II 

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 introduced the following bill; which was read twice and referred 

to the Committee on Veterans’ Affairs 

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, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

6 or the ‘‘TEAM Act of 2020’’ 

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

8 this Act is as follows: 


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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. 

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. 


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1 (2) TOXIC SUBSTANCE.—The term ‘‘toxic sub2 stance’’ has the meaning given that term in section 

3 1720J(i) of such title, as added by section 101(a). 

4 TITLE I—EXPANSION OF HEALTH 

5 CARE AND BENEFITS FOR 

6 VETERANS EXPOSED TO 

7 TOXIC SUBSTANCES 

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

9 CERTAIN VETERANS WHO RECEIVED HAZ10 ARDOUS DUTY PAY OR WERE EXPOSED TO 

11 TOXIC SUBSTANCES. 

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

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

14 end the following new section: 

15 ‘‘§ 1720J. Consultation, testing, and treatment of vet16 erans for exposure to toxic substances 

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

18 covered veterans— 

19 ‘‘(1) covered consultation and testing regarding 

20 the exposure of those veterans to toxic substances; 

21 and 

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

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

24 to approval by the Under Secretary for Health. 


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

2 purposes of this section, covered consultation and testing 

3 is— 

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

5 or other treating physician to determine whether the 

6 covered veteran has an illness related to exposure to 

7 a toxic substance while serving in the Armed Forces; 

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

9 related to exposure to a toxic substance; and 

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

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

12 specialist physician. 

13 ‘‘(c) COVERED VETERANS.—For purposes of this sec14 tion, a covered veteran is a veteran who— 

15 ‘‘(1) received hazardous duty incentive pay 

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

17 or 

18 ‘‘(2) has been identified by the Secretary of De19 fense to have been possibly exposed, inside or out20 side the United States, during service in the Armed 

21 Forces, to— 

22 ‘‘(A) an open burn pit; 

23 ‘‘(B) a toxic substance; or 

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

25 Armed Forces were potentially exposed to a 


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1 toxic substance, as indicated in a database 

2 shared by the Department of Defense and the 

3 Department of Veterans Affairs. 

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

5 under this section for three consultations each year unless 

6 a treating physician for such veteran determines that more 

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

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

9 and testing and treatment may be provided under this sec10 tion at facilities of the Department or under contract ar11 rangements with the Department for such services. 

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

13 (1) When determining whether to approve eligibility for 

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

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

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

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

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

19 evidence. 

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

21 subsection (a)(2) shall be made not later than five busi22 ness days after a request for approval has been made by 

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

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

25 shall provide information and training on eligibility for 


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1 services under this section and the services covered under 

2 this section to— 

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

4 ‘‘(2) health care providers providing services 

5 under this section under contract arrangements; and 

6 ‘‘(3) covered veterans. 

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

8 to pay a copayment for covered consultation and testing 

9 or treatment under this section. 

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

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

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

13 Burial and Other Veterans’ Benefits Improvement 

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

15 note). 

16 ‘‘(2) The term ‘toxic substance’ means a toxi17 cant or a toxin. 

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

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

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

21 of human activities. 

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

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

24 that is produced naturally. 


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1 ‘‘(5) The team ‘treatment’ means any com2 monly accepted medical treatment practiced by the 

3 medical community at large.’’. 

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

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

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

7 item: 

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

substances.’’. 

8 SEC. 102. PERMANENT REAUTHORIZATION OF AUTHORITY 

9 OF SECRETARY OF VETERANS AFFAIRS TO 

10 PRESCRIBE REGULATIONS PROVIDING THAT 

11 A PRESUMPTION OF SERVICE CONNECTION 

12 IS WARRANTED FOR A DISEASE ASSOCIATED 

13 WITH EXPOSURE TO A HERBICIDE AGENT. 

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

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

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

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

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

19 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 00:06 Aug 14, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4393.IS 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 00:06 Aug 14, 2020 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4393.IS 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 

25 Federal agency such information as the Commission conVerDate Sep 11 2014 00:06 Aug 14, 2020 Jkt 099200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S4393.IS S4393

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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 00:06 Aug 14, 2020 Jkt 099200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S4393.IS 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 

25 veteran in the Million Veteran Program of the DeVerDate Sep 11 2014 00:06 Aug 14, 2020 Jkt 099200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S4393.IS S4393

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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). 

Æ 


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