II 

Calendar No. 602 

116TH CONGRESS 

2D SESSION S. 4393 

To improve the provision of health care and other benefits from the Department of Veterans Affairs for veterans who were exposed to toxic substances, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 30, 2020 

Mr. TILLIS (for himself, Mrs. BLACKBURN, Ms. MCSALLY, and Mrs. CAPITO) 

introduced the following bill; which was read twice and referred to the 

Committee on Veterans’ Affairs 

DECEMBER 8, 2020 

Reported by Mr. MORAN, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To improve the provision of health care and other benefits 

from the Department of Veterans Affairs for veterans 

who were exposed to toxic substances, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Toxic Exposure in the American Military Act of 2020’’ 

4 or the ‘‘TEAM Act of 2020’’ 

5 (b) TABLE OF CONTENTS.—The table of contents for 

6 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

TITLE I—EXPANSION OF HEALTH CARE AND BENEFITS FOR 

VETERANS EXPOSED TO TOXIC SUBSTANCES 

Sec. 101. Consultation, testing, and treatment for certain veterans who received 

hazardous duty pay or were exposed to toxic substances. 

Sec. 102. Permanent reauthorization of authority of Secretary of Veterans Affairs to prescribe regulations providing that a presumption of 

service connection is warranted for a disease associated with 

exposure to a herbicide agent. 

Sec. 103. Presumptions of service connection for diseases associated with exposure to certain toxic substances. 

TITLE II—RESEARCH AND REVIEW REGARDING EXPOSURE TO 

TOXIC SUBSTANCES 

Sec. 201. Establishment of Toxic Exposure Review Commission. 

Sec. 202. Agreement with National Academies of Sciences, Engineering, and 

Medicine concerning the exposure of humans to toxic substances. 

Sec. 203. Analysis of results of consultation, testing, and treatment of veterans 

for disabilities related to exposure to toxic substances. 

Sec. 204. Report to evaluate and identify groups at-risk of exposure to toxic 

substances. 

TITLE III—IMPROVEMENT OF RESOURCES OF DEPARTMENT OF 

VETERANS AFFAIRS REGARDING EXPOSURES TO TOXIC SUBSTANCES 

Sec. 301. Publication of list of resources of Department of Veterans Affairs for 

veterans exposed to toxic substances and outreach program for 

such veterans and caregivers and survivors of such veterans. 

Sec. 302. Incorporation of toxic exposure questionnaire during primary care appointments. 

Sec. 303. Portal for access by veterans to individual longitudinal exposure 

record. 

Sec. 304. Training of personnel of Department of Veterans Affairs on illnesses 

related to exposure to toxic substances. 


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1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) ACTIVE MILITARY, NAVAL, OR AIR SERV4 ICE.—The term ‘‘active military, naval, or air serv5 ice’’ has the meaning given that term in section 

6 101(24) of title 38, United States Code. 

7 (2) TOXIC SUBSTANCE.—The term ‘‘toxic sub8 stance’’ has the meaning given that term in section 

9 1720J(i) of such title, as added by section 101(a). 

10 TITLE I—EXPANSION OF HEALTH 

11 CARE AND BENEFITS FOR 

12 VETERANS EXPOSED TO 

13 TOXIC SUBSTANCES 

14 SEC. 101. CONSULTATION, TESTING, AND TREATMENT FOR 

15 CERTAIN VETERANS WHO RECEIVED HAZ16 ARDOUS DUTY PAY OR WERE EXPOSED TO 

17 TOXIC SUBSTANCES. 

18 (a) IN GENERAL.—Subchapter II of chapter 17 of 

19 title 38, United States Code, is amended by adding at the 

20 end the following new section: 

21 ‘‘§ 1720J. Consultation, testing, and treatment of vet22 erans for exposure to toxic substances 

23 ‘‘(a) IN GENERAL.—The Secretary shall furnish to 

24 covered veterans— 


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1 ‘‘(1) covered consultation and testing regarding 

2 the exposure of those veterans to toxic substances; 

3 and 

4 ‘‘(2) treatment for any illness relating to such 

5 exposure diagnosed under subsection (b)(2), subject 

6 to approval by the Under Secretary for Health. 

7 ‘‘(b) COVERED CONSULTATION AND TESTING.—For 

8 purposes of this section, covered consultation and testing 

9 is— 

10 ‘‘(1) consultation with a primary care physician 

11 or other treating physician to determine whether the 

12 covered veteran has an illness related to exposure to 

13 a toxic substance while serving in the Armed Forces; 

14 ‘‘(2) diagnosis by such physician of any illness 

15 related to exposure to a toxic substance; and 

16 ‘‘(3) any medical testing necessary to carry out 

17 paragraphs (1) and (2), including a referral to a 

18 specialist physician. 

19 ‘‘(c) COVERED VETERANS.—For purposes of this sec20 tion, a covered veteran is a veteran who— 

21 ‘‘(1) received hazardous duty incentive pay 

22 under section 351 of title 37 for more than one day; 

23 or 

24 ‘‘(2) has been identified by the Secretary of De25 fense to have been possibly exposed, inside or outVerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393

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1 side the United States, during service in the Armed 

2 Forces, to— 

3 ‘‘(A) an open burn pit; 

4 ‘‘(B) a toxic substance; or 

5 ‘‘(C) a site at which members of the 

6 Armed Forces were potentially exposed to a 

7 toxic substance, as indicated in a database 

8 shared by the Department of Defense and the 

9 Department of Veterans Affairs. 

10 ‘‘(d) CONSULTATION.—A covered veteran is eligible 

11 under this section for three consultations each year unless 

12 a treating physician for such veteran determines that more 

13 consultations are necessary under subsection (b)(1). 

14 ‘‘(e) PROVISION OF SERVICES.—Covered consultation 

15 and testing and treatment may be provided under this sec16 tion at facilities of the Department or under contract ar17 rangements with the Department for such services. 

18 ‘‘(f) DETERMINATIONS RELATING TO TREATMENT.— 

19 (1) When determining whether to approve eligibility for 

20 treatment under subsection (a)(2), the Under Secretary 

21 for Health shall give heavy weight to the diagnosis by the 

22 treating physician under subsection (b)(2). 

23 ‘‘(2) The Under Secretary shall support any denial 

24 of eligibility under subsection (a)(2) with specific scientific 

25 evidence. 


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1 ‘‘(3) Determinations by the Under Secretary under 

2 subsection (a)(2) shall be made not later than five busi3 ness days after a request for approval has been made by 

4 the treating physician under subsection (b)(2). 

5 ‘‘(g) INFORMATION AND TRAINING.—The Secretary 

6 shall provide information and training on eligibility for 

7 services under this section and the services covered under 

8 this section to— 

9 ‘‘(1) health care providers of the Department; 

10 ‘‘(2) health care providers providing services 

11 under this section under contract arrangements; and 

12 ‘‘(3) covered veterans. 

13 ‘‘(h) COPAYMENT.—A covered veteran is not required 

14 to pay a copayment for covered consultation and testing 

15 or treatment under this section. 

16 ‘‘(i) DEFINITIONS.—In this section: 

17 ‘‘(1) The term ‘open burn pit’ has the meaning 

18 given that term in section 201(c) of the Dignified 

19 Burial and Other Veterans’ Benefits Improvement 

20 Act of 2012 (Public Law 112–260; 38 U.S.C. 527 

21 note). 

22 ‘‘(2) The term ‘toxic substance’ means a toxi23 cant or a toxin. 

24 ‘‘(3) The term ‘toxicant’ means any substance 

25 that can injure or kill humans, animals, or plants 


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1 and that is produced by humans or is a by-product 

2 of human activities. 

3 ‘‘(4) The term ‘toxin’ means any substance that 

4 can injure or kill humans, animals, or plants and 

5 that is produced naturally. 

6 ‘‘(5) The team ‘treatment’ means any com7 monly accepted medical treatment practiced by the 

8 medical community at large.’’. 

9 (b) CLERICAL AMENDMENT.—The table of sections 

10 at the beginning of subchapter II of chapter 17 of such 

11 title is amended by adding at the end the following new 

12 item: 

‘‘1720J. Consultation, testing, and treatment of veterans for exposure to toxic 

substances.’’. 

13 SEC. 102. PERMANENT REAUTHORIZATION OF AUTHORITY 

14 OF SECRETARY OF VETERANS AFFAIRS TO 

15 PRESCRIBE REGULATIONS PROVIDING THAT 

16 A PRESUMPTION OF SERVICE CONNECTION 

17 IS WARRANTED FOR A DISEASE ASSOCIATED 

18 WITH EXPOSURE TO A HERBICIDE AGENT. 

19 (a) IN GENERAL.—Section 1116 of title 38, United 

20 States Code, is amended by striking subsection (e). 

21 (b) EFFECTIVE DATE.—Subsection (a) of this section 

22 and subsections (b) through (d) of section 1116 of such 

23 title shall take effect on the date of the enactment of this 

24 Act. 


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1 SEC. 103. PRESUMPTIONS OF SERVICE CONNECTION FOR 

2 DISEASES ASSOCIATED WITH EXPOSURE TO 

3 CERTAIN TOXIC SUBSTANCES. 

4 (a) IN GENERAL.—Subchapter II of chapter 11 of 

5 title 38, United States Code, is amended by adding at the 

6 end the following new section: 

7 ‘‘§ 1119. Presumptions of service connection for dis8 eases associated with exposure to certain 

9 toxic substances 

10 ‘‘(a) PRESUMPTIONS OF SERVICE CONNECTION.—(1) 

11 For purposes of section 1110 of this title, and subject to 

12 section 1113 of this title, each disease specified in para13 graph (2) becoming manifest as specified in that para14 graph shall be considered to have been incurred in or ag15 gravated by service referred to in that paragraph, notwith16 standing that there is no record of evidence of such disease 

17 during the period of such service. 

18 ‘‘(2) A disease specified in this paragraph is any dis19 ease that— 

20 ‘‘(A) the Secretary determines in regulations 

21 prescribed under this section warrants a presump22 tion of service connection by reason of having a posi23 tive association with exposure to a toxic substance; 

24 and 

25 ‘‘(B) becomes manifest within the period, if 

26 any, prescribed in such regulations in a veteran who 


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1 was exposed to that toxic substance during active 

2 military, naval, or air service. 

3 ‘‘(3)(A) For purposes of this subsection, the Sec4 retary may presume that a veteran who has a disease spec5 ified in paragraph (2) was exposed to the toxic substance 

6 for which the Secretary has determined under paragraph 

7 (2)(A) warrants a presumption of service connection by 

8 reason of having a positive association with exposure to 

9 the toxic substance, notwithstanding that there is no 

10 record of evidence of such exposure, if the Secretary deter11 mines based on one or more of the factors set forth in 

12 subparagraph (B) that a presumption of exposure is war13 ranted. 

14 ‘‘(B) The factors set forth in this subparagraph are 

15 as follows: 

16 ‘‘(i) The duty location of the veteran. 

17 ‘‘(ii) The length of service of the veteran. 

18 ‘‘(iii) Such other factors as the Secretary con19 siders appropriate. 

20 ‘‘(b) DETERMINATIONS RELATING TO DISEASES.— 

21 (1) Whenever the Secretary determines, on the basis of 

22 sound medical and scientific evidence, that a positive asso23 ciation exists between the exposure of humans to a toxic 

24 substance and the occurrence of a disease in humans, the 

25 Secretary shall prescribe regulations providing that a preVerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393

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1 sumption of service connection is warranted for that dis2 ease for purposes of this section. 

3 ‘‘(2) In making determinations under paragraph (1), 

4 the Secretary shall take into account— 

5 ‘‘(A) reports received by the Secretary from the 

6 National Academies of Sciences, Engineering, and 

7 Medicine under section 202(g) of the Toxic Expo8 sure in the American Military Act of 2020; and 

9 ‘‘(B) all other sound medical and scientific in10 formation and analyses available to the Secretary. 

11 ‘‘(3)(A) In evaluating any report, information, or 

12 analysis for purposes of making such determinations, the 

13 Secretary shall consider only scientific studies that are 

14 valid in accordance with contemporary scientific stand15 ards. 

16 ‘‘(B) The Secretary may define the standards de17 scribed in subparagraph (A) for purposes of that subpara18 graph. 

19 ‘‘(c) RESPONSE TO REPORTS BY THE NATIONAL

20 ACADEMIES OF SCIENCES, ENGINEERING, AND MEDI21 CINE.—(1) Not later than 60 days after the date on which 

22 the Secretary receives a report from the National Acad23 emies of Sciences, Engineering, and Medicine under sec24 tion 202(g) of the Toxic Exposure in the American Mili25 tary Act of 2020, the Secretary shall determine whether 


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1 a presumption of service connection is warranted for each 

2 disease covered by the report. 

3 ‘‘(2) If the Secretary determines under paragraph (1) 

4 that a presumption of service connection is warranted for 

5 a disease, the Secretary shall, not later than 60 days after 

6 making the determination, issue proposed regulations set7 ting forth the determination. 

8 ‘‘(3)(A) If the Secretary makes a determination de9 scribed in subparagraph (B), the Secretary shall, not later 

10 than 60 days after making the determination, publish in 

11 the Federal Register a notice of the determination. 

12 ‘‘(B) A determination described in this subparagraph 

13 is a determination by the Secretary under paragraph (1) 

14 that— 

15 ‘‘(i) a presumption of service connection is not 

16 warranted for a disease; and 

17 ‘‘(ii)(I) sufficient evidence of an association ex18 ists between the exposure of humans to a toxic sub19 stance and the occurrence of the disease in humans; 

20 or 

21 ‘‘(II) limited evidence or suggestive evidence of 

22 such an association exists. 

23 ‘‘(C) Any notice published under subparagraph (A) 

24 shall include an explanation of the scientific basis for the 

25 determination described in subparagraph (B). 


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1 ‘‘(D) If a disease already presumed to be service con2 nected under this section is subject to a determination de3 scribed in subparagraph (B), the Secretary shall, not later 

4 than 60 days after publication of the notice under sub5 paragraph (A), issue proposed regulations removing the 

6 presumption of service connection for the disease. 

7 ‘‘(4) Not later than 180 days after the date on which 

8 the Secretary issues any proposed regulations under this 

9 subsection, the Secretary shall issue final regulations. 

10 ‘‘(d) REMOVAL OF PRESUMPTION OF SERVICE CON11 NECTION.—Whenever the presumption of service connec12 tion for a disease under this section is removed under sub13 section (c)— 

14 ‘‘(1) a veteran who was awarded compensation 

15 for the disease on the basis of the presumption be16 fore the effective date of the removal of the pre17 sumption shall continue to be entitled to receive 

18 compensation on that basis; and 

19 ‘‘(2) a survivor of a veteran who was awarded 

20 dependency and indemnity compensation for the 

21 death of a veteran resulting from the disease on the 

22 basis of the presumption before that date shall con23 tinue to be entitled to receive dependency and in24 demnity compensation on that basis. 


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1 ‘‘(e) REFERENCE TO NATIONAL ACADEMIES OF

2 SCIENCES, ENGINEERING, AND MEDICINE.—In the case 

3 that the Secretary enters into an agreement with another 

4 organization as described in section 202(i)(1) of the Toxic 

5 Exposure in the American Military Act of 2020, any ref6 erence in this section to the National Academies of 

7 Sciences, Engineering, and Medicine shall be treated as 

8 a reference to the other organization. 

9 ‘‘(f) DEFINITIONS.—In this section: 

10 ‘‘(1) The term ‘positive association’ means, with 

11 respect to an association between exposure to a toxic 

12 substance and the occurrence of a disease in hu13 mans, that there is credible evidence for the associa14 tion and such evidence is equal to or outweighs the 

15 credible evidence against the association. 

16 ‘‘(2) The term ‘toxic substance’ has the mean17 ing given that term in section 1720J(i) of this 

18 title.’’. 

19 (b) CLERICAL AMENDMENT.—The table of sections 

20 at the beginning of chapter 11 of such title is amended 

21 by inserting after the item relating to section 1118 the 

22 following new item: 

‘‘1119. Presumptions of service connection for diseases associated with exposure 

to certain toxic substances.’’. 


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1 (c) CONFORMING AMENDMENT.—Section 1113 of 

2 such title is amended by striking ‘‘or 1118’’ each place 

3 it appears and inserting ‘‘1118, or 1119’’. 

4 TITLE II—RESEARCH AND RE5 VIEW REGARDING EXPOSURE 

6 TO TOXIC SUBSTANCES 

7 SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW 

8 COMMISSION. 

9 (a) IN GENERAL.—Subchapter III of chapter 5 of 

10 title 38, United States Code, is amended by adding at the 

11 end the following new section: 

12 ‘‘§ 547. Toxic Exposure Review Commission 

13 ‘‘(a) ESTABLISHMENT.—There is established within 

14 the Department an independent commission to be known 

15 as the ‘Toxic Exposure Review Commission’ (in this sec16 tion referred to as the ‘Commission’). 

17 ‘‘(b) DUTIES.—The Commission shall carry out the 

18 following duties: 

19 ‘‘(1) Collect any relevant public information 

20 from the Department of Defense and other sources 

21 to identify possible exposures to toxic substances 

22 pertaining to active military, naval, or air service. 

23 ‘‘(2) Hold public meetings to gather relevant in24 formation regarding exposure to toxic substances. 


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1 ‘‘(3) Review such information to assess whether 

2 to recommend that a study be conducted under sec3 tion 202(e) of the Toxic Exposure in the American 

4 Military Act of 2020. 

5 ‘‘(4) Recommend, by majority vote, whether 

6 such a study should be conducted. 

7 ‘‘(5) Recommend to the Secretary, by majority 

8 vote, whether new, independent studies should be 

9 conducted regarding the health outcomes of exposure 

10 to toxic substances. 

11 ‘‘(6) Annually report to Congress on progress 

12 regarding the duties set forth in paragraphs (1) 

13 through (5). 

14 ‘‘(c) MEMBERSHIP.—(1)(A) The Commission shall be 

15 composed of 9 members, appointed as follows: 

16 ‘‘(i) Two members appointed by the Speaker of 

17 the House of Representatives. 

18 ‘‘(ii) Two members appointed by the minority 

19 leader of the House of Representatives. 

20 ‘‘(iii) Two members appointed by the majority 

21 leader of the Senate. 

22 ‘‘(iv) Two members appointed by the minority 

23 leader of the Senate. 

24 ‘‘(v) One member appointed by the Secretary. 


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1 ‘‘(B) The initial members of the Commission shall be 

2 appointed under subparagraph (A) not later than 180 

3 days after the date of the enactment of the Toxic Expo4 sure in the American Military Act of 2020. 

5 ‘‘(2) In appointing individuals under paragraph 

6 (1)(A), the Speaker of the House of Representatives, the 

7 minority leader of the House of Representatives, the ma8 jority leader of the Senate, the minority leader of the Sen9 ate, and the Secretary shall ensure that the following 

10 fields of experience are represented on the Commission: 

11 ‘‘(A) The field of respiratory medicine. 

12 ‘‘(B) The field of endocrinology and metabolic 

13 medicine. 

14 ‘‘(C) The field of hematology. 

15 ‘‘(D) The field of oncology. 

16 ‘‘(E) The field of public health. 

17 ‘‘(F) The field of occupational and environ18 mental health. 

19 ‘‘(3) In appointing individuals under paragraph 

20 (1)(A), the Speaker of the House of Representatives, the 

21 minority leader of the House of Representatives, the ma22 jority leader of the Senate, the minority leader of the Sen23 ate, and the Secretary shall ensure that at least two mem24 bers of the Commission represent an organization recogVerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393

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1 nized by the Secretary for the representation of veterans 

2 under section 5902 of this title. 

3 ‘‘(4) In appointing individuals under paragraph 

4 (1)(A), the Speaker of the House of Representatives, the 

5 minority leader of the House of Representatives, the ma6 jority leader of the Senate, the minority leader of the Sen7 ate, and the Secretary shall give consideration to including 

8 in the Commission at least one member who works with 

9 survivors of illnesses related to exposure to toxic sub10 stances and has a background in the field of study of expo11 sure to toxic substances. 

12 ‘‘(d) MEETINGS.—(1) The Commission shall meet not 

13 less frequently than twice each year. 

14 ‘‘(2)(A) Each meeting of the Commission shall be 

15 open to the public. 

16 ‘‘(B) All the proceedings, information, and delibera17 tions of the Commission shall be available for review by 

18 the public. 

19 ‘‘(e) CHAIR AND VICE CHAIR.—At the initial meeting 

20 of the Commission under subsection (d), the Commission 

21 shall select a Chair and Vice Chair from among the mem22 bers of the Commission by a majority vote of the members 

23 of the Commission. 

24 ‘‘(f) VACANCIES.—A vacancy in the Commission shall 

25 be filled in the same manner as the original appointment, 


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1 but the individual appointed to fill the vacancy shall serve 

2 only for the unexpired portion of the term for which the 

3 individual’s predecessor was appointed. 

4 ‘‘(g) PAY.—(1) Members of the Commission shall 

5 serve without pay. 

6 ‘‘(2) Each member of the Commission who is an offi7 cer or employee of the United States shall serve without 

8 compensation in addition to that received for service as 

9 an officer or employee of the United States. 

10 ‘‘(3) Members shall receive travel expenses, including 

11 per diem in lieu of subsistence, in accordance with sections 

12 5702 and 5703 of title 5. 

13 ‘‘(h) DIRECTOR OF STAFF.—(1) The Commission 

14 shall appoint a Director who— 

15 ‘‘(A) has not served as an employee of the De16 partment during the one-year period preceding the 

17 date of such appointment; and 

18 ‘‘(B) is not otherwise barred or prohibited from 

19 serving as Director under Federal ethics laws and 

20 regulations, by reason of post-employment conflict of 

21 interest. 

22 ‘‘(2) The Director shall be paid at the rate of basic 

23 pay payable for level IV of the Executive Schedule under 

24 section 5315 of title 5. 


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1 ‘‘(i) STAFF.—(1) Subject to paragraphs (2) and (3), 

2 the Director, with the approval of the Commission, may 

3 appoint and fix the pay of additional personnel. 

4 ‘‘(2) The Director may make such appointments 

5 without regard to the provisions of title 5 governing ap6 pointments in the competitive service, and any personnel 

7 so appointed may be paid without regard to the provisions 

8 of chapter 51 and subchapter III of chapter 53 of that 

9 title relating to classification and General Schedule pay 

10 rates, except that an individual so appointed may not re11 ceive pay in excess of the annual rate of basic pay payable 

12 for GS–15 of the General Schedule. 

13 ‘‘(3)(A) Not more than two-thirds of the personnel 

14 employed by or detailed to the Commission may be on de15 tail from the Department. 

16 ‘‘(B) Not more than half of the professional analysts 

17 of the Commission staff may be persons detailed from the 

18 Department to the Commission. 

19 ‘‘(4) Subject to paragraph (3), the head of any Fed20 eral agency, upon the request of the Director, may detail 

21 any of the personnel of that agency to the Commission 

22 to assist the Commission in carrying out its duties under 

23 this section. 

24 ‘‘(5) The Commission may secure directly from any 

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1 siders necessary to carry out this section. Upon request 

2 of the Chair, the head of such agency shall furnish such 

3 information to the Commission, unless such information 

4 is classified. 

5 ‘‘(j) OTHER AUTHORITY.—(1) The Commission may 

6 procure by contract, to the extent funds are available, the 

7 temporary or intermittent services of experts or consult8 ants pursuant to section 3109 of title 5. 

9 ‘‘(2) To the extent funds are available, the Commis10 sion may lease real property and acquire personal property 

11 either of its own accord or in consultation with the General 

12 Services Administration. 

13 ‘‘(k) COMMUNICATIONS.—(1)(A) Except as provided 

14 in subparagraph (B), no person may restrict an employee 

15 of the Department in communicating with the Commis16 sion. 

17 ‘‘(B) Subparagraph (A) does not apply to a commu18 nication that is unlawful. 

19 ‘‘(2) All ex parte communications with the Commis20 sion shall be made part of the public record.’’. 

21 (b) CLERICAL AMENDMENT.—The table of sections 

22 at the beginning of such subchapter is amended by adding 

23 at the end the following new item: 

‘‘547. Toxic Exposure Review Commission.’’. 


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1 SEC. 202. AGREEMENT WITH NATIONAL ACADEMIES OF 

2 SCIENCES, ENGINEERING, AND MEDICINE 

3 CONCERNING THE EXPOSURE OF HUMANS TO 

4 TOXIC SUBSTANCES. 

5 (a) PURPOSE.—The purpose of this section is to pro6 vide for the National Academies of Sciences, Engineering, 

7 and Medicine (in this section referred to as the ‘‘Acad8 emies’’), an independent nonprofit scientific organization 

9 with appropriate expertise that is not part of the Federal 

10 Government, to review and evaluate the available scientific 

11 evidence regarding associations between diseases and ex12 posure to toxic substances. 

13 (b) AGREEMENT.— 

14 (1) IN GENERAL.—The Secretary of Veterans 

15 Affairs shall seek to enter into an agreement with 

16 the Academies to perform the services covered by 

17 this section. 

18 (2) TIMING.—The Secretary shall seek to enter 

19 into an agreement described in paragraph (1) not 

20 later than 60 days after the date of the enactment 

21 of this Act. 

22 (c) REVIEW OF SCIENTIFIC EVIDENCE.—Under an 

23 agreement between the Secretary and the Academies 

24 under this section, the Academies shall review and summa25 rize the scientific evidence, and assess the strength there26 of, concerning the association between exposure to toxic 


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1 substances during active military, naval, or air service and 

2 each disease suspected to be associated with such exposure 

3 in the human population. 

4 (d) SCIENTIFIC DETERMINATIONS CONCERNING DIS5 EASES.—For each disease reviewed under subsection (c), 

6 the Academies shall determine, to the extent that available 

7 scientific data permit meaningful determinations— 

8 (1) whether an association exists between expo9 sure to toxic substances and the occurrence of the 

10 disease, taking into account the strength of the sci11 entific evidence and the appropriateness of the sta12 tistical and epidemiological methods used to detect 

13 the association; 

14 (2) the increased risk of the disease among 

15 those exposed to toxic substances during active mili16 tary, naval, or air service; and 

17 (3) whether there exists a plausible biological 

18 mechanism or other evidence of a causal relationship 

19 between the exposure and the occurrence of the dis20 ease. 

21 (e) SCIENTIFIC STUDIES.— 

22 (1) IN GENERAL.—Under an agreement be23 tween the Secretary and the Academies under this 

24 section, the Academies shall conduct such scientific 

25 studies as the Toxic Exposure Review Commission 


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1 recommends pursuant to section 547(b)(4) of title 

2 38, United States Code, as added by section 201(a). 

3 (2) RECOMMENDATIONS FOR ADDITIONAL SCI4 ENTIFIC STUDIES.— 

5 (A) IN GENERAL.—Under an agreement 

6 between the Secretary and the Academies under 

7 this section, the Academies shall make any rec8 ommendations for additional scientific studies 

9 to resolve areas of continuing scientific uncer10 tainty relating to the exposure of humans to 

11 toxic substances. 

12 (B) CONSIDERATIONS.—In making rec13 ommendations under subparagraph (A), the 

14 Academies shall consider— 

15 (i) the scientific information that is 

16 available at the time of the recommenda17 tion; 

18 (ii) the value and relevance of the in19 formation that could result from additional 

20 studies; and 

21 (iii) the cost and feasibility of car22 rying out such additional studies. 

23 (f) SUBSEQUENT REVIEWS.—Under an agreement 

24 between the Secretary and the Academies under this sec25 tion, the Academies shall— 


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1 (1) conduct as comprehensive a review as is 

2 practicable of the evidence referred to in subsection 

3 (c) that became available since the last review of 

4 such evidence under this section; and 

5 (2) make determinations and estimates on the 

6 basis of the results of such review and all other re7 views conducted for the purposes of this section. 

8 (g) REPORTS.— 

9 (1) INITIAL REPORT.— 

10 (A) IN GENERAL.—Under an agreement 

11 between the Secretary and the Academies under 

12 this section, not later than one year after the 

13 date of the enactment of this Act, the Acad14 emies shall submit to the Secretary, the Com15 mittee on Veterans’ Affairs of the Senate, and 

16 the Committee on Veterans’ Affairs of the 

17 House of Representatives an initial report on 

18 the activities of the Academies under the agree19 ment. 

20 (B) ELEMENTS.—The report submitted 

21 under subparagraph (A) shall include the fol22 lowing: 

23 (i) The determinations described in 

24 subsection (d). 


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1 (ii) A full explanation of the scientific 

2 evidence and reasoning that led to such de3 terminations. 

4 (iii) Any recommendations of the 

5 Academies under subsection (e)(2). 

6 (iv) The recommendation described in 

7 subparagraph (C). 

8 (C) RECOMMENDATION FOR IMPLEMENTA9 TION OF ANALYSIS OF EXAMINATIONS AND

10 TREATMENT OF VETERANS FOR DISABILITIES

11 RELATED TO EXPOSURE TO TOXIC SUB12 STANCES.— 

13 (i) IN GENERAL.—The recommenda14 tion described in this subparagraph is the 

15 recommendation of the Academies as to 

16 whether section 203 should take effect as 

17 provided in subsection (d) of such section. 

18 (ii) CONSIDERATIONS.—In making a 

19 recommendation under clause (i), the 

20 Academies shall consider— 

21 (I) the scientific information that 

22 is available at the time of the rec23 ommendation; 

24 (II) the value and relevance of 

25 the information that could result from 


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1 the implementation of section 203; 

2 and 

3 (III) the cost and feasibility of 

4 such implementation. 

5 (iii) MAINTENANCE OF CLINICAL

6 DATA.—If the Academies recommend that 

7 section 203 should take effect, the Acad8 emies shall recommend the means by which 

9 clinical data referred to in that section 

10 could be maintained in the most scientif11 ically useful way. 

12 (2) PERIODIC UPDATES.—Under an agreement 

13 between the Secretary and the Academies under this 

14 section, not less frequently than once every two 

15 years after the date on which the initial report is 

16 submitted under paragraph (1)(A), the Academies 

17 shall submit to the Secretary, the Committee on Vet18 erans’ Affairs of the Senate, and the Committee on 

19 Veterans’ Affairs of the House of Representatives an 

20 updated report on the activities of the Academies 

21 under the agreement. 

22 (h) LIMITATION ON AUTHORITY.—The authority to 

23 enter into agreements under this section shall be effective 

24 for a fiscal year to the extent that appropriations are 

25 available for such purpose. 


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1 (i) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA2 TION.— 

3 (1) IN GENERAL.—If the Secretary is unable 

4 within the time period prescribed in subsection 

5 (b)(2) to enter into an agreement with the Acad6 emies for the purposes of this section on terms ac7 ceptable to the Secretary, the Secretary shall seek to 

8 enter into an agreement for the purposes of this sec9 tion with another appropriate scientific organization 

10 that— 

11 (A) is not part of the Federal Government; 

12 (B) operates as a not-for-profit entity; and 

13 (C) has expertise and objectivity com14 parable to that of the Academies. 

15 (2) TREATMENT.—If the Secretary enters into 

16 an agreement with another organization as described 

17 in paragraph (1), any reference in this section, sec18 tion 203, and section 1119 of title 38, United States 

19 Code, as added by section 102(a), to the National 

20 Academies of Sciences, Engineering, and Medicine 

21 shall be treated as a reference to the other organiza22 tion. 


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1 SEC. 203. ANALYSIS OF RESULTS OF CONSULTATION, TEST2 ING, AND TREATMENT OF VETERANS FOR 

3 DISABILITIES RELATED TO EXPOSURE TO 

4 TOXIC SUBSTANCES. 

5 (a) IN GENERAL.—The Secretary of Veterans Affairs 

6 shall compile and analyze, on a continuous basis, all clin7 ical data that— 

8 (1) is obtained by the Department of Veterans 

9 Affairs in connection with consultation, testing, and 

10 treatment furnished to veterans by the Department 

11 under section 1720J of title 38, United States Code, 

12 as added by section 101(a); and 

13 (2) is likely to be scientifically useful in deter14 mining the association, if any, between the disability 

15 of a veteran and exposure to a toxic substance. 

16 (b) CONSENT OF PATIENTS.—Compilation and anal17 ysis by the Secretary of clinical data of a veteran under 

18 subsection (a) shall be conducted, and such data shall be 

19 used, consistent with the informed consent of the veteran 

20 and in compliance with all applicable Federal law. 

21 (c) ANNUAL REPORT.—Not later than one year after 

22 the effective date under subsection (d), and annually 

23 thereafter, the Secretary shall submit to the Committee 

24 on Veterans’ Affairs of the Senate and the Committee on 

25 Veterans’ Affairs of the House of Representatives a report 

26 containing— 


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1 (1) the information compiled under subsection 

2 (a); 

3 (2) an analysis of such information; 

4 (3) a description of the types and incidences of 

5 disabilities identified by the Department under such 

6 subsection; 

7 (4) the explanation of the Secretary for the in8 cidence of such disabilities and other explanations 

9 for the incidence of such disabilities as the Secretary 

10 considers reasonable; and 

11 (5) the views of the Secretary on the scientific 

12 validity of drawing conclusions from the incidence of 

13 such disabilities, as evidenced by the data compiled 

14 under subsection (a), regarding any association be15 tween such disabilities and exposure to a toxic sub16 stance. 

17 (d) EFFECTIVE DATE.— 

18 (1) IN GENERAL.—Except as provided in para19 graph (2), this section shall take effect on the date 

20 that is 90 days after the date on which the report 

21 submitted by the National Academies of Sciences, 

22 Engineering, and Medicine under section 202(g)(1) 

23 is received by the Secretary. 

24 (2) EXCEPTION.—This section shall not take ef25 fect if the Secretary, after receiving the report deVerDate Sep 11 2014 03:27 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6401 E:\BILLS\S4393.RS S4393

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1 scribed in paragraph (1) and before the end of the 

2 90-day period described in such paragraph— 

3 (A) determines that it is not feasible or 

4 cost-effective to carry out this section or that 

5 carrying out this section would not make a ma6 terial contribution to the body of scientific 

7 knowledge concerning the health effects in hu8 mans of herbicide exposure; and 

9 (B) notifies the Committee on Veterans’ 

10 Affairs of the Senate and the Committee on 

11 Veterans’ Affairs of the House of Representa12 tives of that determination and the reasons 

13 therefor. 

14 SEC. 204. REPORT TO EVALUATE AND IDENTIFY GROUPS 

15 AT-RISK OF EXPOSURE TO TOXIC SUB16 STANCES. 

17 (a) IN GENERAL.—Not later than one year after the 

18 date of the enactment of this Act, and every two years 

19 thereafter, the Secretary of Defense shall submit to the 

20 appropriate committees of Congress and, subject to appli21 cable Federal privacy laws, make available to the public 

22 a report evaluating and identifying the groups of members 

23 of the Armed Forces and former members of the Armed 

24 Forces who are at-risk of exposure to toxic substances. 


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1 (b) EXISTING DATA.—The Secretary shall use data 

2 from existing record and tracking systems to develop each 

3 report under subsection (a). 

4 (c) USE OF CAPABILITIES OF NATIONAL ARTIFICIAL

5 INTELLIGENCE INSTITUTE.—In developing each report 

6 under subsection (a), the Secretary shall use the capabili7 ties of the National Artificial Intelligence Institute of the 

8 Department of Veterans Affairs to interpret the veteran 

9 population data within the Individual Longitudinal Expo10 sure Record of the Department, including data compiled 

11 under— 

12 (1) the Million Veteran Program of the Depart13 ment; 

14 (2) health records of veterans; and 

15 (3) benefits records of veterans. 

16 (d) ELEMENTS OF REPORT.—Each report submitted 

17 under subsection (a) shall— 

18 (1) identify groups at a high-risk for illnesses 

19 relating to exposure to toxic substances and rec20 ommend an outreach strategy for those groups; and 

21 (2) determine the viability of correlating the In22 dividual Longitudinal Exposure Record and health 

23 records maintained by the Veterans Health Adminis24 tration, including with respect to participation of a 

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1 partment, to provide more data to epidemiologists of 

2 the Department. 

3 (e) APPROPRIATE COMMITTEES OF CONGRESS DE4 FINED.—In this section, the term ‘‘appropriate commit5 tees of Congress’’ means— 

6 (1) the Committee on Armed Services and the 

7 Committee on Veterans’ Affairs of the Senate; and 

8 (2) the Committee on Armed Services and the 

9 Committee on Veterans’ Affairs of the House of 

10 Representatives. 

11 TITLE III—IMPROVEMENT OF 

12 RESOURCES OF DEPARTMENT 

13 OF VETERANS AFFAIRS RE14 GARDING EXPOSURES TO 

15 TOXIC SUBSTANCES 

16 SEC. 301. PUBLICATION OF LIST OF RESOURCES OF DE17 PARTMENT OF VETERANS AFFAIRS FOR VET18 ERANS EXPOSED TO TOXIC SUBSTANCES AND 

19 OUTREACH PROGRAM FOR SUCH VETERANS 

20 AND CAREGIVERS AND SURVIVORS OF SUCH 

21 VETERANS. 

22 (a) PUBLICATION OF LIST OF RESOURCES.— 

23 (1) IN GENERAL.—Not later than one year 

24 after the date of the enactment of this Act, and an25 nually thereafter, the Secretary of Veterans Affairs 


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1 shall publish a list of resources of the Department 

2 of Veterans Affairs for— 

3 (A) veterans provided disability compensa4 tion under chapter 11 of title 38, United States 

5 Code, relating to exposure to toxic substances; 

6 (B) veterans eligible for consultation, test7 ing, and treatment under section 1720J of such 

8 title, as added by section 101(a); 

9 (C) caregivers of veterans described in sub10 paragraph (A) or (B) who are participating in 

11 the program of comprehensive assistance for 

12 family caregivers under section 1720G(a) of 

13 such title; and 

14 (D) survivors of veterans described in sub15 paragraph (A) or (B) (or who would be de16 scribed in any such subparagraph were the vet17 eran alive) who are receiving death benefits 

18 under the laws administered by the Secretary. 

19 (2) UPDATE.—The Secretary shall periodically 

20 update the list published under paragraph (1). 

21 (b) OUTREACH.—The Secretary shall develop, with 

22 input from the community, an informative outreach pro23 gram for veterans on illnesses that may be related to expo24 sure to toxic substances, including outreach with respect 

25 to benefits and support programs. 


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1 SEC. 302. INCORPORATION OF TOXIC EXPOSURE QUES2 TIONNAIRE DURING PRIMARY CARE AP3 POINTMENTS. 

4 (a) IN GENERAL.—The Secretary of Veterans Affairs 

5 shall incorporate a clinical questionnaire to help determine 

6 potential exposure to toxic substances during active mili7 tary, naval, or air service as part of the initial screening 

8 conducted for an appointment of a veteran with a primary 

9 care provider of the Department of Veterans Affairs to 

10 improve understanding by the Department of exposure of 

11 veterans to toxic substances while serving in the Armed 

12 Forces. 

13 (b) DETERMINATION OF QUESTIONS.—The questions 

14 included in the questionnaire required under subsection 

15 (a) shall be determined by the Secretary with input from 

16 medical professionals. 

17 SEC. 303. PORTAL FOR ACCESS BY VETERANS TO INDI18 VIDUAL LONGITUDINAL EXPOSURE RECORD. 

19 (a) IN GENERAL.—The Secretary of Veterans Affairs 

20 shall establish a portal through which a veteran may ac21 cess documents and information with respect to the vet22 eran contained in the Individual Longitudinal Exposure 

23 Record of the Department of Veterans Affairs. 

24 (b) ELEMENTS OF PORTAL.—The portal established 

25 under subsection (a) shall— 


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1 (1) present documents and information with re2 spect to a veteran contained in the Individual Longi3 tudinal Exposure Record of the veteran in a print4 able, read-only format; and 

5 (2) be hosted on an internet website of the De6 partment that is commonly used by veterans. 

7 SEC. 304. TRAINING OF PERSONNEL OF DEPARTMENT OF 

8 VETERANS AFFAIRS ON ILLNESSES RELATED 

9 TO EXPOSURE TO TOXIC SUBSTANCES. 

10 (a) IN GENERAL.—The Secretary of Veterans Affairs 

11 shall ensure that personnel of the Department of Veterans 

12 Affairs, including personnel involved with establishing dis13 ability ratings under the laws administered by the Sec14 retary, and non-Department health care personnel who 

15 provide care to veterans under the laws administered by 

16 the Secretary are appropriately trained to identify, treat, 

17 and assess the impact of illnesses related to exposure to 

18 toxic substances. 

19 (b) ELEMENTS OF TRAINING.—The training required 

20 under subsection (a) shall— 

21 (1) provide veterans and personnel with specific 

22 education with respect to illnesses related to expo23 sure to toxic substances; 


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1 (2) inform disability raters of secondary effects 

2 that can be attributed to exposure to toxic sub3 stances; and 

4 (3) inform personnel of how to probe for addi5 tional information regarding exposures to different 

6 toxicants. 

7 (c) TOXICANT DEFINED.—In this section, the term 

8 ‘‘toxicant’’ has the meaning given that term in section 

9 1720J(i) of title 38, United States Code, as added by sec10 tion 101(a). 

11 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

12 (a) SHORT TITLE.—This Act may be cited as the 

13 ‘‘Toxic Exposure in the American Military Act of 2020’’ 

14 or the ‘‘TEAM Act of 2020’’. 

15 (b) TABLE OF CONTENTS.—The table of contents for 

16 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

TITLE I—EXPANSION OF HEALTH CARE AND BENEFITS FOR 

VETERANS EXPOSED TO TOXIC SUBSTANCES 

Sec. 101. Expansion of health care eligibility for certain individuals exposed to 

open burn pits and other toxic substances. 

Sec. 102. Expansion of health care eligibility for veterans awarded certain medals. 

Sec. 103. Permanent reauthorization of authority of Secretary of Veterans Affairs 

to prescribe regulations providing that a presumption of service 

connection is warranted for a disease associated with exposure 

to a herbicide agent. 

Sec. 104. Permanent reauthorization of authority of Secretary of Veterans Affairs 

to prescribe regulations providing that a presumption of service 

connection is warranted for an illness associated with service in 

the Persian Gulf during the Persian Gulf War. 

Sec. 105. Presumptions of service connection for diseases associated with exposure 

to certain toxic substances. 


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TITLE II—RESEARCH AND REVIEW REGARDING EXPOSURE TO 

TOXIC SUBSTANCES 

Sec. 201. Establishment of Toxic Exposure Review Commission. 

Sec. 202. Agreement with National Academies of Sciences, Engineering, and Medicine concerning the exposure of humans to toxic substances. 

Sec. 203. Collection, analysis, and report on treatment of veterans for medical 

conditions related to exposure to toxic substances. 

TITLE III—IMPROVEMENT OF RESOURCES OF DEPARTMENT OF 

VETERANS AFFAIRS REGARDING EXPOSURES TO TOXIC SUBSTANCES 

Sec. 301. Publication of list of resources of Department of Veterans Affairs for 

veterans exposed to toxic substances and outreach program for 

such veterans and caregivers and survivors of such veterans. 

Sec. 302. Incorporation of toxic exposure questionnaire during primary care appointments. 

Sec. 303. Portal for access by veterans to Individual Longitudinal Exposure 

Record. 

Sec. 304. Training of health care personnel of Department of Veterans Affairs on 

illnesses related to exposure to toxic substances. 

1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) ACTIVE MILITARY, NAVAL, OR AIR SERVICE.— 

4 The term ‘‘active military, naval, or air service’’ has 

5 the meaning given that term in section 101 of title 

6 38, United States Code. 

7 (2) OPEN BURN PIT.—The term ‘‘open burn pit’’ 

8 has the meaning given that term in section 201(c) of 

9 the Dignified Burial and Other Veterans’ Benefits 

10 Improvement Act of 2012 (Public Law 112–260; 38 

11 U.S.C. 527 note). 

12 (3) TOXIC SUBSTANCE.—The term ‘‘toxic sub13 stance’’ has the meaning given that term in subpara14 graph (G)(iv) of section 1710(e)(1) of such title, as 

15 added by section 101(a). 


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1 TITLE I—EXPANSION OF HEALTH 

2 CARE AND BENEFITS FOR 

3 VETERANS EXPOSED TO 

4 TOXIC SUBSTANCES 

5 SEC. 101. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 

6 CERTAIN INDIVIDUALS EXPOSED TO OPEN 

7 BURN PITS AND OTHER TOXIC SUBSTANCES. 

8 (a) IN GENERAL.—Section 1710(e) of title 38, United 

9 States Code, is amended— 

10 (1) in paragraph (1), by adding at the end the 

11 following new subparagraph: 

12 ‘‘(G)(i) Subject to paragraph (2), a covered individual 

13 is eligible for hospital care, medical services, and nursing 

14 home care under subsection (a)(2)(F) for any illness. 

15 ‘‘(ii) For purposes of this subparagraph, a covered in16 dividual is an individual who— 

17 ‘‘(I) is eligible for inclusion in the Airborne Haz18 ards and Open Burn Pit Registry; or 

19 ‘‘(II) has been identified by the Secretary of De20 fense to have been possibly exposed, inside or outside 

21 the United States, during active duty, active duty for 

22 training, or inactive duty training, to— 

23 ‘‘(aa) an open burn pit; 

24 ‘‘(bb) a toxic substance; or 


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1 ‘‘(cc) a site included in a database main2 tained by the Department of Defense and shared 

3 with the Department of Veterans Affairs to serve 

4 as the central portal for exposure-related data 

5 that compiles, collates, presents, and provides 

6 available occupational and environmental expo7 sure information to support the needs of the De8 partment of Defense and the Department of Vet9 erans Affairs. 

10 ‘‘(iii) A covered individual shall be enrolled in the sys11 tem of annual patient enrollment of the Department in the 

12 priority group under subsection (a)(6) of section 1705 of 

13 this title. 

14 ‘‘(iv) In this subparagraph: 

15 ‘‘(I) The term ‘Airborne Hazards and Open 

16 Burn Pit Registry’ means the registry established by 

17 the Secretary under section 201 of the Dignified Bur18 ial and Other Veterans’ Benefits Improvement Act of 

19 2012 (Public Law 112–260; 38 U.S.C. 527 note). 

20 ‘‘(II) The term ‘open burn pit’ has the meaning 

21 given that term in section 201(c) of the Dignified 

22 Burial and Other Veterans’ Benefits Improvement Act 

23 of 2012 (Public Law 112–260; 38 U.S.C. 527 note). 

24 ‘‘(III) The term ‘toxic substance’ means a toxi25 cant or a toxin. 


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1 ‘‘(IV) The term ‘toxicant’ means any substance 

2 that can injure or kill humans, animals, or plants 

3 and that is produced by humans or is a by-product 

4 of human activities. 

5 ‘‘(V) The term ‘toxin’ means any substance that 

6 can injure or kill humans, animals, or plants and 

7 that is produced naturally.’’; and 

8 (2) in paragraph (2)(B), by striking ‘‘or (F)’’ 

9 and inserting ‘‘(F), or (G)’’. 

10 (b) EFFECTIVE DATE.—The amendments made by sub11 section (a) shall take effect on the date that is 90 days after 

12 the date of the enactment of this Act. 

13 (c) DETERMINATIONS OF EXPOSURE.— 

14 (1) IN GENERAL.—The Secretary of Veterans Af15 fairs shall, to the extent practicable, establish and 

16 maintain a mechanism by which veterans may deter17 mine whether or not they have been possibly exposed 

18 to an open burn pit or toxic substance described in 

19 subparagraph (G)(ii)(II) of section 1710(e)(1) of title 

20 38, United States Code, as added by subsection (a), 

21 for purposes of being considered as covered individ22 uals under such subparagraph. 

23 (2) APPROVAL OF SECRETARY.—Any determina24 tion made under paragraph (1) shall be subject to the 

25 approval of the Secretary. 


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1 (3) APPEALS.—The Secretary shall establish a 

2 mechanism for appealing a decision made by the Sec3 retary under paragraph (2). 

4 (d) REPORT.— 

5 (1) IN GENERAL.—Not later than 30 days after 

6 the date on which the Secretary of Defense identifies 

7 the individuals described in subparagraph (G)(ii)(II) 

8 of section 1710(e)(1) of title 38, United States Code, 

9 as added by subsection (a), the Secretary, in consulta10 tion with the Secretary of Veterans Affairs, shall sub11 mit to the appropriate committees of Congress a re12 port. 

13 (2) ELEMENTS.—The report required by para14 graph (1) shall include the following: 

15 (A) The duty locations or units of the indi16 viduals described in paragraph (1), or other in17 formation on groups to which such individuals 

18 belong. 

19 (B) The evidence considered in identifying 

20 individuals who were possibly exposed to an 

21 open burn pit, toxic substance, or site as de22 scribed in subparagraph (G)(ii)(II) of section 

23 1710(e)(1) of title 38, United States Code, as 

24 added by subsection (a). 


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1 (C) The criteria used to determine whether 

2 an individual was so exposed. 

3 (3) APPROPRIATE COMMITTEES OF CONGRESS.— 

4 In this subsection, the term ‘‘appropriate committees 

5 of Congress’’ means— 

6 (A) the Committee on Veterans’ Affairs and 

7 the Committee on Armed Services of the Senate; 

8 and 

9 (B) the Committee on Veterans’ Affairs and 

10 the Committee on Armed Services of the House 

11 of Representatives. 

12 SEC. 102. EXPANSION OF HEALTH CARE ELIGIBILITY FOR 

13 VETERANS AWARDED CERTAIN MEDALS. 

14 (a) IN GENERAL.—Section 1710(e) of title 38, United 

15 States Code, as amended by section 101(a), is further 

16 amended— 

17 (1) in paragraph (1), by adding at the end the 

18 following new subparagraph: 

19 ‘‘(H)(i) Subject to paragraph (2), a veteran is eligible 

20 for hospital care, medical services, and nursing home care 

21 under subsection (a)(2)(F) for any illness if the veteran was 

22 awarded any of the following: 

23 ‘‘(I) The Armed Forces Service Medal. 

24 ‘‘(II) The Afghanistan Campaign Medal. 


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1 ‘‘(III) The Global War on Terrorism Expedi2 tionary Medal. 

3 ‘‘(IV) The Inherent Resolve Campaign Medal. 

4 ‘‘(V) The Iraq Campaign Medal. 

5 ‘‘(VI) The Southwest Asia Service Medal. 

6 ‘‘(ii) A veteran described in clause (i) shall be enrolled 

7 in the system of annual patient enrollment of the Depart8 ment in the priority group under subsection (a)(6) of sec9 tion 1705 of this title.’’; and 

10 (2) in paragraph (2), by striking ‘‘or (G)’’ and 

11 inserting ‘‘(G), or (H)’’. 

12 (b) EFFECTIVE DATE.—The amendments made by sub13 section (a) shall take effect on the date that is 90 days after 

14 the date of the enactment of this Act. 

15 SEC. 103. PERMANENT REAUTHORIZATION OF AUTHORITY 

16 OF SECRETARY OF VETERANS AFFAIRS TO 

17 PRESCRIBE REGULATIONS PROVIDING THAT 

18 A PRESUMPTION OF SERVICE CONNECTION IS 

19 WARRANTED FOR A DISEASE ASSOCIATED 

20 WITH EXPOSURE TO A HERBICIDE AGENT. 

21 (a) IN GENERAL.—Section 1116 of title 38, United 

22 States Code, is amended by striking subsection (e). 

23 (b) EFFECTIVE DATE.—Subsection (a) of this section 

24 and subsections (b) through (d) of section 1116 of such title 

25 shall take effect on the date of the enactment of this Act. 


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1 SEC. 104. PERMANENT REAUTHORIZATION OF AUTHORITY 

2 OF SECRETARY OF VETERANS AFFAIRS TO 

3 PRESCRIBE REGULATIONS PROVIDING THAT 

4 A PRESUMPTION OF SERVICE CONNECTION IS 

5 WARRANTED FOR AN ILLNESS ASSOCIATED 

6 WITH SERVICE IN THE PERSIAN GULF DUR7 ING THE PERSIAN GULF WAR. 

8 (a) IN GENERAL.—Section 1118 of title 38, United 

9 States Code, is amended by striking subsection (e). 

10 (b) EFFECTIVE DATE.—Subsection (a) of this section 

11 and subsections (b) through (d) of section 1118 of such title 

12 shall take effect on the date of the enactment of this Act. 

13 SEC. 105. PRESUMPTIONS OF SERVICE CONNECTION FOR 

14 DISEASES ASSOCIATED WITH EXPOSURE TO 

15 CERTAIN TOXIC SUBSTANCES. 

16 (a) IN GENERAL.—Subchapter II of chapter 11 of title 

17 38, United States Code, is amended by adding at the end 

18 the following new section: 

19 ‘‘§ 1119. Presumptions of service connection for dis20 eases associated with exposure to certain 

21 toxic substances 

22 ‘‘(a) PRESUMPTIONS OF SERVICE CONNECTION.—(1) 

23 For purposes of section 1110 of this title, and subject to 

24 section 1113 of this title, each disease specified in para25 graph (2) becoming manifest as specified in that paragraph 

26 shall be considered to have been incurred in or aggravated 


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1 by service referred to in that paragraph, notwithstanding 

2 that there is no record of evidence of such disease during 

3 the period of such service. 

4 ‘‘(2) A disease specified in this paragraph is any dis5 ease that— 

6 ‘‘(A) the Secretary determines in regulations pre7 scribed under this section warrants a presumption of 

8 service connection by reason of having a positive asso9 ciation with exposure to a toxic substance; and 

10 ‘‘(B) becomes manifest within the period, if any, 

11 prescribed in such regulations in a veteran who was 

12 exposed to that toxic substance during active mili13 tary, naval, or air service. 

14 ‘‘(3)(A) For purposes of this subsection, the Secretary 

15 may presume that a veteran who has a disease specified 

16 in paragraph (2) was exposed to the toxic substance for 

17 which the Secretary has determined under paragraph 

18 (2)(A) warrants a presumption of service connection by rea19 son of having a positive association with exposure to the 

20 toxic substance, notwithstanding that there is no record of 

21 evidence of such exposure, if the Secretary determines based 

22 on one or more of the factors set forth in subparagraph (B) 

23 that a presumption of exposure is warranted. 

24 ‘‘(B) The factors set forth in this subparagraph are as 

25 follows: 


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1 ‘‘(i) The duty location of the veteran. 

2 ‘‘(ii) The length of service of the veteran. 

3 ‘‘(iii) Such other factors as the Secretary con4 siders appropriate. 

5 ‘‘(b) DETERMINATIONS RELATING TO DISEASES.—(1) 

6 Whenever the Secretary determines, on the basis of sound 

7 medical and scientific evidence, that a positive association 

8 exists between the exposure of humans to a toxic substance 

9 and the occurrence of a disease in humans, the Secretary 

10 shall prescribe regulations providing that a presumption of 

11 service connection is warranted for that disease for purposes 

12 of this section. 

13 ‘‘(2) In making determinations under paragraph (1), 

14 the Secretary shall take into account— 

15 ‘‘(A) reports received by the Secretary from the 

16 National Academies of Sciences, Engineering, and 

17 Medicine under section 202(g) of the Toxic Exposure 

18 in the American Military Act of 2020; and 

19 ‘‘(B) all other sound medical and scientific infor20 mation and analyses available to the Secretary. 

21 ‘‘(3)(A) In evaluating any report, information, or 

22 analysis for purposes of making such determinations, the 

23 Secretary shall consider only scientific studies that are 

24 valid in accordance with contemporary scientific standards. 


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1 ‘‘(B) The Secretary may define the standards described 

2 in subparagraph (A) for purposes of that subparagraph. 

3 ‘‘(c) RESPONSE TO REPORTS BY THE NATIONAL ACAD4 EMIES OF SCIENCES, ENGINEERING, AND MEDICINE.—(1) 

5 Not later than 60 days after the date on which the Secretary 

6 receives a report from the National Academies of Sciences, 

7 Engineering, and Medicine under section 202(g) of the 

8 Toxic Exposure in the American Military Act of 2020, the 

9 Secretary shall determine whether a presumption of service 

10 connection is warranted for each disease covered by the re11 port. 

12 ‘‘(2) If the Secretary determines under paragraph (1) 

13 that a presumption of service connection is warranted for 

14 a disease, the Secretary shall, not later than 60 days after 

15 making the determination, issue proposed regulations set16 ting forth the determination. 

17 ‘‘(3)(A) If the Secretary makes a determination de18 scribed in subparagraph (B), the Secretary shall, not later 

19 than 60 days after making the determination, publish in 

20 the Federal Register a notice of the determination. 

21 ‘‘(B) A determination described in this subparagraph 

22 is a determination by the Secretary under paragraph (1) 

23 that a presumption of service connection is not warranted 

24 for a disease as to which the National Academies of 


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1 Sciences, Engineering, and Medicine determined that there 

2 was— 

3 ‘‘(i) sufficient evidence of an association between 

4 the exposure of humans to a toxic substance and the 

5 occurrence of the disease in humans; or 

6 ‘‘(ii) limited evidence or suggestive evidence of 

7 such an association. 

8 ‘‘(C) Any notice published under subparagraph (A) 

9 shall include an explanation of the scientific basis for the 

10 determination described in subparagraph (B). 

11 ‘‘(D) If a disease already presumed to be service con12 nected under this section is subject to a determination de13 scribed in subparagraph (B), the Secretary shall, not later 

14 than 60 days after publication of the notice under subpara15 graph (A), issue proposed regulations removing the pre16 sumption of service connection for the disease. 

17 ‘‘(4) Not later than 180 days after the date on which 

18 the Secretary issues any proposed regulations under this 

19 subsection, the Secretary shall issue final regulations. 

20 ‘‘(d) REMOVAL OF PRESUMPTION OF SERVICE CON21 NECTION.—Whenever the presumption of service connection 

22 for a disease under this section is removed under subsection 

23 (c)— 

24 ‘‘(1) a veteran who was awarded compensation 

25 for the disease on the basis of the presumption before 


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1 the effective date of the removal of the presumption 

2 shall continue to be entitled to receive compensation 

3 on that basis; and 

4 ‘‘(2) a survivor of a veteran who was awarded 

5 dependency and indemnity compensation for the 

6 death of a veteran resulting from the disease on the 

7 basis of the presumption before that date shall con8 tinue to be entitled to receive dependency and indem9 nity compensation on that basis. 

10 ‘‘(e) REFERENCE TO NATIONAL ACADEMIES OF

11 SCIENCES, ENGINEERING, AND MEDICINE.—In the case that 

12 the Secretary enters into an agreement with another organi13 zation as described in section 202(h)(1) of the Toxic Expo14 sure in the American Military Act of 2020, any reference 

15 in this section to the National Academies of Sciences, Engi16 neering, and Medicine shall be treated as a reference to the 

17 other organization. 

18 ‘‘(f) DEFINITIONS.—In this section: 

19 ‘‘(1) The term ‘positive association’ means, with 

20 respect to an association between exposure to a toxic 

21 substance and the occurrence of a disease in humans, 

22 that there is credible evidence for the association and 

23 such evidence is equal to or outweighs the credible evi24 dence against the association. 


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1 ‘‘(2) The term ‘toxic substance’ has the meaning 

2 given that term in section 1710(e)(1)(G)(iv) of this 

3 title.’’. 

4 (b) CLERICAL AMENDMENT.—The table of sections at 

5 the beginning of chapter 11 of such title is amended by in6 serting after the item relating to section 1118 the following 

7 new item: 

‘‘1119. Presumptions of service connection for diseases associated with exposure to 

certain toxic substances.’’. 

8 (c) CONFORMING AMENDMENT.—Section 1113 of such 

9 title is amended by striking ‘‘or 1118’’ each place it appears 

10 and inserting ‘‘1118, or 1119’’. 

11 TITLE II—RESEARCH AND RE12 VIEW REGARDING EXPOSURE 

13 TO TOXIC SUBSTANCES 

14 SEC. 201. ESTABLISHMENT OF TOXIC EXPOSURE REVIEW 

15 COMMISSION. 

16 (a) IN GENERAL.—Subchapter III of chapter 5 of title 

17 38, United States Code, is amended by adding at the end 

18 the following new section: 

19 ‘‘§ 547. Toxic Exposure Review Commission 

20 ‘‘(a) ESTABLISHMENT.—The Secretary shall establish 

21 an independent commission to be known as the ‘Toxic Ex22 posure Review Commission’ (in this section referred to as 

23 the ‘Commission’). 

24 ‘‘(b) PURPOSE.—The Commission shall— 


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1 ‘‘(1) advise the Secretary on questions relating to 

2 exposure to toxic substances that require scientific re3 search; and 

4 ‘‘(2) assist in the consideration of possible pre5 sumptions of service connection. 

6 ‘‘(c) DUTIES.—The Commission shall carry out the fol7 lowing duties: 

8 ‘‘(1) Collect any relevant information from the 

9 Department of Defense and other sources to identify 

10 possible toxic exposures related to service during ac11 tive duty, active duty for training, or inactive duty 

12 training in order to determine the need for a com13 prehensive review under an agreement under section 

14 202 of the Toxic Exposure in the American Military 

15 Act of 2020. Relevant information may be collected 

16 from the following: 

17 ‘‘(A) Any Federal agency, as the Commis18 sion considers necessary to carry out this section. 

19 Upon request of the Chair, the head of such agen20 cy shall furnish such information to the Commis21 sion, unless such information is classified. 

22 ‘‘(B) Public meetings or hearings, which 

23 may be held to take such testimony and receive 

24 such evidence as the Commission considers advis25 able to carry out the duties of the Commission. 


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1 ‘‘(2) Recommend to the Secretary, by majority 

2 vote, whether a comprehensive scientific review should 

3 be conducted by the National Academies of Sciences, 

4 Engineering, and Medicine under an agreement 

5 under section 202 of the Toxic Exposure in the Amer6 ican Military Act of 2020. 

7 ‘‘(3) Recommend to the Secretary, by majority 

8 vote, whether new, independent studies regarding the 

9 health outcomes of exposure to toxic substances, or 

10 any other new, independent studies that the Commis11 sion deems necessary and appropriate, should be con12 ducted. 

13 ‘‘(4) Annually report to Congress on progress re14 garding the duties set forth in paragraphs (1) through 

15 (3), any recommendations made to the Secretary, and 

16 any responses of the Secretary to such recommenda17 tions. 

18 ‘‘(d) MEMBERSHIP.—(1)(A) The Commission shall be 

19 composed of 9 members, appointed as follows: 

20 ‘‘(i) Two members appointed by the Speaker of 

21 the House of Representatives. 

22 ‘‘(ii) Two members appointed by the minority 

23 leader of the House of Representatives. 

24 ‘‘(iii) Two members appointed by the majority 

25 leader of the Senate. 


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1 ‘‘(iv) Two members appointed by the minority 

2 leader of the Senate. 

3 ‘‘(v) One member appointed by the Secretary. 

4 ‘‘(B) The initial members of the Commission shall be 

5 appointed under subparagraph (A) not later than 180 days 

6 after the date of the enactment of the Toxic Exposure in 

7 the American Military Act of 2020. 

8 ‘‘(2) In appointing individuals under paragraph 

9 (1)(A), the Speaker of the House of Representatives, the mi10 nority leader of the House of Representatives, the majority 

11 leader of the Senate, the minority leader of the Senate, and 

12 the Secretary shall ensure that at least five members of the 

13 Commission are scientists or health care professionals— 

14 ‘‘(A) of whom— 

15 ‘‘(i) one has a background in the field of 

16 respiratory medicine; 

17 ‘‘(ii) one has a background in the field of 

18 endocrinology and metabolic medicine; 

19 ‘‘(iii) one has a background in hematology; 

20 ‘‘(iv) one has a background in oncology; 

21 and 

22 ‘‘(v) one has a background in occupational 

23 and environmental health; and 

24 ‘‘(B) who are not officials or employees of the 

25 Federal Government. 


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1 ‘‘(3) In appointing individuals under paragraph 

2 (1)(A), the Speaker of the House of Representatives, the mi3 nority leader of the House of Representatives, the majority 

4 leader of the Senate, the minority leader of the Senate, and 

5 the Secretary shall ensure that at least two members of the 

6 Commission represent an organization recognized by the 

7 Secretary for the representation of veterans under section 

8 5902 of this title. 

9 ‘‘(4) In appointing individuals under paragraph 

10 (1)(A), the Speaker of the House of Representatives, the mi11 nority leader of the House of Representatives, the majority 

12 leader of the Senate, the minority leader of the Senate, and 

13 the Secretary shall give consideration to including in the 

14 Commission at least one member who works with survivors 

15 of illnesses related to exposure to toxic substances and has 

16 a background in the field of study of exposure to toxic sub17 stances. 

18 ‘‘(e) MEETINGS.—(1) The Commission shall meet not 

19 less frequently than twice each year. 

20 ‘‘(2)(A) Each meeting of the Commission shall be open 

21 to the public. 

22 ‘‘(B) All the proceedings, information, and delibera23 tions of the Commission shall be available for review by 

24 the public. 


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1 ‘‘(C) Meetings of the Commission may be carried out 

2 through the use of telephonic or other appropriate tele3 communication technology if the Commission determines 

4 that such technology will allow the members to commu5 nicate simultaneously. 

6 ‘‘(f) CHAIR AND VICE CHAIR.—At the initial meeting 

7 of the Commission under subsection (e), the Commission 

8 shall select a Chair and Vice Chair from among the mem9 bers of the Commission by a majority vote of the members 

10 of the Commission. 

11 ‘‘(g) PERIOD OF APPOINTMENT; VACANCIES.—(1) A 

12 member of the Commission shall be appointed for a term 

13 that may not exceed four years. 

14 ‘‘(2) The Secretary shall ensure that terms of members 

15 of the Commission are staggered so that no such terms end 

16 on the same date. 

17 ‘‘(3) A vacancy in the Commission shall be filled in 

18 the same manner as the original appointment, but the indi19 vidual appointed to fill the vacancy shall serve only for the 

20 unexpired portion of the term for which the individual’s 

21 predecessor was appointed. 

22 ‘‘(4) In appointing the initial members of the Commis23 sion, each official who is authorized to appoint two mem24 bers of the Commission shall appoint— 


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1 ‘‘(A) one member whose term expires after two 

2 years; and 

3 ‘‘(B) one member whose term expires after four 

4 years. 

5 ‘‘(h) PAY.—(1) Members of the Commission shall serve 

6 without pay. 

7 ‘‘(2) Each member of the Commission who is an officer 

8 or employee of the United States shall serve without com9 pensation in addition to that received for service as an offi10 cer or employee of the United States. 

11 ‘‘(3) Members shall receive travel expenses, including 

12 per diem in lieu of subsistence, in accordance with sections 

13 5702 and 5703 of title 5. 

14 ‘‘(i) DIRECTOR OF STAFF.—(1) The Commission shall 

15 appoint a Director who— 

16 ‘‘(A) has not served as an employee of the De17 partment during the one-year period preceding the 

18 date of such appointment; and 

19 ‘‘(B) is not otherwise barred or prohibited from 

20 serving as Director under Federal ethics laws and 

21 regulations, by reason of post-employment conflict of 

22 interest. 

23 ‘‘(2) The Director shall be paid at the rate of basic 

24 pay payable for level IV of the Executive Schedule under 

25 section 5315 of title 5. 


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1 ‘‘(j) STAFF.—(1) Subject to paragraphs (2) and (3), 

2 the Director, with the approval of the Commission, may ap3 point and fix the pay of additional personnel. 

4 ‘‘(2) The Director may make such appointments with5 out regard to the provisions of title 5 governing appoint6 ments in the competitive service, and any personnel so ap7 pointed may be paid without regard to the provisions of 

8 chapter 51 and subchapter III of chapter 53 of that title 

9 relating to classification and General Schedule pay rates, 

10 except that an individual so appointed may not receive pay 

11 in excess of the annual rate of basic pay payable for GS– 

12 15 of the General Schedule. 

13 ‘‘(3)(A) Not more than two-thirds of the personnel em14 ployed by or detailed to the Commission may be on detail 

15 from the Department. 

16 ‘‘(B) Not more than half of the professional analysts 

17 of the Commission staff may be persons detailed from the 

18 Department to the Commission. 

19 ‘‘(4) Subject to paragraph (3), the head of any Federal 

20 agency, upon the request of the Director, may detail any 

21 of the personnel of that agency to the Commission to assist 

22 the Commission in carrying out its duties under this sec23 tion. 

24 ‘‘(5) The Commission may secure directly from any 

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1 siders necessary to carry out this section. Upon request of 

2 the Chair, the head of such agency shall furnish such infor3 mation to the Commission, unless such information is clas4 sified. 

5 ‘‘(k) OTHER AUTHORITY.—(1) The Commission may 

6 procure by contract, to the extent funds are available, the 

7 temporary or intermittent services of experts or consultants 

8 pursuant to section 3109 of title 5. 

9 ‘‘(2) To the extent funds are available, the Commission 

10 may lease real property and acquire personal property ei11 ther of its own accord or in consultation with the General 

12 Services Administration. 

13 ‘‘(l) COMMUNICATIONS.—(1)(A) Except as provided in 

14 subparagraph (B), no person may restrict an employee of 

15 the Department in communicating with the Commission. 

16 ‘‘(B) Subparagraph (A) does not apply to a commu17 nication that is unlawful. 

18 ‘‘(2) All ex parte communications with the Commis19 sion shall be made part of the public record. 

20 ‘‘(m) REFERENCE TO NATIONAL ACADEMIES OF

21 SCIENCES, ENGINEERING, AND MEDICINE.—In the case that 

22 the Secretary enters into an agreement with another organi23 zation as described in section 202(h)(1) of the Toxic Expo24 sure in the American Military Act of 2020, any reference 

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1 neering, and Medicine shall be treated as a reference to the 

2 other organization. 

3 ‘‘(n) TOXIC SUBSTANCE DEFINED.—In this section, 

4 the term ‘toxic substance’ has the meaning given that term 

5 in subparagraph (G)(iv) of section 1710(e)(1) of this title.’’. 

6 (b) CLERICAL AMENDMENT.—The table of sections at 

7 the beginning of chapter 5 of such title is amended by add8 ing at the end the following new item: 

‘‘547. Toxic Exposure Review Commission.’’. 

9 SEC. 202. AGREEMENT WITH NATIONAL ACADEMIES OF 

10 SCIENCES, ENGINEERING, AND MEDICINE 

11 CONCERNING THE EXPOSURE OF HUMANS TO 

12 TOXIC SUBSTANCES. 

13 (a) PURPOSE.—The purpose of this section is to pro14 vide for the National Academies of Sciences, Engineering, 

15 and Medicine (in this section referred to as the ‘‘Acad16 emies’’), an independent nonprofit scientific organization 

17 with appropriate expertise that is not part of the Federal 

18 Government, to review and evaluate the available scientific 

19 evidence regarding associations between diseases and expo20 sure to toxic substances. 

21 (b) AGREEMENT.— 

22 (1) IN GENERAL.—The Secretary of Veterans Af23 fairs shall seek to enter into a five-year agreement 

24 with the Academies to perform the services covered by 

25 this section. 


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1 (2) TIMING.—The Secretary shall seek to enter 

2 into an agreement described in paragraph (1) not 

3 later than 60 days after the date of the enactment of 

4 this Act. 

5 (3) EXTENSION.—An agreement under this sec6 tion may be extended in five-year increments. 

7 (c) REVIEW OF SCIENTIFIC EVIDENCE.—Under an 

8 agreement between the Secretary and the Academies under 

9 this section, the Academies shall review and summarize the 

10 scientific evidence, and assess the strength thereof, con11 cerning the association between exposure to toxic substances 

12 during active military, naval, or air service and each dis13 ease suspected to be associated with such exposure in the 

14 human population. 

15 (d) SCIENTIFIC DETERMINATIONS CONCERNING DIS16 EASES.—For each disease reviewed under subsection (c), the 

17 Academies shall determine, to the extent that available sci18 entific data permit meaningful determinations— 

19 (1) whether an association exists between expo20 sure to toxic substances and the occurrence of the dis21 ease, taking into account the strength of the scientific 

22 evidence and the appropriateness of the statistical 

23 and epidemiological methods used to detect the asso24 ciation; 


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1 (2) the increased risk of the disease among those 

2 exposed to toxic substances during active military, 

3 naval, or air service; and 

4 (3) whether there exists a plausible biological 

5 mechanism or other evidence of a causal relationship 

6 between the exposure and the occurrence of the disease. 

7 (e) COOPERATION OF FEDERAL AGENCIES.— 

8 (1) IN GENERAL.—The head of each relevant 

9 Federal agency, including the Secretary of Defense, 

10 shall cooperate fully with the Academies in per11 forming the services covered by this section. 

12 (2) TECHNICAL AND SCIENTIFIC CAPABILITIES.— 

13 In performing the services covered by this section, the 

14 Academies shall make use of the technical and sci15 entific capabilities of any Federal agency. 

16 (f) RECOMMENDATIONS FOR ADDITIONAL SCIENTIFIC

17 STUDIES.— 

18 (1) IN GENERAL.—Under an agreement between 

19 the Secretary and the Academies under this section, 

20 the Academies shall make any recommendations for 

21 additional scientific studies to resolve areas of con22 tinuing scientific uncertainty relating to the exposure 

23 of humans to toxic substances. 


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1 (2) CONSIDERATIONS.—In making recommenda2 tions under paragraph (1), the Academies shall con3 sider— 

4 (A) the scientific information that is avail5 able at the time of the recommendation; 

6 (B) the value and relevance of the informa7 tion that could result from additional studies; 

8 and 

9 (C) the cost and feasibility of carrying out 

10 such additional studies. 

11 (g) REPORTS.— 

12 (1) INITIAL REPORT.— 

13 (A) IN GENERAL.—Under an agreement be14 tween the Secretary and the Academies under 

15 this section, not later than one year after the 

16 date of the enactment of this Act, the Academies 

17 shall submit to the Secretary, the Committee on 

18 Veterans’ Affairs of the Senate, and the Com19 mittee on Veterans’ Affairs of the House of Rep20 resentatives an initial report on the activities of 

21 the Academies under the agreement. 

22 (B) ELEMENTS.—The report submitted 

23 under subparagraph (A) shall include the fol24 lowing: 


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1 (i) The determinations described in 

2 subsection (d). 

3 (ii) A full explanation of the scientific 

4 evidence and reasoning that led to such de5 terminations. 

6 (iii) Any recommendations of the 

7 Academies under subsection (f). 

8 (2) PERIODIC UPDATES.—Under an agreement 

9 between the Secretary and the Academies under this 

10 section, not less frequently than once every two years 

11 after the date on which the initial report is submitted 

12 under paragraph (1)(A), the Academies shall submit 

13 to the Secretary, the Committee on Veterans’ Affairs 

14 of the Senate, and the Committee on Veterans’ Affairs 

15 of the House of Representatives an updated report on 

16 the activities of the Academies under the agreement. 

17 (h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA18 TION.— 

19 (1) IN GENERAL.—If the Secretary is unable 

20 within the time period prescribed in subsection (b)(2) 

21 to enter into an agreement with the Academies for the 

22 purposes of this section on terms acceptable to the 

23 Secretary, the Secretary shall seek to enter into an 

24 agreement for the purposes of this section with an25 other appropriate scientific organization that— 


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1 (A) is not part of the Federal Government; 

2 (B) operates as a not-for-profit entity; and 

3 (C) has expertise and objectivity comparable 

4 to that of the Academies. 

5 (2) TREATMENT.—If the Secretary enters into an 

6 agreement with another organization as described in 

7 paragraph (1), any reference in this section, section 

8 547 of title 38, United States Code, as added by sec9 tion 201(a), and section 1119 of such title, as added 

10 by section 105(a), to the National Academies of 

11 Sciences, Engineering, and Medicine shall be treated 

12 as a reference to the other organization. 

13 SEC. 203. COLLECTION, ANALYSIS, AND REPORT ON TREAT14 MENT OF VETERANS FOR MEDICAL CONDI15 TIONS RELATED TO EXPOSURE TO TOXIC 

16 SUBSTANCES. 

17 (a) IN GENERAL.—The Secretary of Veterans Affairs 

18 shall compile and analyze, on a continuous basis, all clin19 ical data that— 

20 (1) is obtained by the Department of Veterans 

21 Affairs in connection with hospital care, medical serv22 ices, and nursing home care furnished under section 

23 1710(a)(2)(F) of title 38, United States Code; and 

24 (2) is likely to be scientifically useful in deter25 mining the association, if any, between the medical 


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1 condition of a veteran and exposure to a toxic sub2 stance. 

3 (b) CONSENT OF PATIENTS.—Compilation and anal4 ysis by the Secretary of clinical data of a veteran under 

5 subsection (a) shall be conducted, and such data shall be 

6 used, consistent with the informed consent of the veteran 

7 and in compliance with all applicable Federal law 

8 (c) ANNUAL REPORT.—Not later than one year after 

9 the date of the enactment of this Act, and annually there10 after, the Secretary shall submit to the Committee on Vet11 erans’ Affairs of the Senate, the Committee on Veterans’ Af12 fairs of the House of Representatives, and the Toxic Expo13 sure Review Commission established by section 547 of title 

14 38, United States Code, as added by section 201(a) of this 

15 Act, a report containing— 

16 (1) the data compiled under subsection (a); 

17 (2) an analysis of such data; 

18 (3) a description of the types and incidences of 

19 medical conditions identified by the Department 

20 under such subsection; 

21 (4) the explanation of the Secretary for the inci22 dence of such medical conditions and other expla23 nations for the incidence of such conditions as the 

24 Secretary considers reasonable; and 


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1 (5) the views of the Secretary on the scientific 

2 validity of drawing conclusions from the incidence of 

3 such medical conditions, as evidenced by the data 

4 compiled under subsection (a), regarding any associa5 tion between such conditions and exposure to a toxic 

6 substance. 

7 TITLE III—IMPROVEMENT OF RE8 SOURCES OF DEPARTMENT 

9 OF VETERANS AFFAIRS RE10 GARDING EXPOSURES TO 

11 TOXIC SUBSTANCES 

12 SEC. 301. PUBLICATION OF LIST OF RESOURCES OF DE13 PARTMENT OF VETERANS AFFAIRS FOR VET14 ERANS EXPOSED TO TOXIC SUBSTANCES AND 

15 OUTREACH PROGRAM FOR SUCH VETERANS 

16 AND CAREGIVERS AND SURVIVORS OF SUCH 

17 VETERANS. 

18 (a) PUBLICATION OF LIST OF RESOURCES.— 

19 (1) IN GENERAL.—Not later than one year after 

20 the date of the enactment of this Act, and annually 

21 thereafter, the Secretary of Veterans Affairs shall pub22 lish a list of resources of the Department of Veterans 

23 Affairs for— 


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1 (A) veterans provided disability compensa2 tion under chapter 11 of title 38, United States 

3 Code, relating to exposure to toxic substances; 

4 (B) veterans eligible for hospital care, med5 ical services, and nursing home care under sec6 tion 1710(a)(2)(F) of such title; 

7 (C) caregivers of veterans described in sub8 paragraph (A) or (B) who are participating in 

9 the program of comprehensive assistance for fam10 ily caregivers under section 1720G(a) of such 

11 title; and 

12 (D) survivors of veterans described in sub13 paragraph (A) or (B) (or who would be described 

14 in any such subparagraph were the veteran 

15 alive) who are receiving death benefits under the 

16 laws administered by the Secretary. 

17 (2) UPDATE.—The Secretary shall periodically 

18 update the list published under paragraph (1). 

19 (b) OUTREACH.—The Secretary shall develop, with 

20 input from the community, an informative outreach pro21 gram for veterans on illnesses that may be related to expo22 sure to toxic substances, including outreach with respect to 

23 benefits and support programs. 


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1 SEC. 302. INCORPORATION OF TOXIC EXPOSURE QUESTION2 NAIRE DURING PRIMARY CARE APPOINT3 MENTS. 

4 (a) IN GENERAL.—The Secretary of Veterans Affairs 

5 shall incorporate a clinical questionnaire to help determine 

6 potential exposure to toxic substances during active mili7 tary, naval, or air service as part of the initial screening 

8 conducted for an appointment of a veteran with a primary 

9 care provider of the Department of Veterans Affairs to im10 prove understanding by the Department of exposure of vet11 erans to toxic substances while serving in the Armed Forces. 

12 (b) DETERMINATION OF QUESTIONS.—The questions 

13 included in the questionnaire required under subsection (a) 

14 shall be determined by the Secretary with input from med15 ical professionals. 

16 SEC. 303. PORTAL FOR ACCESS BY VETERANS TO INDI17 VIDUAL LONGITUDINAL EXPOSURE RECORD. 

18 (a) IN GENERAL.—The Secretary of Veterans Affairs 

19 shall establish a portal through which a veteran may access 

20 documents and information with respect to the veteran con21 tained in the Individual Longitudinal Exposure Record of 

22 the Department of Veterans Affairs. 

23 (b) ELEMENTS OF PORTAL.—The portal established 

24 under subsection (a) shall— 

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1 tudinal Exposure Record of the veteran in a print2 able, read-only format; and 

3 (2) be hosted on an internet website of the De4 partment that is commonly used by veterans. 

5 SEC. 304. TRAINING OF HEALTH CARE PERSONNEL OF DE6 PARTMENT OF VETERANS AFFAIRS ON ILL7 NESSES RELATED TO EXPOSURE TO TOXIC 

8 SUBSTANCES. 

9 (a) IN GENERAL.—The Secretary of Veterans Affairs 

10 shall ensure that health care personnel of the Department 

11 of Veterans Affairs are appropriately trained to identify, 

12 treat, and assess the impact of illnesses related to exposure 

13 to toxic substances. 

14 (b) ELEMENTS OF TRAINING.—The training required 

15 under subsection (a) shall— 

16 (1) provide health care personnel of the Depart17 ment with specific education with respect to illnesses 

18 related to exposure to toxic substances; and 

19 (2) inform such personnel of how to probe for ad20 ditional information from veterans regarding expo21 sures to different toxicants. 

22 (c) TOXICANT DEFINED.—In this section, the term 

23 ‘‘toxicant’’ has the meaning given that term in subpara24 graph (G)(iv) of section 1710(e)(1) of title 38, United States 

25 Code, as added by section 101(a). 


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Calendar No. 602 

116TH CONGRESS 

2D SESSION S. 4393 

A BILL 

To improve the provision of health care and other 

stances, and for other purposes. for veterans who were exposed to toxic subbenefits from the Department of Veterans Affairs 

DECEMBER 8, 2020 

Reported with an amendment 


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