Veterans' Toxic Wounds Research Act of 2014

Summary: Veterans' Toxic Wounds Research Act of 2014 - Directs the Secretary of Veterans Affairs (VA) to establish a master registry of veterans who experienced toxic exposures while serving in the Armed Forces. Includes in the master registry the registries for:  Agent Orange; exposure to toxins relating to a deployment during the Persian Gulf War; exposure to toxins relating to a deployment during Operation Iraqi Freedom, Operation New Dawn, Operation Enduring Freedom, or the Global War on Terror; exposure to toxins relating to a deployment to Bosnia, Somalia, or the Philippines; and exposure to toxins relating to being stationed at a military installation potentially contaminated by toxic substances.  Directs the Secretary to enter into an agreement with the National Academy of Sciences (NAS) to review published scientific information and studies, and make recommendations for future research, on the health effects: (1) of the toxic exposures covered in those registries, and (2) on the children and grandchildren of veterans who had a toxic exposure covered in those registries. Requires those reviews to inform the Secretary's selection of research to be conducted or funded by the VA. Establishes a presumption of a service connection, for the purpose of veterans' disability and survivor benefits, for an illness that:  the Secretary determines warrants such a presumption by reason of having a positive association with exposure to a toxic substance covered in the master registry; and becomes manifest, within the period the Secretary prescribes, in a veteran who experienced such exposure while serving in the Armed Forces.  Requires the Secretary's service connection determinations to be based on sound medical and scientific evidence that a positive association exists between: (1) the exposure of humans or animals to a toxic substance covered in the master registry, and (2) the occurrence of a diagnosed or undiagnosed illness in humans or animals. Directs the Secretary, in implementing the VA's electronic health record system, to include specified information in each individual's electronic health record, including whether the individual served in the Armed Forces and, if so, the locations and dates of such service.  

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans' Toxic Wounds Research Act 
of 2014''.

SEC. 2. COMPREHENSIVE PROGRAM OF RESEARCH INTO TOXIC EXPOSURES 
              ENCOUNTERED BY VETERANS DURING MILITARY SERVICE.

    (a) Registry of Toxic Exposures.--
            (1) Establishment.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary of Veterans Affairs 
        shall establish a master registry of veterans who experienced 
        toxic exposures while serving in the Armed Forces.
            (2) Elements.--The master registry established under 
        paragraph (1) shall consist of the registries described in 
        paragraph (3). The Secretary shall establish each such registry 
        using the Clinical Case Registry of the Department of Veterans 
        Affairs as a model.
            (3) Registries described.--The registries described in this 
        paragraph are registries for each of the following:
                    (A) Agent Orange.
                    (B) Exposure to toxins relating to a deployment 
                during the Persian Gulf War (as defined in section 
                101(33) of title 38, United States Code), including 
                with respect to such exposures leading to Gulf War 
                Illness (as defined by the Institute of Medicine of the 
                National Academies).
                    (C) Exposure to toxins relating to a deployment 
                during Operation Iraqi Freedom, Operation New Dawn, 
                Operation Enduring Freedom, or the Global War on 
                Terror.
                    (D) Exposure to toxins relating to a deployment to 
                Bosnia, Somalia, the Philippines, or other locations 
                determined appropriate by the Secretary.
                    (E) Exposure to toxins relating to being stationed 
                at a military installation potentially contaminated by 
                toxic substances, including Camp Lejeune, North 
                Carolina, Fort McClellan, Alabama, and such 
                installations in Guam.
                    (F) Any other toxic exposure the Secretary 
                determines appropriate.
    (b) Review.--The Secretary of Veterans Affairs shall enter into an 
agreement with the National Academy of Sciences to review published 
scientific information and studies on the health effects of toxic 
exposures covered in a registry described in subsection (a)(3). Under 
such agreement, the Institute of Medicine of the National Academies 
shall submit to the Secretary on a biennial basis a report on toxic 
substance exposure-related illnesses. Such report shall include--
            (1) a review of all scientific studies and research on the 
        association between toxic substance exposures and specific 
        diseases covered in such a registry, including the level of 
        association between such exposures and the specific diseases; 
        and
            (2) recommendations for future research.
    (c) Research Into the Effects of Toxic Exposure on Second and Third 
Generations.--In addition to the reviews under subsection (b), the 
Secretary shall enter into an agreement with the National Academy of 
Sciences to review published scientific information and studies on the 
health effects on the children and grandchildren of veterans with toxic 
exposures covered in a registry described in subsection (a)(3). Under 
such agreement, the Institute of Medicine of the National Academies 
shall submit to the Secretary on a biennial basis a report on toxic 
substance exposure-related illnesses. Such report shall include--
            (1) a review of all scientific studies and research on the 
        association between toxic substance exposures and specific 
        diseases covered in such a registry in such children and 
        grandchildren, including the level of association between such 
        exposures and the specific diseases; and
            (2) recommendations for future research.
    (d) Research.--The Secretary shall use the reviews conducted under 
subsections (b) and (c) to inform the decisions made by the Secretary 
with respect to selecting the research to be conducted or funded by the 
Department of Veterans Affairs. The Secretary shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report describing how the Secretary used such reviews to make 
such selections.

SEC. 3. PRESUMPTIONS OF SERVICE CONNECTION FOR ILLNESSES ASSOCIATED 
              WITH TOXIC EXPOSURES ENCOUNTERED BY VETERANS DURING 
              MILITARY SERVICE.

    (a) In General.--Subchapter II of chapter 11 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 1119. Presumptions of service connection for illnesses 
              associated with toxic exposures
    ``(a) Presumption.--(1) For purposes of section 1110 of this title, 
and subject to section 1113 of this title, each illness, if any, 
described in paragraph (2) shall be considered to have been incurred in 
or aggravated by service referred to in that paragraph, notwithstanding 
that there is no record of evidence of such illness during the period 
of such service.
    ``(2) An illness referred to in paragraph (1) is any diagnosed or 
undiagnosed illness that--
            ``(A) the Secretary determines in regulations prescribed 
        under this section to warrant a presumption of service 
        connection by reason of having a positive association with 
        exposure to a toxic substance covered in the master registry; 
        and
            ``(B) becomes manifest within the period, if any, 
        prescribed in such regulations in a veteran who served in the 
        Armed Forces and by reason of such service experienced such 
        exposure.
    ``(3) For purposes of this subsection, a veteran who served in the 
Armed Forces in a location recognized under the master registry as 
being a source of exposure and has an illness described in paragraph 
(2) shall be presumed to have been exposed by reason of such service 
unless there is conclusive evidence to establish that the veteran was 
not so exposed by reason of such service.
    ``(b)(1)(A) Whenever the Secretary makes a determination described 
in subparagraph (B), the Secretary shall prescribe regulations 
providing that a presumption of service connection is warranted for the 
illness covered by that determination for purposes of this section.
    ``(B) A determination referred to in subparagraph (A) is a 
determination based on sound medical and scientific evidence that a 
positive association exists between--
            ``(i) the exposure of humans or animals to a toxic 
        substance covered in the master registry; and
            ``(ii) the occurrence of a diagnosed or undiagnosed illness 
        in humans or animals.
    ``(2)(A) In making determinations for purposes of paragraph (1), 
the Secretary shall take into account--
            ``(i) the reports submitted to the Secretary by the 
        National Academy of Sciences under section 2(b) of the 
        Veterans' Toxic Wounds Research Act of 2014; and
            ``(ii) all other sound medical and scientific information 
        and analyses available to the Secretary.
    ``(B) In evaluating any report, information, or analysis for 
purposes of making such determinations, the Secretary shall take into 
consideration whether the results are statistically significant, are 
capable of replication, and withstand peer review.
    ``(3) An association between the occurrence of an illness in humans 
or animals and exposure to a toxic substance covered in the master 
registry shall be considered to be positive for purposes of this 
subsection if the credible evidence for the association is equal to or 
outweighs the credible evidence against the association.
    ``(c)(1) Not later than 60 days after the date on which the 
Secretary receives a report from the National Academy of Sciences under 
section 2(b) of the Veterans' Toxic Wounds Research Act of 2014, the 
Secretary shall determine whether or not a presumption of service 
connection is warranted for each illness, if any, covered by the 
report.
    ``(2) If the Secretary determines under this subsection that a 
presumption of service connection is warranted, the Secretary shall, 
not later than 60 days after making the determination, issue proposed 
regulations setting forth the Secretary's determination.
    ``(3)(A) If the Secretary determines under this subsection that a 
presumption of service connection is not warranted, the Secretary 
shall, not later than 60 days after making the determination, publish 
in the Federal Register a notice of the determination. The notice shall 
include an explanation of the scientific basis for the determination.
    ``(B) If an illness already presumed to be service connected under 
this section is subject to a determination under subparagraph (A), the 
Secretary shall, not later than 60 days after publication of the notice 
under that subparagraph, issue proposed regulations removing the 
presumption of service connection for the illness.
    ``(4) Not later than 90 days after the date on which the Secretary 
issues any proposed regulations under this subsection, the Secretary 
shall issue final regulations. Such regulations shall be effective on 
the date of issuance.
    ``(d) Whenever the presumption of service connection for an illness 
under this section is removed under subsection (c)--
            ``(1) a veteran who was awarded compensation for the 
        illness on the basis of the presumption before the effective 
        date of the removal of the presumption shall continue to be 
        entitled to receive compensation on that basis; and
            ``(2) a survivor of a veteran who was awarded dependency 
        and indemnity compensation for the death of a veteran resulting 
        from the illness on the basis of the presumption before that 
        date shall continue to be entitled to receive dependency and 
        indemnity compensation on that basis.
    ``(e) Master Registry Defined.--In this section, the term `master 
registry' means the registry of veterans who experienced toxic 
exposures established by section 2 of the Veterans' Toxic Wounds 
Research Act of 2014.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1118 the following new item:

``1119. Presumptions of service connection for illnesses associated 
                            with toxic exposures.''.

SEC. 4. INCLUSION OF CERTAIN INFORMATION IN ELECTRONIC HEALTH RECORDS.

    In implementing the electronic health record system of the 
Department of Veterans Affairs, the Secretary of Veterans Affairs shall 
ensure that the electronic health record of each individual includes, 
at a minimum, the following information:
            (1) Whether the individual served in the Armed Forces.
            (2) The Armed Force in which the individual served.
            (3) The locations in which the individual was stationed or 
        deployed to during such service.
            (4) The dates of such service.
            (5) The military occupational specialty of the individual.
            (6) The results of any tests or assessments of the 
        individual regarding--
                    (A) vision;
                    (B) hearing;
                    (C) hepatitis C;
                    (D) HIV;
                    (E) blood pressure;
                    (F) cholesterol;
                    (G) blood glucose test and diabetes information;
                    (H) body mass index measurement;
                    (I) bone density, as appropriate based on the age 
                or sex of the individual;
                    (J) cancer screenings (as appropriate based on the 
                age, sex, race, or ethnicity of the individual) for--
                            (i) breast cancer;
                            (ii) colorectal cancer;
                            (iii) lung cancer;
                            (iv) prostate cancer; and
                            (v) skin cancer;
                    (K) preventive immunizations, if not current;
                    (L) spirometry (for lung function);
                    (M) smoking;
                    (N) a mental health evaluation;
                    (O) substance abuse; or
                    (P) infectious diseases or parasites or other 
                adverse health conditions endemic to where the 
                individual served while in the military.