently than
annually thereafter, 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 on the use by the Secretary of the
authority under this section.
(2) Elements.--Each report required by paragraph (1) shall
include the following:
(A) The number of health care professionals for whom a
service contract buyout payment was made under subsection (a)
in the previous fiscal year, disaggregated by occupation or
specialty.
(B) The average, highest, and lowest amount of the service
contract buyout payments made under subsection (a) for each
occupation or specialty in the previous fiscal year.
(C) Each location where contract buyout authority under
subsection (a) was utilized and the number of covered health
care professionals who agreed to be employed at such location
in the previous fiscal year.
(g) Definitions.--In this section:
(1) Covered health care professional.--The term ``covered
health care professional'' means a physician, nurse
anesthetist, physician assistant, or nurse practitioner
offered employment with the Department regardless of the
authority under which such employment is offered.
(2) Rural; highly rural.--The terms ``rural'' and ``highly
rural'' have the meanings given those terms under the rural-
urban commuting areas coding system of the Department of
Agriculture.
(h) Sunset.--This section shall terminate on September 30,
2027.
SEC. 903. QUALIFICATIONS FOR HUMAN RESOURCES POSITIONS WITHIN
DEPARTMENT OF VETERANS AFFAIRS AND PLAN TO
RECRUIT AND RETAIN HUMAN RESOURCES EMPLOYEES.
(a) Establishment of Qualifications.--Not later than 180
days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall--
(1) establish qualifications for each human resources
position within the Department of Veterans Affairs in
coordination with the Office of Personnel Management;
(2) establish standardized performance metrics for each
such position; and
(3) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on
[[Page S2833]]
Veterans' Affairs of the House of Representatives a report
containing the qualifications and standardized performance
metrics established under paragraphs (1) and (2).
(b) Improvement of Human Resources Actions.--Not later than
90 days after the date of the enactment of this Act, the
Secretary shall establish or enhance systems of the
Department to monitor the hiring and other human resources
actions that occur at the local, regional, and national
levels of the Department to improve the performance of those
actions.
(c) Report.--Not later than one year after the
establishment of the qualifications and performance metrics
under subsection (a), the Comptroller General of the United
States shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report containing--
(1) a description of the implementation of such
qualifications and performance metrics;
(2) an assessment of the quality of such qualifications and
performance metrics;
(3) an assessment of performance and outcomes based on such
metrics; and
(4) such other matters as the Comptroller General considers
appropriate.
(d) Plan to Recruit and Retain Human Resources Employees.--
Not later than one year 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 plan for the recruitment and retention of
human resources employees within the Department of Veterans
Affairs.
SEC. 904. MODIFICATION OF PAY CAP FOR CERTAIN EMPLOYEES OF
VETERANS HEALTH ADMINISTRATION.
(a) In General.--Section 7455(c) is amended--
(1) in paragraph (1), by striking ``30 percent'' inserting
``50 percent'';
(2) in paragraph (2), by striking ``level IV'' inserting
``level II''; and
(3) by adding at the end the following new paragraph:
``(3)(A) Notwithstanding section 5304 of title 5 or any
other provision of law, but subject to the limitation under
paragraph (2), pursuant to an increase under subsection (a),
the Secretary may pay a special rate or an adjusted rate of
basic pay in excess of the rate of basic pay payable for
level IV of the Executive Schedule.
``(B) If an employee is in receipt of a special rate of pay
under subparagraph (A) in excess of the rate of basic pay
payable for level IV of the Executive Schedule with an
established special rate supplement of greater value than a
supplement based on the applicable locality-based
comparability payment percentage under section 5304 of title
5, but a pay adjustment would cause such established special
rate supplement to be of lesser value, the special rate
supplement shall be converted to a supplement based on the
applicable locality-based comparability percentage unless the
Secretary determines that some other action is
appropriate.''.
(b) Pay for Critical Positions.--Section 7404(a)(1)(B) is
amended by inserting ``7306 or'' before ``7401(4)''.
SEC. 905. EXPANSION OF OPPORTUNITIES FOR HOUSEKEEPING AIDES.
Section 3310 of title 5, United States Code, is amended by
inserting ``(other than for positions of housekeeping aides
in the Department of Veterans Affairs)'' after ``competitive
service''.
SEC. 906. MODIFICATION OF AUTHORITY OF THE SECRETARY OF
VETERANS AFFAIRS RELATING TO HOURS, CONDITIONS
OF EMPLOYMENT, AND PAY FOR CERTAIN EMPLOYEES OF
VETERANS HEALTH ADMINISTRATION.
(a) Expansion of Eligibility of Employees for Certain
Awards.--Section 7404(c) is amended--
(1) by striking ``Notwithstanding'' and inserting ``(1)
Notwithstanding'';
(2) by inserting ``or 7401(4)'' after ``section 7306'';
(3) by striking ``who is not eligible for pay under
subchapter III'' and inserting ``or in a covered executive
position under section 7401(1) of this title'';
(4) by striking ``sections 4507 and 5384'' and inserting
``section 4507''; and
(5) by adding at the end the following new paragraph:
``(2) In this subsection, the term `covered executive
position' means a position that the Secretary has determined
is of equivalent rank to a Senior Executive Service position
(as such term is defined in section 3132(a) of title 5) and
is subject to an agency performance management system.''.
(b) Authority for Awards Programs of Department of Veterans
Affairs.--
(1) In general.--Subchapter I of chapter 74 is amended by
inserting after section 7404 the following new section:
``Sec. 7404A. Awards
``(a) Superior Accomplishments and Performance Awards
Program.--The Secretary may establish an awards program for
personnel listed in section 7421(b) of this title consistent
with chapter 45 of title 5, to the extent practicable.
``(b) Executive Performance Awards Program.--
Notwithstanding section 7425 of this title or any other
provision of law, the Secretary may establish a performance
awards program consistent with section 5384 of title 5 for--
``(1) personnel appointed under section 7401(1) of this
title for a position that the Secretary has determined is of
equivalent rank to a Senior Executive Service position (as
such term is defined in section 3132(a) of title 5) and is
subject to an agency performance management system; and
``(2) personnel appointed under section 7306 or 7401(4) of
this title.
``(c) Payment of Awards.--Awards under this section may be
paid based on criteria established by the Secretary and shall
not be considered in calculating the limitation under section
7431(e)(4) of this title.
``(d) Not Considered Basic Pay.--Awards under this section
shall not be considered basic pay for any purpose.
``(e) Regulations.--The Secretary may prescribe regulations
for the administration of this section.''.
(2) Limitation on past awards.--Notwithstanding any other
provision of law, awards made by the Secretary of Veterans
Affairs for any period on or after January 1, 2017, and
before the date of the enactment of this Act for an employee
under section 7306 or 7401(4) of title 38, United States
Code, or for a position described in section 7401(1) of such
title that the Secretary has determined is of equivalent rank
to a Senior Executive Service position (as such term is
defined in section 3132(a) of title 5, United States Code),
may be subject to section 7404A of title 38, United States
Code, as added by paragraph (1).
(c) Modification of Employees Subject to Regulation by
Secretary of Veterans Affairs of Hours and Conditions of
Employment and Leaves of Absence.--
(1) In general.--Section 7421 is amended--
(A) in subsection (a), by striking ``chapter'' and
inserting ``title''; and
(B) in subsection (b), by adding at the end the following
new paragraph:
``(9) Any position for which the employee is appointed
under section 7306 or 7401(4) of this title.''.
(2) Administration of full-time employees.--Section 7423 is
amended--
(A) in subsection (a)(2), by adding at the end the
following new subparagraph:
``(D) The Secretary may exclude from the requirements of
paragraph (1) employees hired under section 7306 or 7401(4)
of this title or for a position described in section 7401(1)
of this title that the Secretary has determined is of
equivalent rank to a Senior Executive Service position (as
such term is defined in section 3132(a) of title 5).''; and
(B) in subsection (e)(1), by striking ``7401(1)'' and
inserting ``7421(b)''.
(3) Additional pay authorities.--Section 7410(a) is
amended--
(A) by striking ``The Secretary'' and inserting ``(1) The
Secretary'';
(B) by striking ``the personnel described in paragraph (1)
of section 7401 of this title'' and inserting ``personnel
appointed under section 7306 of this title or section 7401(4)
of this title, or personnel described in section 7401(1) of
this title,''; and
(C) by striking ``in the same manner, and subject to the
same limitations, as in the case of'' and inserting ``in a
manner consistent with''; and
(D) by adding at the end the following new paragraph:
``(2) Payments under paragraph (1) shall not be considered
in calculating the limitation under section 7431(e)(4) of
this title.''.
(4) Treatment of pay authority changes.--For the purposes
of the amendments made by paragraph (3), the Secretary of
Veterans Affairs shall treat any award or payment made by the
Secretary between January 1, 2017, and the date of the
enactment of this Act to employees appointed under sections
7306, 7401(1), and 7401(4) of title 38, United States Code,
that the Secretary has determined are of equivalent rank to a
Senior Executive Service position (as such term is defined in
section 3132(a) of title 5, United States Code), as if such
amendments had been in effect at the time of such award or
payment.
(5) Treatment of prior leave balances.--Notwithstanding any
other provision of law, the Secretary may adjust the leave
balance and carryover leave balance of any employee described
in section 7421(b)(9) of title 38, United States Code, as
amended by paragraph (1)(B), to ensure any leave accrued or
carried over before the date of the enactment of this Act
remains available to such employee.
(d) Treatment of Certain Employees as Appointed Under
Section 7306.--Section 7306 is amended--
(1) in subsection (a), by redesignating the second
paragraph (11) as paragraph (12); and
(2) by adding at the end the following new subsection:
``(g) For purposes of applying any provision of chapter 74
of this title, including sections 7404, 7410, and 7421, or
any other provision of law, the Secretary may treat any
appointment for a position under this chapter to be an
appointment under this section.''.
(e) Conforming Amendment.--Section 7431(e)(4) is amended by
striking ``In no case'' and inserting ``Except as provided in
sections 7404A(c) and 7410(a)(2) of this title, in no case''.
SEC. 907. WAIVER OF PAY LIMITATION FOR CERTAIN EMPLOYEES OF
DEPARTMENT OF VETERANS AFFAIRS.
Subchapter I of chapter 7 is amended by inserting after
section 703 the following new section:
[[Page S2834]]
``Sec. 704. Waiver of pay limitation for certain employees
``(a) Employees of Veterans Health Administration Impacted
by Closure or Realignment.--Notwithstanding any other
provision of law, the Secretary may waive any annual premium
or aggregate limitation on pay for an employee of the
Veterans Health Administration for the calendar year during
which--
``(1) the official duty station of the employee is closed;
or
``(2) the office, facility, activity, or organization of
the employee is realigned.
``(b) Employees Providing Care to Veterans Exposed to Open
Burn Pits.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary may waive any annual premium or aggregate
limitation on pay for an employee of the Department whose
primary duties include providing expanded care for veterans
exposed to open burn pits.
``(2) Open burn pit defined.--In this subsection, the term
`open burn pit' has the meaning given that term in section
201(c) of the Dignified Burial and Other Veterans' Benefits
Improvement Act of 2012 (Public Law 112-260; 38 U.S.C. 527
note).
``(c) Coordination With Office of Personnel Management.--In
implementing this section, the Secretary shall coordinate
with the Director of the Office of Personnel Management.
``(d) Reports.--
``(1) In general.--For each quarter that the Secretary
waives a limitation under this section, the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate,
the Committee on Veterans' Affairs of the House of
Representatives, and the Office of Personnel Management a
report on the waiver or waivers.
``(2) Contents.--Each report submitted under paragraph (1)
with respect to a waiver or waivers shall include the
following:
``(A) Where the waiver or waivers were used, including in
which component of the Department and, as the case may be,
which medical center of the Department.
``(B) For how many employees the waiver or waivers were
used, disaggregated by component of the Department and, if
applicable, medical center of the Department.
``(C) The average amount by which each payment exceeded the
pay limitation that was waived, disaggregated by component of
the Department and, if applicable, medical center of the
Department.
``(e) Employee Defined.--In this section, the term
`employee' means any employee regardless of the authority
under which the employee was hired.
``(f) Termination.--This section shall terminate on
September 30, 2027.''.
SEC. 908. ELIMINATION OF LIMITATION ON AWARDS AND BONUS FOR
EMPLOYEES OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 705(a) of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146;
38 U.S.C. 703 note) is amended by striking paragraph (3).
(b) Applicability.--Subsection (a) shall take effect on the
date of the enactment of this Act and apply as if such
subsection had been enacted on September 30, 2021.
SEC. 909. ADDITIONAL AUTHORITY OF THE SECRETARY OF VETERANS
AFFAIRS RELATING TO RECRUITMENT AND RETENTION
OF PERSONNEL.
Subchapter I of chapter 7 is amended by inserting after
section 705 the following new section:
``Sec. 706. Additional authority relating to recruitment and
retention of personnel
``(a) Recruitment and Relocation Bonuses.--The Secretary
may pay a recruitment or relocation bonus under section
5753(e) of title 5 without regard to any requirements for
certification or approval under that section.
``(b) Retention Bonuses.--(1) The Secretary may pay a
retention bonus under section 5754(f) of title 5 without
regard to any requirement for certification or approval under
that subsection.
``(2) The Secretary may pay a retention bonus as specified
in subsection (e)(2) of section 5754 of title 5 and may pay
the bonus as a single lump-sum payment at the beginning of
the full period of service required by an agreement under
subsection (d) of such section.
``(c) Merit Awards.--The Secretary may grant a cash award
under section 4502(b) of title 5 without regard to any
requirement for certification or approval under that section.
``(d) Incentives for Critical Skills.--(1) Subject to the
provisions of this paragraph, the Secretary may provide a
critical skill incentive to an employee in a case in which
the Secretary determines--
``(A) the employee possesses a high-demand skill or skill
that is at a shortage;
``(B) such skill is directly related to the duties and
responsibilities of the employee's position; and
``(C) employment of an individual with such skill in such
position serves a critical mission-related need of the
Department.
``(2) An incentive provided to an employee under paragraph
(1) may not to exceed 25 percent of the basic pay of the
employee.
``(3) Provision of an incentive under paragraph (1) shall
be contingent on the employee entering into a written
agreement to complete a period of employment with the
Department.
``(4) An incentive provided under paragraph (1) shall not
be considered basic pay for any purpose.
``(5) The Secretary may prescribe conditions, including
with respect to eligibility, and limitations on provision of
incentive under paragraph (1).
``(6) Incentive provided under paragraph (1) shall not be
included in the calculation of total amount of compensation
under section 7431(e)(4) of this title.
``(e) Student Loan Repayments.--(1) Subject to the
provisions of this subsection, the Secretary may repay a
student loan pursuant to section 5379(b) of title 5.
``(2) Paragraph (2) of such section shall not apply to
payment under this subsection.
``(3) Payment under this subsection shall be made subject
to such terms, limitations, or conditions as may be mutually
agreed to by the Secretary and the employee concerned, except
that the amount paid by the Secretary under this subsection
may not exceed--
``(A) $40,000 for any employee in any calendar year; or
``(B) a total of $100,000 in the case of any employee.
``(f) Expedited Hiring Authority for College Graduates;
Competitive Service.--(1) Subject to paragraph (2) of this
subsection, the Secretary may expedite hiring for college
graduates under section 3115 of title 5 without regard to
subsection (e) of such section or any regulations prescribed
by the Office of Personnel Management for administration of
such subsection.
``(2) The number of employees the Secretary may appoint
under section 3115 of title 5 may not exceed the number equal
to 25 percent of individuals that the Secretary appointed
during the previous fiscal year to a position in the
competitive service classified in a professional or
administrative occupational category, at the GS-11 level, or
an equivalent level, or below, under a competitive examining
procedure.
``(g) Expedited Hiring Authority for Post-secondary
Students; Competitive Service.--(1) Subject to paragraph (2)
of this subsection, the Secretary may expedite hiring of
post-secondary students under section 3116 of title 5,
without regard to subsection (d) of such section or any
regulations prescribed by the Office of Personnel Management
for administration of such subsection.
``(2) The number of employees the Secretary may appoint
under section 3116 of title 5 may not exceed the number equal
to 25 percent of the number of students that the Secretary
appointed during the previous fiscal year to a position at
the GS-11 level, or an equivalent level, or below.
``(h) Pay Authority for Critical Positions.--(1) Subject to
the provisions of this subsection, the Secretary may
authorize the fixing of the rate of pay for a critical
position in the Department consistent with the authorities
and requirements of section 5377 of title 5 that apply to the
Office of Personnel Management.
``(2) The Secretary may fix the rate of pay for a critical
position under this subsection in excess of the limitation
set forth by section 5377(d)(2) of such title.
``(3) Basic pay may not be fixed under this subsection at a
rate greater than the rate payable for the Vice President of
the United States established under section 104 of title 3,
except upon written approval of the President.
``(4) Notwithstanding section 5377(f) of title 5, the
Secretary may authorize the exercise of authority under this
subsection with respect to up to 200 positions at any time.
``(i) Rates of Special Pay.--(1) The Secretary may
establish a rate for special pay under section 5305(a)(1) of
title 5.
``(2) In applying such section to the Secretary's authority
under paragraph (1)--
``(A) `50 percent' shall be substituted for `30 percent';
and
``(B) `level II of the Executive Schedule' shall be
substituted for `level IV of the Executive Schedule'.
``(j) Waiver of Limitations on Certain Payments Under Pay
Comparability System.--The Secretary may waive the limitation
in section 5307 of title 5 for an employee or a payment.
``(k) Termination.--The authorities under this section
shall terminate on September 30, 2027.''.
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