II 

116TH CONGRESS 

2D SESSION S. 4572 

To amend title 38, United States Code, to provide for a presumption of 

service connection for certain diseases associated with exposure to toxins, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 15, 2020 

Mrs. GILLIBRAND introduced the following bill; which was read twice and 

referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to provide for a 

presumption of service connection for certain diseases 

associated with exposure to toxins, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Presumptive Benefits 

5 for War Fighters Exposed to Burn Pits and Other Toxins 

6 Act of 2020’’. 


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1 SEC. 2. PRESUMPTION OF SERVICE CONNECTION FOR CER2 TAIN DISEASES ASSOCIATED WITH EXPO3 SURE TO BURN PITS AND OTHER TOXINS. 

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. Presumption of service connection for cer8 tain diseases associated with exposure to 

9 burn pits and other toxins 

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

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

12 to section 1113 of this title, a disease specified in para13 graph (2) becoming manifest in a veteran described in 

14 paragraph (3) shall be considered to have been incurred 

15 in or aggravated during active military, naval, or air serv16 ice, notwithstanding that there is no record of evidence 

17 of such disease during the period of such service. 

18 ‘‘(2) The diseases specified in this paragraph are the 

19 following: 

20 ‘‘(A) Asthma that was diagnosed after service 

21 in a country or territory listed under paragraph 

22 (4)(B). 

23 ‘‘(B) Cancer of any type. 

24 ‘‘(C) Chronic bronchitis. 

25 ‘‘(D) Chronic obstructive pulmonary disease. 


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1 ‘‘(E) Constrictive bronchiolitis or obliterative 

2 bronchiolitis. 

3 ‘‘(F) Emphysema. 

4 ‘‘(G) Granulomatous disease. 

5 ‘‘(H) Interstitial lung disease. 

6 ‘‘(I) Lymphoma. 

7 ‘‘(J) Pleuritis. 

8 ‘‘(K) Pulmonary fibrosis. 

9 ‘‘(L) Sarcoidosis. 

10 ‘‘(M) Any other disease with respect to which 

11 final regulations have been prescribed under sub12 section (c)(3). 

13 ‘‘(3) A veteran described in this paragraph is any vet14 eran who— 

15 ‘‘(A) on or after August 2, 1990— 

16 ‘‘(i) served as a member of the Armed 

17 Forces in support of a military operation de18 scribed in paragraph (4); and 

19 ‘‘(ii) was present for 15 or more cumu20 lative days in a country or territory listed under 

21 subparagraph (B) of that paragraph; or 

22 ‘‘(B) was awarded any of the following: 

23 ‘‘(i) The Southwest Asia Service Medal. 

24 ‘‘(ii) The Global War on Terrorism Expe25 ditionary Medal. 


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1 ‘‘(iii) A campaign medal in recognition of 

2 service in any of the following: 

3 ‘‘(I) Operation Enduring Freedom. 

4 ‘‘(II) Operation Iraqi Freedom. 

5 ‘‘(III) Operation Nomad Shadow. 

6 ‘‘(IV) Operation New Dawn. 

7 ‘‘(V) Operation Inherent Resolve. 

8 ‘‘(VI) Operation Freedom’s Sentinel. 

9 ‘‘(VII) Operation Odyssey Lightning. 

10 ‘‘(VIII) Operation Pacific Eagle. 

11 ‘‘(4) A military operation described in this paragraph 

12 is— 

13 ‘‘(A) any contingency operation (as defined in 

14 section 101(a)(13) of title 10); or 

15 ‘‘(B) any military operation in any of the fol16 lowing countries or territories: 

17 ‘‘(i) Afghanistan. 

18 ‘‘(ii) Bahrain 

19 ‘‘(iii) Burkina Faso. 

20 ‘‘(iv) Cameroon. 

21 ‘‘(v) Chad. 

22 ‘‘(vi) Diego Garcia. 

23 ‘‘(vii) Djibouti. 

24 ‘‘(viii) Egypt. 

25 ‘‘(ix) Ethiopia. 


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1 ‘‘(x) Gabon. 

2 ‘‘(xi) Ghana. 

3 ‘‘(xii) Iraq. 

4 ‘‘(xiii) Jordan. 

5 ‘‘(xiv) Kenya. 

6 ‘‘(xv) Kuwait. 

7 ‘‘(xvi) Kyrgyzstan. 

8 ‘‘(xvii) Libya. 

9 ‘‘(xviii) Mali. 

10 ‘‘(xix) Niger. 

11 ‘‘(xx) Nigeria. 

12 ‘‘(xxi) Oman 

13 ‘‘(xxii) Pakistan. 

14 ‘‘(xxiii) Philippines. 

15 ‘‘(xxiv) Saudi Arabia. 

16 ‘‘(xxv) Somalia. 

17 ‘‘(xxvi) South Sudan. 

18 ‘‘(xxvii) Sudan. 

19 ‘‘(xxviii) Syria. 

20 ‘‘(xxix) Tajikistan. 

21 ‘‘(xxx) Tunisia. 

22 ‘‘(xxxi) Turkey. 

23 ‘‘(xxxii) United Arab Emirates. 

24 ‘‘(xxxiii) Uzbekistan. 

25 ‘‘(xxxiv) Yemen. 


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1 ‘‘(b) PROCESS TO ADD DISEASES THROUGH WRIT2 TEN PETITION.—(1) In the case that the Secretary re3 ceives a written petition from an interested party to add 

4 a disease to the list of diseases specified in subsection 

5 (a)(2), not later than 90 days after the date of receipt 

6 of such petition, the Secretary shall request a determina7 tion by the National Academies of Sciences, Engineering, 

8 and Medicine (referred to in this section as the ‘National 

9 Academies’) with respect to whether there is a positive as10 sociation between— 

11 ‘‘(A) the exposure of humans to one or more 

12 covered toxins; and 

13 ‘‘(B) the occurrence of the disease in humans. 

14 ‘‘(2) For purposes of this subsection, the term ‘inter15 ested party’ includes a representative of— 

16 ‘‘(A) a congressionally chartered veterans serv17 ice organization; 

18 ‘‘(B) an organization that— 

19 ‘‘(i) is described in section 501(c)(3) of the 

20 Internal Revenue Code of 1986 and exempt 

21 from taxation under section 501(a) of such 

22 Code; 

23 ‘‘(ii) serves veterans or members of the 

24 Armed Forces; and 


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1 ‘‘(iii) has continuously operated for a pe2 riod of five years or more preceding the date of 

3 the submittal of the written petition under 

4 paragraph (1); 

5 ‘‘(C) a collective bargaining agent for civilian 

6 employees of the United States Government; 

7 ‘‘(D) a nationally recognized medical associa8 tion; 

9 ‘‘(E) the National Academies; or 

10 ‘‘(F) a State or political subdivision of a State. 

11 ‘‘(c) DETERMINATIONS BY NATIONAL ACADEMIES.— 

12 (1) If the Secretary receives a determination described in 

13 paragraph (2), not later than 180 days after receipt of 

14 such determination, the Secretary shall— 

15 ‘‘(A) publish in the Federal Register proposed 

16 regulations to add the disease covered by the deter17 mination to the list of diseases specified in sub18 section (a)(2); 

19 ‘‘(B) publish in the Federal Register, and sub20 mit to the Committee on Veterans’ Affairs of the 

21 Senate and the Committee on Veterans’ Affairs of 

22 the House of Representatives— 

23 ‘‘(i) the decision of the Secretary not to 

24 publish such proposed regulations; and 


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1 ‘‘(ii) the basis for such decision, including 

2 specific medical science refuting the determina3 tion; or 

4 ‘‘(C) publish in the Federal Register a decision 

5 that insufficient evidence exists to take action under 

6 subparagraph (A) or (B). 

7 ‘‘(2) A determination described in this paragraph— 

8 ‘‘(A) is a determination by the National Acad9 emies that there is a positive association between— 

10 ‘‘(i) the exposure of humans to one or 

11 more covered toxins; and 

12 ‘‘(ii) the occurrence of the disease in hu13 mans; and 

14 ‘‘(B) may be made pursuant to— 

15 ‘‘(i) a request from the Secretary under 

16 subsection (b); or 

17 ‘‘(ii) an agreement between the Secretary 

18 and the National Academies under section 3 of 

19 the Presumptive Benefits for War Fighters Ex20 posed to Burn Pits and Other Toxins Act of 

21 2020. 

22 ‘‘(3)(A) Not later than 180 days after the date on 

23 which the Secretary publishes any proposed regulations 

24 under paragraph (1)(A) for a disease, the Secretary shall 

25 prescribe final regulations for that disease. 


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1 ‘‘(B) Such regulations shall be effective on the date 

2 of issuance. 

3 ‘‘(d) REFERENCE TO NATIONAL ACADEMIES.—In the 

4 case that the Secretary enters into an agreement with an5 other organization as described in section 3(h)(1) of the 

6 Presumptive Benefits for War Fighters Exposed to Burn 

7 Pits and Other Toxins Act of 2020, any reference in this 

8 section to the National Academies shall be treated as a 

9 reference to the other organization. 

10 ‘‘(e) DEFINITIONS.—In this section: 

11 ‘‘(1) The term ‘covered toxin’ includes the fol12 lowing: 

13 ‘‘(A) Any toxic chemical or toxic fume. 

14 ‘‘(B) Hazardous waste, mixed waste, solid 

15 waste, or used oil (as those terms are defined 

16 in section 1004 of the Solid Waste Disposal Act 

17 (42 U.S.C. 6903)). 

18 ‘‘(C) Radiological waste. 

19 ‘‘(D) Any other carcinogen. 

20 ‘‘(2) The term ‘veterans service organization’ 

21 means an organization recognized by the Secretary 

22 for the representation of veterans under section 

23 5902 of this title.’’. 

24 (b) EFFECTIVE DATE.— 


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1 (1) IN GENERAL.—The amendment made by 

2 subsection (a) shall take effect on the date that is 

3 180 days after the date of the enactment of this Act. 

4 (2) WRITTEN PETITIONS.—With respect to a 

5 written petition described in section 1119(b)(1) of 

6 title 38, United States Code, as added by subsection 

7 (a), that was received by the Secretary of Veterans 

8 Affairs before the effective date described in para9 graph (1), the Secretary shall make a request of the 

10 National Academies of Sciences, Engineering, and 

11 Medicine under such section, as so added, not later 

12 than 90 days after such effective date. 

13 (c) CLERICAL AMENDMENT.—The table of sections 

14 at the beginning of chapter 11 of title 38, United States 

15 Code, is amended by inserting after the item relating to 

16 section 1118 the following new item: 

‘‘1119. Presumption of service connection for certain diseases associated with 

exposure to burn pits and other toxins.’’. 

17 (d) CONFORMING AMENDMENT.—Section 1113 of 

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

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

20 SEC. 3. AGREEMENT WITH THE NATIONAL ACADEMIES OF 

21 SCIENCES, ENGINEERING, AND MEDICINE 

22 CONCERNING THE EXPOSURE OF HUMANS TO 

23 BURN PITS AND OTHER TOXINS. 

24 (a) AGREEMENT.— 


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

2 Affairs shall seek to enter into an agreement with 

3 the National Academies of Sciences, Engineering, 

4 and Medicine (referred to in this section as the ‘‘Na5 tional Academies’’) to perform the services covered 

6 by this section. 

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

8 into the agreement described in paragraph (1) not 

9 later than 60 days after the date of the enactment 

10 of this Act. 

11 (b) REVIEWS OF SCIENTIFIC EVIDENCE.— 

12 (1) IN GENERAL.—Under an agreement be13 tween the Secretary and the National Academies, 

14 the National Academies shall review and summarize 

15 the scientific evidence, and assess the strength there16 of, concerning the association between the exposure 

17 of humans to covered toxins and each disease sus18 pected to be associated with such exposure. 

19 (2) REVIEWS UPON REQUEST.—Under an 

20 agreement between the Secretary and the National 

21 Academies under this section, the National Acad22 emies shall conduct a review described in paragraph 

23 (1) in response to each request made by the Sec24 retary under section 1119(b)(1) of title 38, United 

25 States Code, as added by section 2(a). 


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1 (c) SCIENTIFIC DETERMINATIONS CONCERNING DIS2 EASES.— 

3 (1) IN GENERAL.—For each disease reviewed 

4 under subsection (b), the National Academies shall 

5 determine (to the extent that available scientific data 

6 permit meaningful determinations) whether there is 

7 a positive association between the exposure of hu8 mans to one or more covered toxins and the occur9 rence of the disease in humans, taking into account 

10 the strength of the scientific evidence and the appro11 priateness of the statistical and epidemiological 

12 methods used to detect the association. 

13 (2) SUBMISSIONS FOR REVIEWS UPON RE14 QUEST.—Under an agreement between the Secretary 

15 and the National Academies under this section, not 

16 later than 270 days after the date on which the Sec17 retary transmits a request to the National Acad18 emies with respect to a disease under section 

19 1119(b)(1) of title 38, United States Code, as added 

20 by section 2(a), the National Academies shall submit 

21 to the Secretary the determination made with re22 spect to that disease under paragraph (1). 

23 (d) RECOMMENDATIONS FOR ADDITIONAL SCI24 ENTIFIC STUDIES.— 


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1 (1) IN GENERAL.—Under an agreement be2 tween the Secretary and the National Academies 

3 under this section, the National Academies shall 

4 make any recommendations it has for additional sci5 entific studies to resolve areas of continuing sci6 entific uncertainty relating to the exposure of hu7 mans to covered toxins. 

8 (2) CONSIDERATIONS.—In making recommen9 dations for additional scientific studies, the National 

10 Academies shall consider— 

11 (A) the scientific information that is avail12 able at the time of the recommendation; 

13 (B) the value and relevance of the informa14 tion that could result from additional studies; 

15 and 

16 (C) the feasibility of carrying out such ad17 ditional studies. 

18 (e) SUBSEQUENT REVIEWS.—Under an agreement 

19 between the Secretary and the National Academies under 

20 this section, the National Academies shall— 

21 (1) conduct as comprehensive a review as is 

22 practicable of the evidence referred to in subsection 

23 (b)(1) that became available since the last review of 

24 such evidence under this section; and 


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1 (2) make determinations and estimates on the 

2 basis of the results of such review and all other re3 views conducted for the purposes of this section. 

4 (f) REPORTS.— 

5 (1) INITIAL REPORT.— 

6 (A) IN GENERAL.—Under an agreement 

7 between the Secretary and the National Acad8 emies under this section, not later than 540 

9 days after the date of the enactment of this 

10 Act, the National Academies shall submit to the 

11 Secretary and the Committee on Veterans’ Af12 fairs of the Senate and the Committee on Vet13 erans’ Affairs of the House of Representatives 

14 a report on the activities of the National Acad15 emies under the agreement. 

16 (B) ELEMENTS.—The report submitted 

17 under subparagraph (A) shall include the fol18 lowing: 

19 (i) The determinations described in 

20 subsection (c)(1). 

21 (ii) An explanation of the scientific 

22 evidence and reasoning that led to such de23 terminations. 

24 (iii) Any recommendations of the Na25 tional Academies under subsection (d). 


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1 (2) PERIODIC UPDATES.—Under an agreement 

2 between the Secretary and the National Academies 

3 under this section, not less frequently than once 

4 every two years, the National Academies shall sub5 mit to the Secretary and the Committee on Vet6 erans’ Affairs of the Senate and the Committee on 

7 Veterans’ Affairs of the House of Representatives an 

8 updated report on the activities of the National 

9 Academies under the agreement. 

10 (g) LIMITATION ON AUTHORITY.—The authority to 

11 enter into agreements under this section shall be effective 

12 for a fiscal year to the extent that appropriations are 

13 available. 

14 (h) ALTERNATIVE CONTRACT SCIENTIFIC ORGANIZA15 TION.— 

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

17 within the period prescribed in subsection (a)(2) to 

18 enter into an agreement with the National Acad19 emies on terms acceptable to the Secretary, the Sec20 retary shall seek to enter into such an agreement 

21 with another appropriate scientific organization 

22 that— 

23 (A) is not part of the Government; 

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


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1 (C) has expertise and objectivity com2 parable to that of the National Academies. 

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

4 an agreement with another organization as described 

5 in paragraph (1), any reference in this section, sec6 tion 4, and section 1119 of title 38, United States 

7 Code, as added by section 2(a), to the National 

8 Academies shall be treated as a reference to the 

9 other organization. 

10 (i) COVERED TOXIN DEFINED.—In this section, the 

11 term ‘‘covered toxin’’ has the meaning given that term in 

12 section 1119(e) of title 38, United States Code, as added 

13 by section 2(a). 

14 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to the Department of 

16 Veterans Affairs such sums as may be necessary to carry 

17 out this section. 

18 SEC. 4. ACCESS OF THE NATIONAL ACADEMIES OF 

19 SCIENCES, ENGINEERING, AND MEDICINE TO 

20 INFORMATION FROM FEDERAL AGENCIES. 

21 (a) IN GENERAL.—Upon request by the National 

22 Academies of Sciences, Engineering, and Medicine (re23 ferred to in this section as the ‘‘National Academies’’), 

24 the head of any Federal agency with relevant information 

25 shall provide to the National Academies information in the 


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1 possession of the agency that the National Academies de2 termines useful in conducting a review under section 3(b). 

3 (b) FEDERAL AGENCY DEFINED.—In this section, 

4 the term ‘‘Federal agency’’ means any agency as that term 

5 is defined in section 551 of title 5, United States Code. 

6 SEC. 5. PRESUMPTION RELATING TO PERSONAL INJURY OF 

7 CERTAIN FEDERAL EMPLOYEES. 

8 (a) IN GENERAL.—Section 8102 of title 5, United 

9 States Code, is amended by adding at the end the fol10 lowing: 

11 ‘‘(c)(1) In this subsection, the term ‘covered em12 ployee’ means an employee who, on or after August 2, 

13 1990, carried out the job responsibilities of the employee 

14 for not fewer than 15 total days in a country or territory 

15 listed under subparagraph (B) of paragraph (4) of section 

16 1119(a) of title 38 in support of a military operation de17 scribed in that paragraph. 

18 ‘‘(2) Disability or death from a disease described in 

19 paragraph (2) of such section suffered by a covered em20 ployee is deemed to have resulted from personal injury 

21 sustained while in the performance of the duty of the cov22 ered employee, whether or not the covered employee was 

23 engaged in the course of employment when the disability 

24 or disability resulting in death occurred.’’. 


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1 (b) EFFECTIVE DATE.—The amendment made by 

2 subsection (a) shall take effect on the date that is 180 

3 days after the date of enactment of this Act. 

Æ 


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