[Congressional Record Volume 168, Number 97 (Tuesday, June 7, 2022)]
[Senate]
[Pages S2818-S2838]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 5048. Mr. LEE 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:

        On page 30, strike lines 4 through 19 and insert the 
     following:
       ``(b) Removal of Presumption.--(1) The Secretary shall--
       ``(A) issue a regulation to remove an illness from a 
     presumption of service connection previously established 
     pursuant to a regulation issued under subsection (a) if there 
     is a lack of evidence establishing a positive association 
     between the illness and the toxic exposure; and
       ``(B) 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 there is a lack of 
     evidence establishing a positive association between the 
     disease and the toxic exposure.
                                 ______
                                 
  SA 5049. Mr. LEE 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:

        Beginning on page 64, strike line 1 and all that follows 
     through page 65, line 9, and insert the following:
       ``(1) Chronic asthma that was diagnosed after service of 
     the covered veteran as specified in subsection (c).
       ``(2) The following types of cancer:
       ``(A) Squamous cell carcinoma of the larynx.
       ``(B) Squamous cell carcinoma of the trachea.
       ``(C) Adenocarcinoma of the trachea.
       ``(D) Salivary gland-type tumors of the trachea.
       ``(E) Adenosquamous carcinoma of the lung.
       ``(F) Large cell carcinoma of the lung.
       ``(G) Salivary gland-type tumors of the lung.
       ``(H) Sacromatoid carcinoma of the lung.
       ``(I) Typical and atypical carcinoid of the lung.
       ``(3) chronic rhinitis.
       ``(4) Chronic sinusitis.
                                 ______
                                 
  SA 5050. Mr. LEE (for himself and Mr. Romney) 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:

        Beginning on page 5, strike line 1 and all that follows 
     through page 67, line 15.

       Beginning on page 86, strike line 1 and all that follows 
     through page 150, line 16.

       At the appropriate place, insert the following:

     SEC. ___. SENSE OF THE SENATE ON PROVISION OF COMPENSATION.

       It is the sense of the Senate that, for the purposes of 
     section 1110 of title 38, United States Code, and subject to 
     section 1113 of such title, for disabilities where there is 
     affirmative evidence to establish that a personal injury 
     suffered or disease contracted in line of duty for which 
     there is a recognized cause, or for aggravation of a 
     preexisting disease contracted in line of duty for which 
     there is a recognized cause, in the active military, naval, 
     air, or space service, during a period of war, the United 
     States will pay to any veteran thus disabled and who was 
     discharged or released under conditions other than 
     dishonorable from the period of service in which said injury 
     or disease was incurred, or preexisting injury or disease was 
     aggravated, compensation, but no compensation shall be paid 
     if the disability is a result of the veteran's own willful 
     misconduct or abuse of alcohol or drugs.
                                 ______
                                 
  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.''.
                                 ______
                                 
  SA 5052. Mr. TESTER 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:

        On page 18, strike lines 17 through 20 and insert the 
     following:

     SEC. 201. SHORT TITLE.

       This title may be cited as the ``Toxic Exposure in the 
     American Military Act'' or the ``TEAM Act''.
                                 ______
                                 
  SA 5053. Mr. TESTER 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:

        On page 47, strike lines 5 through 7 and insert the 
     following:

     SEC. 301. SHORT TITLE.

       This title may be cited as the ``Veterans Burn Pits 
     Exposure Recognition Act''.
                                 ______
                                 
  SA 5054. Mr. TESTER submitted an amendment intended to be proposed by

[[Page S2835]]

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:

        At the appropriate place, insert the following:
       (a) Short Title.--This section may be cited as the ``Fair 
     Care for Vietnam Veterans Act''.
                                 ______
                                 
  SA 5055. Mr. JOHNSON submitted an amendment intended to be proposed 
to amendment SA 5051 submitted by Mr. Tester (for himself and Mr. 
Moran) and intended to be proposed 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:

        At the end, add the following:

                        TITLE XI--OTHER MATTERS

     SEC. 1101. OFFSET OF COSTS USING UNOBLIGATED FUNDS FROM THE 
                   AMERICAN RESCUE PLAN ACT OF 2021.

       Effective on the date of the enactment of this Act, of the 
     unobligated balances made available under the American Rescue 
     Plan Act of 2021 (Public Law 117-2; 135 Stat. 4), or an 
     amendment made by such Act, there is rescinded, on a pro rata 
     basis, $270,000,000,000.
                                 ______
                                 
  SA 5056. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 5051 submitted by Mr. Tester (for himself and Mr. 
Moran) and intended to be proposed 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:

        At the end of title I, add the following:

                 Subtitle C--Other Health Care Matters

     SEC. 121. REQUIREMENT OF DENTAL CLINIC OF DEPARTMENT OF 
                   VETERANS AFFAIRS IN EACH STATE.

       The Secretary of Veterans Affairs shall ensure that each 
     State has a dental clinic of the Department of Veterans 
     Affairs to service the needs of the veterans within that 
     State by not later than September 30, 2024.
                                 ______
                                 
  SA 5057. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 5051 submitted by Mr. Tester (for himself and Mr. 
Moran) and intended to be proposed 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:

        At the end of title I, add the following:

           Subtitle C--Expansion of Dental Care for Veterans

     SEC. 121. PILOT PROGRAM TO FURNISH DENTAL CARE FROM THE 
                   DEPARTMENT OF VETERANS AFFAIRS IN THE SAME 
                   MANNER AS ANY OTHER MEDICAL SERVICE.

       (a) In General.--Commencing not later than one year after 
     the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall carry out a pilot program to assess 
     the feasibility and advisability of furnishing dental care in 
     the same manner as medical services furnished by the 
     Department, notwithstanding the limitations on the provision 
     of dental care under sections 1710(c) and 1712 of title 38, 
     United States Code.
       (b) Medical Services Defined.--In this section, the term 
     ``medical services'' has the meaning given that term in 
     section 1701(6) of title 38, United States Code

     SEC. 122. PILOT PROGRAM ON EXPANSION OF FURNISHING BY 
                   DEPARTMENT OF VETERANS AFFAIRS OF DENTAL CARE 
                   TO CERTAIN ENROLLED VETERANS.

       (a) In General.--Commencing not later than one year after 
     the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall carry out a pilot program under which 
     the Secretary shall furnish dental care to all covered 
     veterans who are not eligible for dental services and 
     treatment and related dental appliances under the laws 
     administered by the Secretary as of the date of the enactment 
     of this Act.
       (b) Duration.--The pilot program shall be carried out 
     during the two-year period beginning on the date of the 
     commencement of the pilot program.
       (c) Locations.--
       (1) In general.--The Secretary shall carry out the pilot 
     program at the following locations:
       (A) Each medical center of the Department with an 
     established dental clinic.
       (B) Not fewer than four military medical treatment 
     facilities of the Department of Defense with the capacity to 
     furnish dental care, which shall be selected in consultation 
     with the Secretary of Defense.
       (C) Not fewer than four community-based outpatient clinics 
     with space available for the furnishing of dental care under 
     the pilot program.
       (D) Not fewer than four Federally Qualified Health Centers.
       (E) Not fewer than four facilities of the Indian Health 
     Service with established dental clinics, which shall be 
     selected in consultation with the Secretary of Health and 
     Human Services.
       (2) Considerations.--In selecting locations for the pilot 
     program, the Secretary shall consider the feasibility and 
     advisability of selecting locations in each of the following:
       (A) Rural areas.
       (B) Areas that are not in close proximity to an active duty 
     military installation.
       (C) Areas representing different geographic locations, such 
     as census tracts established by the Bureau of the Census.
       (3) Mobile dental clinics.--In carrying out the pilot 
     program, the Secretary shall test the efficacy of mobile 
     dental clinics to service rural areas that do not have a 
     population base to warrant a full-time clinic but where there 
     are covered veterans in need of dental care.
       (4) Home based dental care.--In carrying out the pilot 
     program, the Secretary shall test the efficacy of portable 
     dental care units to service rural veteran in their homes, as 
     the Secretary considers medically appropriate.
       (d) Services.--
       (1) Scope.--The dental care furnished to covered veterans 
     under the pilot program shall be consistent with the dental 
     services and treatment furnished by the Secretary to veterans 
     with service-connected disabilities rated 100 percent 
     disabling under the laws administered by the Secretary.
       (2) Dental therapists and tele-dentistry.--
       (A) In general.--In carrying out the pilot program, The 
     Secretary shall test the efficacy of the use of dental 
     therapists and tele-dentistry to service the dental care 
     needs of covered veterans.
       (B) Use of tele-dentistry.--When providing tele-dentistry 
     under subparagraph (A), the Secretary shall use Federal 
     employees to the maximum extent possible.
       (e) Voluntary Participation.--The participation of a 
     covered veteran in the pilot program shall be at the election 
     of the veteran.
       (f) Administration.--
       (1) Notice to covered veterans.--In carrying out the pilot 
     program, the Secretary shall inform all covered veterans of 
     the services and treatment available under the pilot program.
       (2) Copayments.--The Secretary may collect copayments for 
     dental care furnished under the pilot program in accordance 
     with authorities on the collection of copayments for medical 
     care of veterans under chapter 17 of title 38, United States 
     Code.
       (3) Contracts.--
       (A) In general.--Subject to subparagraph (C), in carrying 
     out the pilot program, the Secretary may enter into contracts 
     with appropriate entities for the provision of dental care 
     under the pilot program.
       (B) Performance standards and metrics.--Each contract 
     entered into under subparagraph (A) shall specify performance 
     standards and metrics and processes for ensuring compliance 
     of the contractor concerned with such performance standards.
       (C) Limitation.--The Secretary may only enter into 
     contracts under subparagraph (A) if the Secretary determines 
     that the Department does not employ, and cannot recruit and 
     retain, qualified dentists, dental hygienists, and oral 
     surgeons in the applicable location.
       (g) Reports.--
       (1) In general.--Not later than 90 days before the 
     completion of the pilot program, and not later than 180 days 
     after the completion of the pilot program, the Secretary 
     shall submit to the Committee on Veterans' Affairs and the 
     Committee on Armed Services of the Senate and the Committee 
     on Veterans' Affairs and the Committee on Armed Services of 
     the House of Representatives a report on the pilot program.
       (2) Contents.--Each report under paragraph (1) shall 
     include the following:
       (A) A description of the implementation and operation of 
     the pilot program.
       (B) The number of covered veterans receiving dental care 
     under the pilot program and a description of the dental care 
     furnished to such veterans.
       (C) An analysis of the costs and benefits of the pilot 
     program, including a comparison of costs and benefits by 
     location type.
       (D) An assessment of the impact of the pilot program on 
     appointments for care, prescriptions, hospitalizations, 
     emergency room visits, wellness, employability, and 
     satisfaction of patients, and perceived quality of life of 
     covered veterans.
       (E) An analysis and assessment of the efficacy of mobile 
     clinics and home based dental care to service the dental 
     needs of covered veterans under the pilot program.
       (F) An analysis and assessment of the efficacy of dental 
     therapists and tele-dentistry to service the dental needs of 
     covered veterans under the pilot program, to include a cost 
     benefit analysis of such services.
       (G) The findings and conclusions of the Secretary with 
     respect to the pilot program.
       (H) A comparison of the costs for private sector dental 
     care with cost of furnishing dental care from the Department, 
     broken down by each locality included in the pilot program.
       (I) Such recommendations as the Secretary considers 
     appropriate for the expansion of dental care to all veterans 
     eligible for health care from the Department.
       (h) Definitions.--In this section:
       (1) Covered veteran.--The term ``covered veteran'' means a 
     veteran enrolled in the system of annual patient enrollment 
     of the Department of Veterans Affairs established and 
     operated under section 1705(a) of title 38,

[[Page S2836]]

     United States Code, pursuant to paragraph (1) or (2) of such 
     section.
       (2) Federally qualified health center.--The term 
     ``Federally Qualified Health Center'' means a federally-
     qualified health center as defined in section 1905(l)(2)(B) 
     of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).

     SEC. 123. REQUIREMENT OF DENTAL CLINIC OF DEPARTMENT OF 
                   VETERANS AFFAIRS IN EACH STATE.

       (a) In General.--The Secretary of Veterans Affairs shall 
     ensure that each State has a dental clinic of the Department 
     of Veterans Affairs to service the needs of the veterans 
     within that State.
       (b) Effective Date.--This section shall take effect on the 
     date that is one year after the date of the enactment of this 
     Act.

     SEC. 124. PROGRAM ON EDUCATION TO PROMOTE DENTAL HEALTH IN 
                   VETERANS.

       (a) Program Required.--The Secretary of Veterans Affairs 
     shall carry out a program of education to promote dental 
     health for veterans who are enrolled in the system of annual 
     patient enrollment of the Department of Veterans Affairs 
     established and operated under section 1705(a) of title 38, 
     United States Code.
       (b) Elements.--The program required by subsection (a) shall 
     provide education for veterans on the following:
       (1) The association between dental health and overall 
     health and well-being.
       (2) Proper techniques for dental care.
       (3) Signs and symptoms of commonly occurring dental 
     conditions.
       (4) Treatment options for commonly occurring dental issues.
       (5) Options for obtaining access to dental care, including 
     information on eligibility for dental care through the 
     Department.
       (6) Available and accessible options for obtaining low or 
     no-cost dental care, including through dental schools and 
     Federally Qualified Health Centers.
       (7) Such other matters relating to dental health as the 
     Secretary considers appropriate.
       (c) Delivery of Educational Materials.--
       (1) In general.--The Secretary shall provide educational 
     materials to veterans under the program required by 
     subsection (a) through a variety of mechanisms, including the 
     following:
       (A) The availability and distribution of print materials at 
     facilities of the Department (including at medical centers, 
     clinics, Vet Centers, and readjustment counseling centers) 
     and to providers (including members of Patient Aligned Care 
     Teams).
       (B) The availability and distribution of materials over the 
     Internet, including through webinars, My HealtheVet, and 
     VA.gov.
       (C) Presentations by the dental program office of the 
     Department of information, including both small group and 
     large group presentations, and distribution of such 
     information to all locations in which the program is being 
     carried out.
       (2) Selection of mechanisms.--In selecting mechanisms under 
     paragraph (1), the Secretary shall select mechanisms designed 
     to maximize the number of veterans who receive education 
     under the program.
       (d) Construction.--Nothing in this section shall be 
     construed to alter or revise the eligibility of any veteran 
     for dental care under the laws administered by the Secretary.
       (e) Definitions.--In this section
       (1) Federally qualified health center.--The term 
     ``Federally Qualified Health Center'' means a federally-
     qualified health center as defined in section 1905(l)(2)(B) 
     of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).'
       (2) Vet center.--The term ``Vet Center'' has the meaning 
     given that term in section 1712A(h) of title 38, United 
     States Code.
       (f) Effective Date.--This section shall take effect on the 
     date that is one year after the date of the enactment of this 
     Act.

     SEC. 125. STUDENT LOAN REPAYMENT PROGRAM TO INCENTIVIZE 
                   DENTAL TRAINING AND ENSURE THE DENTAL WORKFORCE 
                   OF THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) Program Required.--The Secretary of Veterans Affairs, 
     to ensure that the Department of Veterans Affairs has 
     sufficient staff to provide dental service to veterans, shall 
     implement a loan reimbursement program for qualified 
     dentists, dental therapists, dental hygienists, and oral 
     surgeons who agree--
       (1) to be appointed by the Secretary as a dentist, dental 
     therapist, dental hygienist, or oral surgeon, as the case may 
     be, under section 7401 of title 38, United States Code; and
       (2) to serve as a dentist, dental therapist, dental 
     hygienist, or oral surgeon, as the case may be, of the 
     Department pursuant to such appointment at a dental clinic of 
     the Department for a period of not less than five years.
       (b) Maximum Amount.--
       (1) In general.--Except as provided in paragraph (2), the 
     Secretary may reimburse not more than--
       (A) $75,000 for each dentist participating in the program 
     under subsection (a);
       (B) $20,000 for each dental therapist participating in such 
     program;
       (C) $10,000 for each dental hygienist participating in such 
     program; and
       (D) $20,000 for each credentialed doctor of medicine in 
     dentistry serving as an oral surgeon and participating in 
     such program.
       (2) Dual eligibility.--The Secretary may reimburse an 
     individual serving in multiple positions described in 
     subparagraphs (A) through (D) of paragraph (1) not more than 
     $95,000.
       (c) Selection of Locations.--The Secretary shall monitor 
     demand among veterans for dental care and require 
     participants in the program under subsection (a) to choose 
     from dental clinics of the Department with the greatest need 
     for dentists, dental hygienists, or oral surgeons, as the 
     case may be, according to facility enrollment and patient 
     demand.

     SEC. 126. EDUCATIONAL AND TRAINING PARTNERSHIPS FOR DENTISTS, 
                   DENTAL THERAPISTS, DENTAL HYGIENISTS AND ORAL 
                   SURGEONS.

       The Secretary of Veterans Affairs shall enter into 
     educational and training partnerships with dental schools to 
     provide training and employment opportunities for dentists, 
     dental therapists, dental hygienists, and oral surgeons.

     SEC. 127. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There is authorized to be appropriated for 
     the Department of Veterans Affairs for fiscal year 2023 such 
     sums as may be necessary to carry out this subtitle.
       (b) Availability.--The amount authorized to be appropriated 
     under subsection (a) shall be available for obligation for 
     the eight-year period beginning on the date that is one year 
     after the date of the enactment of this Act.
                                 ______
                                 
  SA 5058. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 5051 submitted by Mr. Tester (for himself and Mr. 
Moran) and intended to be proposed 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:

        At the end of title I, add the following:

                 Subtitle C--Other Health Care Matters

     SEC. 121. EXPANSION OF HEALTH CARE FROM DEPARTMENT OF 
                   VETERANS AFFAIRS TO INCLUDE MEMBERS OF THE 
                   RESERVE COMPONENTS OF THE ARMED FORCES WHO ARE 
                   NOT ON ACTIVE ORDERS.

       (a) Expansion of Care.--
       (1) In general.--Section 1789 of title 38, United States 
     Code, is amended to read as follows:

     ``Sec. 1789. Health care for members of the reserve 
       components of the Armed Forces

       ``(a) In General.--The Secretary (subject to subsection 
     (c)) shall furnish hospital care and medical services to any 
     member of the reserve components of the Armed Forces during 
     any period in which the member is not entitled to health care 
     furnished by the Secretary of Defense.
       ``(b) Mental Health Care.--The Secretary may furnish mental 
     health services to members of the reserve components of the 
     Armed Forces.
       ``(c) Limitation.--The requirement in subsection (a) shall 
     be effective in any fiscal year only to the extent and in the 
     amount provided in advance in appropriations Acts for such 
     purpose.
       ``(d) Consultation With Secretary of Defense.--The 
     Secretary shall carry out this section in consultation with 
     the Secretary of Defense.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of subchapter VIII of chapter 17 of such title is 
     amended by striking the item relating to section 1789 and 
     inserting the following new item:

``1789. Health care for members of the reserve components of the Armed 
              Forces.''.
       (b) Enrollment in Patient Enrollment System.--
       (1) Priority for enrollment.--Section 1705(a) of title 38, 
     United States Code, is amended--
       (A) in the matter preceding paragraph (1), by striking 
     ``enrollment of veterans'' and inserting ``enrollment of 
     individuals under such system''; and
       (B) in paragraph (7)--
       (i) by striking ``Veterans'' and inserting ``(A) 
     Veterans''; and
       (ii) by adding at the end the following new subparagraph:
       ``(B) Members of the reserve components of the Armed Forces 
     for purposes of furnishing hospital care and medical services 
     under section 1789(a) of this title.''.
       (2) Initial enrollment.--The Secretary of Veterans Affairs 
     shall enroll all members of the reserve components of the 
     Armed Forces in the patient enrollment system by not later 
     than December 31, 2022.
       (3) Ongoing enrollment.--After December 31, 2022, the 
     Secretary shall automatically enroll in the patient 
     enrollment system all new members of the reserve components 
     of the Armed Forces upon those members joining the reserve 
     components.
       (4) Consultation with secretary of defense.--The Secretary 
     shall carry out this subsection and the amendments made by 
     this subsection in consultation with the Secretary of 
     Defense.
       (5) Patient enrollment system defined.--In this subsection, 
     the term ``patient enrollment system'' means the system of 
     annual patient enrollment of the Department of Veterans 
     Affairs established and operated under section 1705(a) of 
     title 38, United States Code.
                                 ______
                                 
  SA 5059. Mr. SANDERS submitted an amendment intended to be proposed 
to amendment SA 5051 submitted by Mr. Tester (for himself and Mr. 
Moran)

[[Page S2837]]

and intended to be proposed 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:

        At the end of title I, add the following:

                 Subtitle C--Other Health Care Matters

     SEC. 121. MODIFICATION OF DETERMINATION OF ELIGIBILITY OF 
                   VETERANS FOR TREATMENT AS A LOW-INCOME FAMILY 
                   FOR PURPOSES OF ENROLLMENT IN THE PATIENT 
                   ENROLLMENT SYSTEM OF THE DEPARTMENT OF VETERANS 
                   AFFAIRS.

       (a) Areas of Residence.--The Secretary of Veterans Affairs 
     shall modify the areas in which veterans reside as specified 
     for purposes of determining whether veterans qualify for 
     treatment as low-income families for enrollment in the 
     patient enrollment system of the Department of Veterans 
     Affairs under section 1705(a)(7) of title 38, United States 
     Code, to meet the requirements as follows:
       (1) Any area so specified shall be within only one State.
       (2) Any area so specified shall be coextensive with one or 
     more counties (or similar political subdivisions) in the 
     State concerned.
       (b) Variable Income Thresholds.--The Secretary shall modify 
     the thresholds for income as specified for purposes of 
     determining whether veterans qualify for treatment as low-
     income families for enrollment in the patient enrollment 
     system referred to in subsection (a) to meet the requirements 
     as follows:
       (1) There shall be one income threshold for each State, 
     equal to 100 percent of the highest income threshold among--
       (A) the counties or metropolitan statistical areas within 
     such State; and
       (B) any metropolitan statistical area that encompasses 
     territory of such State and one or more other States.
       (2) The calculation of the highest income threshold of a 
     county or metropolitan statistical area shall be consistent 
     with the calculation used for purposes of section 3(b) of the 
     United States Housing Act of 1937 (42 U.S.C. 1437a(b)).
       (3) The timing and methodology for implementing any 
     modifications in geographic income thresholds pursuant to 
     paragraph (1) shall be determined by the Secretary in such a 
     manner as to permit the Department to build capacity for 
     enrolling such additional veterans in the patient enrollment 
     system of the Department as become eligible for enrollment as 
     a result of such modifications, except that all required 
     modifications shall be completed not later than five years 
     after date of the enactment of this Act.
       (c) Metropolitan Statistical Area.--In this section, the 
     term ``metropolitan statistical area'' has the meaning given 
     that term by the Office of Management and Budget.

     SEC. 122. GUARANTEE OF HEALTH CARE BENEFITS FOR ENROLLED 
                   VETERANS.

       The Secretary of Veterans Affairs shall ensure that all 
     veterans, once enrolled in the patient enrollment system of 
     the Department of Veterans Affairs under section 1705(a) of 
     title 38, United States Code, remain enrolled in such system 
     and may continue receiving health care furnished by the 
     Department if they choose, subject to such cost-sharing 
     requirements as may apply to the veteran under existing 
     provisions of law.
                                 ______
                                 
  SA 5060. Mr. PAUL submitted an amendment intended to be proposed to 
amendment SA 5051 submitted by Mr. Tester (for himself and Mr. Moran) 
and intended to be proposed 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:

        At the appropriate place, insert the following:

     SEC. __. OFFSET THROUGH TEMPORARY REDUCTION IN FOREIGN 
                   ASSISTANCE PROGRAMS.

       During the 10-year period beginning on October 1, 2022, no 
     Federal funds may be expended by the United States Agency for 
     International Development other than funds that have been 
     appropriated for Israel.
                                 ______
                                 
  SA 5061. Ms. LUMMIS submitted an amendment intended to be proposed to 
amendment SA 5051 submitted by Mr. Tester (for himself and Mr. Moran) 
and intended to be proposed 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:

        Beginning on page 58, strike line 19 and all that follows 
     through page 61, line 11, and insert the following:
       (c) Effective Dates and Applicability.--
       (1) 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:
       (A) 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.
       (B) On October 1, 2022, for everyone not described in 
     subparagraph (A).
       (2) 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 paragraph (1)(A) of 
     this subsection.
                                 ______
                                 
  SA 5062. Ms. LUMMIS submitted an amendment intended to be proposed to 
amendment SA 5051 submitted by Mr. Tester (for himself and Mr. Moran) 
and intended to be proposed 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:

        Beginning on page 58, strike line 5 and all that follows 
     through page 61, line 11.

                                 ______
                                 
  SA 5063. Mr. MORAN submitted an amendment intended to be proposed to 
amendment SA 5051 submitted by Mr. Tester (for himself and Mr. Moran) 
and intended to be proposed 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:

        Beginning on page 117, strike line 22 and all that follows 
     through page 121, line 12.
                                 ______
                                 
  SA 5064. Mr. MORAN submitted an amendment intended to be proposed to 
amendment SA 5051 submitted by Mr. Tester (for himself and Mr. Moran) 
and intended to be proposed 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:

       At the end of title I, add the following:

                 Subtitle C--Other Health Care Matters

     SEC. 121. MODIFICATION TO STANDARDS FOR ACCESS TO HEALTH CARE 
                   FROM DEPARTMENT OF VETERANS AFFAIRS AND NON-
                   DEPARTMENT PROVIDERS.

       (a) In General.--Section 1703B of title 38, United States 
     Code, is amended--
       (1) by striking subsections (a) through (e) and inserting 
     the following new subsections:
       ``(a) Threshold Eligibility Standards for Access to 
     Community Care.--(1) A covered veteran may elect to receive 
     non-Department hospital care, medical services, or extended 
     care services through the Veterans Community Care Program 
     under section 1703 of this title pursuant to subsection 
     (d)(1)(D) of such section using the following eligibility 
     access standards:
       ``(A) With respect to primary care, mental health care, or 
     non-institutional extended care services, if the Department 
     cannot schedule an appointment for the covered veteran with a 
     health care provider of the Department--
       ``(i) within 30 minutes average driving time from the 
     residence of the veteran; and
       ``(ii) within 20 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran in consultation with the health care provider.
       ``(B) With respect to specialty care or specialty services, 
     if the Department cannot schedule an appointment for the 
     covered veteran with a health care provider of the 
     Department--
       ``(i) within 60 minutes average driving time from the 
     residence of the veteran; and
       ``(ii) within 28 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran in consultation with the health care provider.
       ``(2) For the purposes of determining the eligibility of a 
     covered veteran for care or services under paragraph (1), the 
     Secretary shall not take into consideration the availability 
     of telehealth appointments from the Department when 
     determining whether the Department is able to furnish such 
     care or services in a manner that complies with the 
     eligibility access standards under such paragraph.
       ``(b) Access to Care Standards for Community Care.--(1) 
     Subject to subsection (c), the Secretary shall meet the 
     following access to care standards when furnishing non-
     Department hospital care, medical services, or extended care 
     services to a covered veteran through the Veterans Community 
     Care Program under section 1703 of this title:
       ``(A) With respect to an appointment for primary care, 
     mental health care, or non-institutional extended care 
     services--
       ``(i) within 30 minutes average driving time from the 
     residence of the veteran unless a longer driving time has 
     been agreed to by the veteran; and
       ``(ii) within 20 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran.
       ``(B) With respect to an appointment for specialty care or 
     specialty services--
       ``(i) within 60 minutes average driving time from the 
     residence of the veteran unless a

[[Page S2838]]

     longer driving time has been agreed to by the veteran; and
       ``(ii) within 28 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran.
       ``(2) The Secretary shall ensure that--
       ``(A) health care providers specified under section 1703(c) 
     of this title are able to comply with the applicable access 
     to care standards under paragraph (1) for such providers; and
       ``(B) meeting such standards is reflected in the 
     contractual requirements of third-party administrators.
       ``(c) Waivers to Access to Care Standards for Community 
     Care Providers.--(1) A third-party administrator may request 
     a waiver to the requirement to meet the access to care 
     standards under subsection (b) if--
       ``(A)(i) the scarcity of available providers or facilities 
     in the region precludes the third-party administrator from 
     meeting those access standards; or
       ``(ii) the landscape of providers or facilities has changed 
     and certain providers or facilities are not available such 
     that the third-party administrator is not able to meet those 
     access standards; and
       ``(B) to address the scarcity of available providers or the 
     change in the provider or facility landscape, as the case may 
     be, the third-party administrator has contracted with other 
     providers or facilities that may not meet those access 
     standards, but are the currently available providers or 
     facilities most accessible to veterans within the region of 
     responsibility of the third-party administrator.
       ``(2) Any waiver requested by a third-party administrator 
     under paragraph (1) must be requested in writing and 
     submitted to the Office of Community Care of the Department 
     for approval by that office.
       ``(3) As part of any waiver request under paragraph (1), a 
     third-party administrator must include conclusive evidence 
     and documentation that the access to care standards under 
     subsection (b) cannot be met because of scarcity of available 
     providers or changes to the landscape of providers or 
     facilities.
       ``(4) In evaluating a waiver request under paragraph (1), 
     the Secretary shall consider the following:
       ``(A) The number and geographic distribution of eligible 
     health care providers available within the geographic area 
     and specialty referenced in the waiver request.
       ``(B) The prevailing market conditions within the 
     geographic area and specialty referenced in the waiver 
     request, which shall include the number and distribution of 
     health care providers contracting with other health care 
     plans (including commercial plans and the Medicare program 
     under title XVIII of the Social Security Act (42 U.S.C. 1395 
     et seq.)) operating in the geographic area and specialty 
     referenced in the waiver request.
       ``(C) Whether the service area is comprised of highly 
     rural, rural, or urban areas or some combination of such 
     areas.
       ``(D) How significantly the waiver request differs from the 
     access to care standards under subsection (b).
       ``(E) The rates offered to providers in the geographic area 
     covered by the waiver.
       ``(5) The Secretary shall not consider inability to 
     contract as a valid sole rationale for granting a waiver 
     under paragraph (1).
       ``(d) Calculation of Driving Times and Wait Times.--(1) For 
     purposes of calculating average driving time from the 
     residence of the veteran under subsections (a) and (b), the 
     Secretary shall use geographic information system software.
       ``(2) For purposes of calculating the wait time for a 
     veteran to schedule an appointment with the Department under 
     subsection (a), the Secretary shall measure from the date of 
     request for the appointment unless a later date has been 
     agreed to by the veteran in consultation with a health care 
     provider of the Department to the first next available 
     appointment date in the clinic schedule relevant to the 
     requested medical service.
       ``(e) Periodic Review of Access Standards.--Not later than 
     three 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 three years thereafter, the Secretary shall--
       ``(1) conduct a review of the eligibility access standards 
     under subsection (a) and the access to care standards under 
     subsection (b) in consultation with--
       ``(A) such Federal entities as the Secretary considers 
     appropriate, including the Department of Defense, the 
     Department of Health and Human Services, and the Centers for 
     Medicare & Medicaid Services;
       ``(B) entities in the private sector; and
       ``(C) other entities that are not part of the Federal 
     Government; and
       ``(2) submit to the appropriate committees of Congress a 
     report on--
       ``(A) the findings of the Secretary with respect to the 
     review conducted under paragraph (1); and
       ``(B) such recommendations as the Secretary may have with 
     respect to the eligibility access standards under subsection 
     (a) and the access to care standards under subsection (b).'';
       (2) in subsection (f), by striking ``The Secretary'' and 
     inserting ``Compliance by Community Care Providers.--The 
     Secretary'';
       (3) by striking subsection (g) and inserting the following 
     new subsection (g):
       ``(g) Publication of Access Standards.--The Secretary shall 
     publish in the Federal Register and on a publicly available 
     internet website of the Department--
       ``(1) the eligibility access standards established under 
     subsection (a); and
       ``(2) the access to care standards established under 
     subsection (b).'';
       (4) in subsection (h)(1), by striking ``(1) Consistent 
     with'' and inserting ``Requests for Determinations.--(1) 
     Consistent with''; and
       (5) in subsection (i)--
       (A) by striking ``In this section'' and inserting 
     ``Definitions.--In this section''; and
       (B) by adding at the end the following new paragraphs:
       ``(3) The term `inability to contract', with respect to a 
     third-party administrator, means the inability of the third-
     party administrator to successfully negotiate and establish a 
     community care network contract with a provider or facility.
       ``(4) The term `third-party administrator' means an entity 
     that manages a provider network and performs administrative 
     services related to such network within the Veterans 
     Community Care Program under section 1703 of this title.''.
       (b) Prevention of Suspension of Veterans Community Care 
     Program.--Section 1703(a) of such title is amended by adding 
     at the end the following new paragraph:
       ``(4) Nothing in this section shall be construed to 
     authorize the Secretary to suspend the program established 
     under paragraph (1).''.
       (c) Establishment of Requirements for Documentation of 
     Postponement of Appointment Date.--Not later than 180 days 
     after the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall establish a process and requirements 
     for facilities of the Department of Veterans Affairs to 
     document the agreement of a veteran to postpone an 
     appointment as specified under section 1703B of title 38, 
     United States Code, as amended by subsection (a).

                          ____________________